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Bipolar Spectrum and Bipolar Disorder NOS

For every person who is diagnosed with a bona fide Bipolar Disorder (Bipolar I or II Disorder or Cyclothymia) there can be found another person in the general population who experiences symptoms of mood elevation and instability that are similar to Hypomania and that cause disability, but which do not meet the full criteria for this condition [ref]. If all of these individuals are counted, then upwards of 10% of all people in the general population would be considered to have forms of Bipolar Disorder; and if still "softer" forms of mood instability were counted, then a quarter of all people would qualify [ref]. This suggests that the bona fide Bipolar Disorders (Bipolar I or II Disorder or Cyclothymia) may represent one extreme of what is actually a spectrum of mood stability and reactivity among all people [ref]. The term Bipolar Spectrum captures this idea.

The DSM-IV-TR does not officially recognize the concept of Bipolar Spectrum disorders, but it does include a category called Bipolar Disorders Not Otherwise Specified (NOS), which includes syndromes with bipolar features that do not meet criteria for Bipolar I or II Disorder or Cyclothymia

In this category of Bipolar Disorder NOS, one could find, for example, a person who experiences episodes with manic symptoms or depressive symptoms that do not include enough symptoms to qualify as a full Manic, Hypomanic or Major Depressive Episode, or the duration of the symptoms would not be enough to qualify for these episodes. Another example would be where a person has recurrent Hypomanic Episodes but no Major Depressive Episodes (so that they do not qualify for Bipolar II Disorder).   Still other examples include cases where a clinician cannot determine whether or not a person's Bipolar Disorder was caused by a general medical condition or a particular substance rather than occuring naturally.

 

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Cyclothymia

Manic Episode (Mania)