Diagnosis of Bipolar Disorder Not Always Clear

Bipolar disorder — also known as manic-depressive illness — is a mental disorder with two polar-opposite phases, mania and depression, and with periods of complete remission of symptoms. The episodes of illness usually last weeks or months and the periods of remission may last months or years.

Mania may be severe or mild.
In the manic phase of the illness the person is likely to be energetic and need little sleep. He or she may be

• exhilarated, or even ecstatic
• talkative and argumentative
• enthused about any number of plans, many of them unrealistic

The person may be impatient, impulsive, and resist any attempts to dissuade him or her from irrational plans or from dangerous or harmful behavior.

In this phase of the disorder, the person may have grandiose or paranoid delusions and experience hallucinations that reinforce these delusions. When the episode is milder, the person’s judgment is less severely impaired and no hallucinations or delusions are present, the episode is referred to as “hypomania.”

Variations in depression may also exist.
In the depressed phase of the disorder the person is likely to be

• slowed down
• lacking in energy
• unwilling to get out of bed or leave the house

Sleep may be excessive or disturbed. The person often wakes feeling un-rested. He or she may ruminate about negative events in his or her life, feel helpless and hopeless, have low self-esteem, and think, plan or attempt suicide.

The depressive episode may be free of psychotic symptoms but, when delusions are present, they often focus on death, disease, or guilt about some imagined offence, and hallucinations are likely to be critical or abusive in nature.

Confusion surrounds bipolar disorder diagnosis.
Confusion has arisen regarding the diagnosis of bipolar disorder in recent years due to the practice among child psychiatrists in the U.S of diagnosing aggressive and irritable children with volatile emotions as suffering from “bipolar disorder.”

The vast majority of these children never go on to develop bipolar disorder, with the manic-depressive features described above, in adulthood. However, the practice has led to an expansion of the rate of diagnosis of bipolar disorder to 40 times the previous prevalence.

The American Psychiatric Association plans to rectify this error and reduce the confusion with the publication, in 2013, of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The revised manual will require emotionally volatile children of this type to be diagnosed as suffering from “temper dysregulation disorder with dysphoria.” With this change, it will again become clear that “bipolar disorder” follows the description above.

Resources are available for coping with bipolar disorder.
More information about bipolar disorder may be found in The Bipolar Disorder Survival Guide by David Miklowitz, Ph.D. (Guilford Press, 2002).

Dr. Miklowitz is a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior in Los Angeles, California. He is renowned in the field of bipolar disorder research and the Survival Guide is recommended reading.