Bipolar Spectrum Disorder May Be Underrecognized

What is bipolar spectrum disorder?

There are several different definitions of BSD.

There is also considerable debate over whether or not BSD even exists or has any diagnostic value.

bipolar spectrum disorder?

There are several different definitions of BSD.

There is also considerable debate over whether or not BSD even exists or has any diagnostic value.

According to Dr Elizabeth Brondolo and Dr Xavier Amador, the bipolar spectrum disorders are:

“a group of disorders all of which involve cycling moods. . . [BSDs] are also accompanied by a wide range of other symptoms that affect not just your mood but also your energy, your memory and thinking, and your connection with other people”.

Another expert who has done a lot of work in this area is Dr Jim Phelps. He points out that many people have symptoms: that are more than depression but less than bipolar.

Dr Phelps has written a very well received book on bipolar ii and soft bipolar disorder called Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder.

This describes bipolar spectrum disorder as the “Mood Spectrum”.

In the Mood Spectrum model depression and bipolar disorder are seen as the two opposite ends of a continuum, and people can be found all along the spectrum.

In other words, you can be at any point along the Mood Spectrum, and we can conceptualize different people as having different degrees of bipolar.

See concerns on “Underrecognized and Improperly Treated Bipolar Spectrum Illness” from the National Institute of Mental Health

The features of sub-threshold bipolar, (the mildest form of bipolar spectrum disorder, sometimes known as soft bipolar,) include:

A. At least one major depressive episode.

B. No spontaneous hypomanic or manic episode.


C. Either one of the following, plus at least two items from D, or both of the following plus one item from D:

1. A family history of bipolar disorder in a first-degree relative.

2. Antidepressant-induced mania or hypomania.

D. If no items from C are present, six of the following 9 are needed:

1. Excessive emotionalism and/or excessive activity.

2. More than 3 recurrent episodes of major depression.

3. Brief major depressive episodes lasting less than 3 months.

4. Atypical symptoms of depression such as increased sleep or appetite.

5. Psychotic major depressive episode.

6. Early age of onset of major depression (before 25).

7. Postpartum depression.

8. Antidepressant tolerance.

9. Lack of response after trying more than 3 different antidepressants.

Bipolar Spectrum Disorder does exist, but is a problematic concept because of the danger of losing diagnostic rigor.

Responding to a diagnosis of BSD

What is the harm in broadening our understand of mood disorders to accommodate the notion of a spectrum of bipolar?

In Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition Drs Kay Jamison and Fred Goodwin, support the notion of a spectrum, but do acknowledge the danger of having such a broad and fuzzy approach that a diagnosis of BSD would be “theoretically and clinically meaningless”.

It seems there are several dangers:

1. An on-going collapse of academic and clinical rigor.

2. Unnecessary prescription of strong medications such as the currently fashionable anti-psychotics.

3. Substantial self-diagnosis and self-medication, with the danger of treatment that is either unnecessary of inadequate.

4. Cultural trends that reward and romanticize mental illness in much the same way as we have erred in elevating a culture of victim-hood. Yes it is important to eliminate stigma, but do we want a society that embraces mental illness as a badge of honor?

However, there is also a substantial upside – more people getting the medication and/or therapy and other support they need instead of falling through the cracks.

A lot depends on what people DO with their diagnosis.

If folks are prepared to put the work into achieving stable moods through learning about appropriate medication, keeping a mood chart, developing a wellness plan and treatment contract, sleeping regular hours, and following the right program of diet and exercise, then success is almost inevitable.

However, those who “fall in love” with their diagnosis of bipolar spectrum disorder and wallow in neurosis may have little to gain.

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