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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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