Diagnosing bipolar disorder

An extract from Bipolar & the Art of Roller-coaster Riding

"Bipolar disorder has been defined and redefined by the psychiatric profession over the years. The definitions currently in use in North America and Australia are taken from ‘DSM-IV’, the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, published by the American Psychiatric Association. This manual lists various criteria that a person’s illness must meet in order to be diagnosed.(i)

The criteria include:

whether an episode of mood disturbance has occurred in the past;
whether that episode was depressive, manic, hypomanic or mixed; and
making sure the condition is a mood disorder and not something else.

The criteria have been developed for the use of researchers (so they can ‘compare apples with apples’), and mental health workers (so they know what each other is talking about).

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Five categories of bipolar disorder

There are five major categories of mood disorder that together make up the ‘manic-depressive spectrum’:

Bipolar Affective Disorder Type I;
Major Depressive Disorder;
Bipolar Affective Disorder Type II;
Cyclothymia; and
Dysthymic Disorder.

Technically, the term ‘bipolar’ only covers Bipolar I and Bipolar II disorders. These five categories, while being different from each other in many ways, can all be self-managed by sufferers, using techniques discussed in this book.

Bipolar Affective Disorder Type I

This is what most people think of as the bipolar disorder. To get diagnosed you need to have had at least one manic episode or one mixed episode. Over the course of the illness, it’s likely you’ll also have depressive episodes.

Bipolar I affects about equal numbers of men and women. Women with Bipolar I have an increased risk of having a mood episode around childbirth, and the premenstrual part of the cycle can certainly worsen a current episode of mania, hypomania, mixed state or depression.

Bipolar Affective Disorder Type II

Bipolar II involves Major Depressive episodes on a recurring basis, with recurring hypomanic episodes, but no full-blown mania.

To get diagnosed you need to have had at least one Major Depressive episode and at least one hypomanic episode. Once you have a manic or a mixed episode, the diagnosis changes to Bipolar Type I.

Up to 70 per cent of hypomanic episodes happen just before or just after a depressive episode. Rapid cycling (four or more episodes in a year) occurs in about 10–15 per cent of people with Bipolar II. Ultra-rapid cycling can also occur, with more frequent fluctuations.

Women with Bipolar II have an increased risk of having an episode related to reproductive events.

Major Depressive Disorder

Major Depressive Disorder involves episodic severe depression but you don’t get hypomania or mania. If you have one episode of Major Depression, you have a 50 per cent chance of having another. If you have a second episode, your chances of having yet another increase to around 70 per cent. If you are unlucky enough to have that third episode, you have a 90 per cent chance of yet another.(ii). In between episodes people recovery fully or partially.

Sometimes people go on to experience manic or hypomanic episodes—if that happens, you are awarded a new diagnosis of Bipolar Disorder Type I or II.

Cyclothymia

Cyclothymia gives you hypomania and mild depression. You may develop Bipolar I as well as Cyclothymia. The likelihood of this is estimated at 15–50 per cent.(iii)

While not as spectacularly devastating as Bipolar I, II or Major Depressive Disorders, Cyclothymia can still cause significant damage to work, education, employment and relationships.

Dysthymic Disorder

Dysthymic disorder is a seemingly never-ending, grumbling, pain-in-the-neck sense of being mildly depressed but not so depressed as to be in desperate or suicidal pain. The main criterion for diagnosis is that you are chronically (iv)depressed—most of the day, every day, for at least two years, with no more than two months free of the depression.

Footnotes

[i] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, American Psychiatric Association, Washington, DC, 1994

[ ii] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, American Psychiatric Association, Washington, DC, 1994 p341–342

[iii] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, American Psychiatric Association, Washington, DC, 1994 p364

[iv] See Appendix I The Jargon Decoder

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