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What Is the Bipolar Spectrum?

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The bipolar spectrum is a term used to refer to conditions of many people with depression, substance abuse, and a wide range of other psychiatric conditions who also have some symptoms of bipolar disorder. Although they have these similar symptoms, they are not diagnosed with bipolar disorder as it is commonly defined. Some psychiatrists find the concept useful. But since it has not been rigorously studied it hasn't been widely adopted.

The Bipolar Spectrum: Bipolar I - IV?

Bipolar disorder is commonly believed by psychiatrists to have three main forms:

  • In bipolar disorder I (bipolar I), a person has at least one manic episode lasting at least a week. He or she also has multiple episodes of major depression. Without treatment, the episodes of depression and mania usually repeat in erratic cycles with the periods of depression, outnumbering the episodes of mania by about 3 to 1.
  • In bipolar disorder II (bipolar II), a person has a milder form of mania, called hypomania, lasting several days or longer. Periods of  depression, though, outnumber the episodes of hypomania by almost 40 to 1 in most people with this form of the disorder. Because hypomania can be mistaken for ordinary happiness or even normal functioning, bipolar II may often be misdiagnosed as depression alone.
  • In cyclothymic disorder (sometimes unofficially called bipolar III), a person has hypomanias (as in bipolar II disorder) that alternate frequently with periods of depression. When present, though, the symptoms of depression are not full syndromes of major depression.

The concept of a bipolar spectrum may include additional subtypes of bipolar disorder that were proposed in the 1980s. Those subtypes include:

  • Bipolar IV, identified by manic or hypomanic episodes that occur only after taking antidepressant medications
  • Bipolar V, which refers to patients who have a family history of bipolar disorder but only have symptoms of major depression themselves

The symptoms described by these last two subtypes have long been known to exist. But they have not been officially studied enough to warrant their being made distinct diagnostic categories.

Possible Bipolar Spectrum Conditions

Bipolar spectrum advocates also propose that people with many other mental conditions may be in the bipolar spectrum. Mental or behavioral conditions that have been suggested as part of the bipolar spectrum include:

  • Depression (especially re-occurring, treatment-resistant depression)
  • Impulsive disorders
  • Substance abuse disorders
  • Eating disorders, such as anorexia and bulimia
  • Personality disorders, such as borderline personality disorder
  • Childhood behavioral disorders, such as conduct disorder

When people with these or other conditions also have some symptoms of bipolar disorder, it may sometimes be useful to consider whether their conditions fall within range of the bipolar spectrum.

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