There is also considerable debate over whether or not BSD even exists or has any diagnostic value.
According to Dr Elizabeth Brondolo and Dr Xavier Amador, the bipolar spectrum disorders are:
“a group of disorders all of which involve cycling moods. . . [BSDs] are also accompanied by a wide range of other symptoms that affect not just your mood but also your energy, your memory and thinking, and your connection with other people”.
Another expert who has done a lot of work in this area is Dr Jim Phelps. He points out that many people have symptoms: that are more than depression but less than bipolar.“
Dr Phelps has written a very well received book on bipolar ii and soft bipolar disorder called Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder.
This describes bipolar spectrum disorder as the “Mood Spectrum”.
In the Mood Spectrum model depression and bipolar disorder are seen as the two opposite ends of a continuum, and people can be found all along the spectrum.
In other words, you can be at any point along the Mood Spectrum, and we can conceptualize different people’s symptom presentation as having different degrees of bipolar.
Drs Kay Jamison and Fred Goodwin, support the notion of a spectrum, but do acknowledge the danger of having such a broad and fuzzy approach that a diagnosis of BSD would be “theoretically and clinically meaningless”.
It seems there are several dangers:
1. An on-going collapse of academic and clinical rigor.
2. Unnecessary prescription of strong medications such as the currently fashionable anti-psychotics.
3. Substantial self-diagnosis and self-medication, with the danger of treatment that is either unnecessary of inadequate.
4. Cultural trends that reward and romanticize mental illness in much the same way as we have erred in elevating a culture of victim-hood. Yes it is important to eliminate stigma, but do we want a society that embraces mental illness as a badge of honor?
However, there is also a substantial upside – more people getting the medication and/or therapy and other support they need instead of falling through the cracks.
A lot depends on what people DO with their diagnosis.
If folks are prepared to put the work into achieving stable moods through learning about appropriate medication, keeping a mood chart, developing a wellness plan and treatment contract, sleeping regular hours, and following the right program of diet and exercise, then success is almost inevitable.2
However, those who “fall in love” with their diagnosis of bipolar spectrum disorder and wallow in neurosis may have little to gain.
I am not a doctor and am unable to offer an informed opinion about the validity or usefulness of diagnosing up to 8% of the population of the US as having some form of bipolar.
At this stage I am a fence sitter. What I am sure of is that just as many folks with bipolar disorder still go undiagnosed, there are also many people – especially young people – who are being misdiagnosed as bipolar.
One 2010 research study from Rhode Island showed that people with borderline personality disorder are at particular risk of a misdiagnosis as bipolar.
There are also good reasons to believe that the recent 4,000% increase in diagnosing childhood bipolar is simply not credible, and must involve thousands of children with ADHD, Oppositional Defiant Disorder, Conduct Disorders, Major Depressive Disorder, or possibly no clinical condition at all, being seriously mislabeled.
Bottom line? There probably are a huge number of people for whom a diagnosis of a bipolar spectrum disorder would be helpful, especially if they educate themselves and incorporate lifestyle changes and therapy such as DBT or IPSRT into their recovery.
The notion of transitioning the definitions or diagnostic description of Bipolar Disorder into a spectrum rather than two types of the disorder could certainly be more inclusive as far as accounting for people who do not quite meet criteria for the existing types described in the DSM-5. The most recent edition of the DSM, the DSM-5, is now reflecting more of a spectrum or dimensional approach to diagnoses combined with the traditional categorical format; therefore, it is possible that a Bipolar spectrum could be a possibility in future editions.
For the time being, the DSM-5 provides numerous specifiers that can account for the more atypical symptoms or for symptoms that are not specified under the main diagnostic criteria for mania, hypomania, and depression. Although the person must still meet criteria for one of the two types of Bipolar Disorder, the specifiers help to add more clarity and, in a sense, individualize the diagnosis to the unique individual, as all people will present differently and display symptoms in diverse ways.
There is also the diagnosis of ‘Other Specified Bipolar and Related Disorder’ in the DSM-5, which includes the following:
• Individuals who have shorter duration hypomanic episodes that last 2-3 days (rather than the required 4 days) along with major depressive episodes • Individuals who have hypomanic episodes with no major depressive episodes (this would not qualify the person for Bipolar I or II because for Bipolar I, at least one full manic episode is required in the person’s lifetime to meet diagnosis and for Bipolar II, at least one major depressive episode is required to meet diagnosis)
The diagnosis of ‘Other Specified Bipolar and Related Disorder’ accounts for circumstances where the affected person has symptoms that vary from the traditional categories under Bipolar I and II. We are not quite at a ‘spectrum’ approach, but the DSM-5 is providing room for people with diverse symptom presentations.
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