As we begin to describe the face of the mood disorders, let’s have a look at the bipolar disorders. And let’s consider this the old once over lightly.
Though you still hear the term once in a while, bipolar disorder was once known as manic-depressive disorder. Boiled-down, to be diagnosed with a bipolar disorder one has to experience mood cycling that hits the peaks and valleys of manic, hypomanic, major depressive, or mixed episodes.
If you take a gander at the DSM-IV-TR, you’ll find diagnoses of Bipolar I and Bipolar II Disorders. And the distinction is the presence of manic or hypomanic (shorter in duration, with what are considered to be less severe symptoms) episodes.
To be thorough, we have to mention Cyclothymic Disorder, though I’ve rarely seen the diagnosis assigned. Cyclothymia is a mood cycling disorder alright; but manic, hypomanic, major depressive, and mixed episodes aren’t in the picture.
Bipolar disorder can be one tough hombre. At its most prolific, the sufferer, and anyone associated with him/her, are the victims of high-risk behaviors, participation in pleasurable activities at dangerous levels, over-the-top grandiosity and expansiveness, decreased need for sleep, racing thoughts, and speech that tries to keep up with them.
And then there’s the crash into the depths of depression that leave the sufferer flat and without motivation to do much of anything. Suicidal ideation and behavior are major potentialities.
We can’t forget about mixed episodes, which are the most dangerous states in terms of the potential for harm to self or others. Yes, a manic and major depressive episode present at the same time. Can you image?
Finally, there’s the eternal catch-all of psych diagnostics; the “not otherwise specified” designation. So a diagnosis of Bipolar Disorder NOS is assigned when it looks and quacks like a duck, but isn’t.
Now, I’ve presented the bipolar disorders from the perspective of the strict diagnostic criteria of the DSM-IV-TR. But rarely are presentations that cut and dried. And that’s why these days bipolarity is being assessed and treated within the context of a mood spectrum.
See, the depressive piece is always there, in between major depressive episodes, and the personality of the disorder is determined by the frequency and severity of mania.
By the way, anxiety is very much in the picture when it comes to the bipolar disorders. It can certainly present as a symptom, and can bolster the misdiagnosis of some level of mania.
Will you come back and see us as we discuss the depressive disorders?