The Separation of Depression and Bipolar in the New DSM-5

Posted by Natasha Tracy | May 7, 2013

The Diagnostic and Statistical Manual of Mental Disorders (the DSM) is frequently called psychiatry’s “bible.” I, however, would not pen it that way. I would suggest that the DSM is simply a guideline for the diagnosis of mental illness. It lists the criteria one has to have in order to be diagnosed with a mental illness.

And, as the name of this post suggests, the DSM is releasing its fifth major version – the DSM-5 – in just a couple of weeks.

Now, the DSM-5 has been controversial from the get-go and I have said that much of this controversy is overstated, but some of the changes do have fundamental nosological implications. In other words, some of the changes in the DSM-5 can change how people fundamentally think of certain mental illnesses.

The DSM-5 Cuts the Chord between Depression and Bipolar

And one of the changes in the DSM-5 is the separation of major depression and bipolar disorder into their own chapters. No longer is there a chapter called “Mood Disorders” with both disorder types listed (Can we still call them mood disorders?). Now they each represent a separate category.

This may seem like a small change, and I’m not going to have a fit over it, but I will say that I think it was the wrong move.

Do Objective Diagnostic Criteria Matter in Psychiatry?

Posted by Natasha Tracy | Mar 15, 2012

One of the criticisms antipsychiatry folks like to make of psychiatry is its lack of objective diagnostic criteria. In other words, there’s no blood test that says you have bipolar disorder or schizophrenia.

And this is true. While today we do have blood tests for biological markers indicative of mental illness diagnosis, there is no hard and fast test that can diagnose a psychiatric disorder (except Huntington’s, for which we have discovered a gene).

The fact of the matter is no matter what is written in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or what blood we draw or which scans we do nothing diagnoses a person properly except a trained psychiatric professional.

But that doesn’t mean there’s nothing objective or meaningful about it.

Bipolar Spectrum Disorders – What is Cyclothymia?

Posted by Natasha Tracy | Jan 22, 2012

Cyclothymia is neither bipolar depression nor unipolar depression but instead it is an illness that lies somewhere in the middle.

When psychiatric illnesses first started being recognized, some doctors felt that unipolar and bipolar depressions weren’t really the binary options for an illness but really just opposite ends of a spectrum. So then, one would have a spectrum where one could be a 100% bipolar depressive, or 100% unipolar depressive or they could lay somewhere in the middle. However, as illnesses need names and diagnostic criteria and not really vague percentages, bipolar and unipolar depression were defined separately.

Bipolar II – Within the Bipolar Spectrum

Bipolar 2 though, is recognition of this false dichotomy. Bipolar 2 really sits in between unipolar and bipolar depression as more depressed than bipolar 1 but more hypomanic (emotionally dysregulatory) than unipolar depression. (See the difference between bipolar 1 and bipolar 2 disorders.)

And that’s fine as far as it goes. But there is also recognition from a lot of doctors that other states lie even more in the middle, and cyclothymia is one such disorder.

Alternative Medicine Resource, Fad Diagnoses, St. John’s Wort – 3 New Things

Posted by Natasha Tracy | Aug 19, 2011

In today’s 3 New Things series I talk about:

A great resource for alternative medicine information
A New St. John’s Wort and depression study
A new “fad” diagnosis up for consideration in the Diagnostic and Statistical Manual of Mental Disorders Version V (DSM-V)