Dsm definition of bipolar disorder
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DSM-5 Definition of Bipolar Disorder
Introduction to Bipolar Disorder in DSM-5
Bipolar disorder, a severe mental illness characterized by extreme mood swings, has undergone significant changes in its diagnostic criteria over the years. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013, introduced several important updates to the diagnosis of bipolar disorders1 2.
Diagnostic Criteria and Categories
Bipolar I Disorder
In DSM-5, Bipolar I Disorder is defined by the occurrence of at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. Notably, a depressive episode or psychosis is not required for the diagnosis of Bipolar I Disorder2.
Bipolar II Disorder
Bipolar II Disorder is characterized by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder. This distinction is crucial as it affects the treatment and management of the disorder2 5.
Cyclothymic Disorder
Cyclothymic Disorder involves periods of hypomanic symptoms and periods of depressive symptoms that do not meet the full criteria for a hypomanic episode or a major depressive episode. These symptoms must be present for at least two years (one year for children and adolescents)2.
Changes from DSM-IV to DSM-5
Introduction of "With Mixed Features" Specifier
One of the significant changes in DSM-5 is the introduction of the "with mixed features" specifier. This specifier can be applied to episodes of mania, hypomania, or depression when symptoms of the opposite mood pole are present. This change has led to an increase in the diagnosis of mixed features, which are associated with a younger age of onset, more frequent hospitalizations, and a higher risk of suicide6.
Emphasis on Increased Activity and Energy
DSM-5 identifies increased activity and energy as cardinal symptoms of mania and hypomania, alongside mood changes. This revision is supported by extensive research and highlights the importance of these symptoms in the diagnosis of bipolar disorder7.
Broader Implications and Prevalence
Broadening of Bipolar Spectrum
The DSM-5 has contributed to a broader understanding of the bipolar spectrum, which includes a range of conditions from cyclothymia to schizoaffective mania. This broader definition has implications for the prevalence and diagnosis of bipolar disorder, potentially leading to earlier and more accurate identification of the disorder3 10.
Impact on Prevalence Rates
Studies have shown that the changes in DSM-5 criteria have led to a decrease in the point prevalence of bipolar disorder compared to DSM-IV, but a smaller decrease in lifetime prevalence. This suggests that while fewer people may be diagnosed at any given time, the overall number of people affected over their lifetime remains significant4.
Conclusion
The DSM-5 has introduced several important changes to the diagnosis of bipolar disorder, including the addition of the "with mixed features" specifier and the emphasis on increased activity and energy as key symptoms. These changes have broadened the understanding of the bipolar spectrum and have implications for the prevalence and diagnosis of the disorder. As research continues, these criteria will likely evolve to further improve the accuracy and effectiveness of bipolar disorder diagnosis and treatment.
Sources and full results
Most relevant research papers on this topic
Bipolar and related disorders in DSM-5 and ICD-10
The DSM-5 and ICD-10 have some concordance in diagnosing bipolar disorders, but there are major differences in their diagnostic categories and criteria.
Diagnosing bipolar disorders in DSM-5
Bipolar disorders in DSM-5 are now grouped into a separate chapter, potentially addressing the issue of overrestrictive diagnostic criteria in the past.
Broadening bipolar disorder — by design or by accident?
The expansion of bipolar disorder diagnosis may have been unintended consequences of certain DSM decisions, such as the ambiguity of mania definitions and the elimination of irritability as a symptom of depression.
DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis – A narrative review from the ECNP bipolar disorders network
The use of DSM-5 and ICD-11 may result in diagnostic delay and delayed early intervention in bipolar disorder, with a smaller reduction in lifetime prevalence compared to DSM-IV.
Literature ReviewBipolar disorders in ICD-11: current status and strengths
The ICD-11 definition of hypomanic episodes represents important progress, with a higher prevalence of bipolar-II disorder compared to DSM-5.
Observational Study
Rigorous JournalPrevalence rates and clinical implications of bipolar disorder "with mixed features" as defined by DSM-5.
The DSM-5 criteria significantly increase the prevalence of bipolar disorder with mixed features, potentially underdiagnosing these patients.
Observational StudyRigorous JournalActivation in Bipolar Disorders: A Systematic Review
Activation is a distinct symptom from mood in bipolar disorder, with lower activity levels during euthymia and depression, and understudied.
Systematic Review
Highly CitedThe Prevalent Clinical Spectrum of Bipolar Disorders: Beyond DSM-IV
The DSM-IV recognizes a broad spectrum of bipolar disorders, including mixed states and temperamental factors that can lead to switching between depression and bipolar I disorder.
Highly CitedPsychiatric and Medical Comorbidities of Bipolar Disorder
Bipolar disorder is strongly associated with substance abuse, anxiety disorders, ADHD, and eating disorders, and medical disorders, which may be comorbid or caused by treatment.
Systematic ReviewHighly CitedEpidemiology of Bipolar Disorders
Bipolar disorders have a lifetime prevalence rate of 2.8 to 6.5%, with a dimensional composition of conditions, and early diagnosis and treatment can prevent suffering, suicidal behavior, and increased socioeconomic costs.
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