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Bipolar Disorder:
What is it Really?
Bipolar Disorder Diagnosis:
 The main symptoms
of bipolar disorder are found during discrete periods of abnormal mood
states such as depression, mania and hypomania. The diagnosis of
bipolar disorder is related to the descriptive appearance of the
symptoms as they appear over time. You may conceive of
phenomenological data for the diagnosis of bipolar disorder as related
to two different types: cross-sectional and longitudinal.
Cross-sectional data refers to symptoms that appear at one time such
as counting descriptive symptoms related to a specific depressive
episode. Longitudinal data refers to symptoms as they appear over
time such is the timing, duration and recurrence of these depressive
episodes. You must consider both cross-sectional and longitudinal
data in order to give a proper diagnosis of bipolar disorder. It is
common for diagnostic errors to occur when both cross-sectional and
longitudinal data are not used and the clinician focuses strictly on
cross-sectional presentation of symptoms.
While the
diagnostic definition of bipolar disorder has relied upon the
identification of individual mood disorders, it is important to
understand that the diagnosis of bipolar disorder is derived from the
occurrence of individual episodes over a period of time. Usually,
persons who experience a manic, hypomanic or mixed episode, virtually
all have a history of one or more major depressive episodes and are
usually diagnosed with bipolar disorder. Individuals who experience
manic and major depressive episodes are diagnosed with bipolar I
disorder and those individuals with major depressive disorder and
hypomanic episodes (milder form of mania) are diagnosed with bipolar
II disorder.
Most of the
research regarding bipolar disorder has usually focused on the more
severe form of bipolar I disorder. Most of the information referred
to in this series of articles will focus on bipolar I disorder unless
it is otherwise noted. The most recent form of the Diagnostic and
Statistical Manual of Mental Disorders (which is used for diagnosing
mental illness by clinicians), the DSM- IV was the first version of
the DSM to include a specific category for Bipolar II disorder.
Differentiating between Bipolar I and Bipolar II Disorders:
The separation of
type I and type II disorders has been supported by several types of
evidence. For example, type II disorder has been found to occur more
frequently in families of other individuals with type II, in
comparison to families of persons with type I or major depressive
disorder. Also, studies have found that the course over time of type
II disorder indicates that persons with hypomania frequently seem to
have recurrent hypomanic episodes while not converting into type I by
developing mania. In addition, it has been found that individuals
with type II seem to have more episodes over time than individuals
with type I, which indicates that the course of the two disorders
might actually be different. Biological differences however have not
been reliably demonstrated. It should not be construed however that
in all cases and in all respects that bipolar II is milder than I,
although hypomania by definition is a milder form of mania.
Interestingly enough, the social and occupational functioning and
quality-of-life for individuals with type II bipolar disorder is very
similar to those with type I disorder.
From DSM-IV-TR Mental
Disorders: Diagnosis, Etiology and Treatment by Michael B. First and
Allan Tasman
Additional information and
webpage by
Paul Susic MA Licensed Psychologist Ph.D Candidate (Health
Psychology
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