Unfit: The Key
Significance of the DSM-IV
By Dr. Neff Breen
The American Psychiatric Association has released an updated version of the
Diagnostic and Statistical Manual of Mental Disorder-the DSM-IV. This manual
is revised every few years to reflect the latest advances in scientific
research. One of the most important differences between DSM-IV and its
predecessors (DSM-III revised or DSM-IIIR)is in the area of bipolar
disorders. The DSM-IIIR listed only two types of bipolar conditions: the
diagnosis of bipolar disorder was given to people who suffered a manic
episode with or with out any history of depression; and the diagnosis of
cyclothymia was given to people who had suffered a number of hypomanic
episodes as well as some symptoms of depression. Everything else was called
„Bipolar Disorder Not Otherwise Specified“ (NOS).
The classification scheme was obviously inadequate, only two types of
bipolar conditions were classified. There was not enough emphasis on
describing an individual patients long term course. During the 1980’s,
however, much effort was spent trying to separate out the different subtypes
of bipolar disorder. These subtypes basically differ in their long-term
course and in the intensity of their manic and depressive symptoms.
The new categories include:
Bipolar I Disorder: This is the classic bipolar disorder. People with
Bipolar I have at least one full blown Manic or Mixed (manic and depressed
simultaneously) episode, with or without depression.
Bipolar II Disorder:
This is a new diagnostic category. People with this
diagnosis have had at least one Major Depressive Episode and one Hypomanic
Episode, but have never had a full blown manic or mixed episode.
Cyclothymic patients have a different long term
pattern than patients with the other bipolar disorders. Whereas people
people with Bipolar I or II have had a severe mood disturbance within the
first two years of their illness, cyclothymics start with at least two years
of more subtle depressive and hypomanic symptoms. They may continue to have
a number of these episodes throughout their lives without ever having a
complete Major Depressive or Manic Episode. They also may go on to develop
Bipolar I or II disorders.