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Changes in the DSM-5 Related to Bipolar Disorders
The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) is due out any moment now, and in it, there are changes to the diagnosis of bipolar disorder. The changes aren’t huge, but they are worth knowing about if you have bipolar disorder. Here’s an overview of what the DSM-5 does to bipolar disorder.
The Separation of Depressive and Bipolar Disorders
Bipolar disorder and depression have now each been placed in their own chapter in the DSM-5. Whereas once we had a mood disorders chapter, now we have a Bipolar and Related Disorders and a Depressive Disorders chapter.
This separation may not seem like a big deal, but it seems to signal a move away from thinking about depression and bipolar existing along a spectrum, and this is a change I disagree with (more on this change here).
DSM-5 Changes to Bipolar Disorders
In addition to putting bipolar disorders in their own chapter, there are a couple of other changes as well. One change is to the main criteria of bipolar manic or hypomanic episodes which did state the mood must be markedly expansive, elated, or irritable. Added to this list is now, “an emphasis on changes in activity and energy as well as mood.”
There is no longer a “Bipolar Not Otherwise Specified” diagnosis, now there is an “Other Specified Bipolar and Related Disorder” diagnosis. This diagnosis is designed to take into account people who may, for example, have a history of depression and meet all the criteria of hypomania, except the duration. Similarly, if a person has too few symptoms to meet the bipolar II criteria, but has been symptomatic for more than four days, they may also fall under this new diagnosis.
Bipolar Disorder Specifiers
In addition to the typical diagnoses of bipolar mania, hypomania, and depression, further information about the mood can be denoted with a “specifier.” A specifier is an extension to the diagnosis that further clarifies the course, severity or special features of the disorder or illness. Specifiers were used in the DSM-IV but not much was ever said about them. The two new specifiers in the DSM-5 are “with mixed features” and “with anxious distress.”
The “with mixed features” specifier denotes a mood that simultaneously contains both manic/hypomanic and depressive symptoms. It is interesting as it can be applied to any mood: manic, hypomanic or depressed (including unipolar depression). This is a fairly major change as previously mixed moods could only officially be diagnosed in bipolar I mania.
The “with anxious distress” specifier is designed to denote patients suffering from anxiety symptoms that are not part of the bipolar diagnostic criteria.
What Do the DSM-5 Changes Mean for People with Bipolar?
Not much, actually.
In all, people with bipolar disorder got off easy with very few changes, which is good in terms of healthcare coverage and billing codes.