Bipolar Thoughts

The Bipolar Spectrum

A long long time ago, in the early 1920’s, dimensional ideas about mood disorders started to formulate. Schizophrenia and Bipolar both got put into spectrums (not the same one) and people thought about them in terms of their severity and intensity as opposed to a simple ‘yes/no’ diagnosis. These models were massaged and changed over the decades as our understanding grew and this continued until the DSM was created. The DSM (Diagnostic and Statistical Manual of Mental Disorders) was first published in 1952, and has since had 4 (and two sub) revisions. DSM-5 was published in 2013.

And none of them have defined bipolar or schizophrenia as a spectrum disease, like autism for example.

The DSM is used in a ton of countries (over 60), even though it is written by the APA. There is a counterpart out there called the International Statistical Classification of Diseases and Related Health Problems ICD-10, which is put out by the World Health Organization. For whatever it matters, on an international scale, professionals prefer to use ICD-10 for clinical diagnosis, while the DSM-IV is considered better for research. Here in America, DSM is the standard and is used for everything, and is necessary for insurance coverage.

Before you go out and buy a copy of the DSM or ICD to diagnose yourself, realize that most of what is contained therein are codes that are used as diagnostic shortcuts. This isn’t only for mental health. The next time your doctor gives you a script, if one will ever do that ever again, you will usually see a four or five digit number on the bottom. That is the diagnostic code. It is a shortcut for insurance companies, but also useful for communication. And these codes are almost identical for the mental health section. The APA and WHO collaborated for the most recent DSM-V and ICD-10.

So how are they different, at least with regards to bipolar? The answer is significant actually. The DSM lists out several different forms of bipolar, while ICD only refers to “Bipolar Affective”, and groups them all together.

This gets me back to the spectrum. It is still around. It is not in the DSM. And technically it is not in the ICD either, but they certainly lean more in that direction.

Here is an image of the spectrum (click to enlarge):

F1.large

It is useful to see where thing fit in relation to each other, but it is often criticized that things like Cyclothymic Disorder can be viewed as ‘bipolar lite’ when really it claims many lives from suicide; or that we need clean lines somewhere to make clear diagnoses. But I find the real usefulness of this spectrum is the idea that people aren’t set into one of these categories, but often slide around within them.

Crazy right (is that a pun?)?  But we know that bipolar can become more and less severe. And when it does, should we change our treatment to meet what would be our current diagnosis? It also says that there is a spectrum between Type II and Type I. A lot of research has shown for a long time that symptoms may present between these two Types not just throughout cycles but also as we age or as we changes our stressors.

In America, it takes a single Manic episode to get a Type I diagnosis. And this is basically where I am at. I was given a Type II diagnosis a long time ago and then had my manic episode and popped into Type I. But we all know that some people are manic 4-5, or more, times a year! My condition is certainly not as severe as theirs. I am further left on this spectrum. Now I have noticed as I age that my moods are less depression heavy and more hypomanic or simply in remission more of the time.

I like the idea that we are on a spectrum from depression to mania all the time. And our symptoms range from normal or remission to very severe. It is far from perfect, obviously. But I like it better than ‘you are A, and will always be A and we will always treat you like A even if you haven’t presented symptoms in 30 years’.

A big reason that bipolars stop their treatment is because they feel it no longer fits their symptoms. Either is isn’t doing enough, or there is no need for it. Maybe if we started to look at the spectrum and treating it accordingly, we could rectify this.