DSM-5 Draft Criteria Open for Final Public Comment

I don’t know about everyone else but I have a hunch this is typical: when first receiving a psychiatric diagnosis I inevitably wanted to know where the names and criteria of these disorders came from. I was led directly to the Diagnostic and Statistical Manual; version 4 (also referred to the DSM-4). This is the book that holds the categorization and criteria for diagnosing an inexplicable range of mental illnesses.

Well, the DSM has been under revision lately, and the latest draft of the new version (DSM-5) can be found at the American Psychiatric Association’s DSM-5 Development page. May 2nd through June 15th is the last opportunity for the public to submit comments on the draft (posted on the website), and after that we will be able to watch the final proposals posted to the website (without the ability to comment) until it is published.

Many things have been changed (though some only minutely), but bipolar disorder (as well as borderline personality disorder, and major depressive disorder, to name a few) is something that has had some tweaking done.

Have you checked out the website yet, or the changes made to the criteria for bipolar disorder? Most notably, increased energy/activity has been added to the symptoms of mania/hypomania, which I think is a big step in the right direction. Had this been considered an indicator ten years ago, I am certain my diagnosis would have happened much more quickly.

Bipolar NOS (not otherwise specified) is now NEC (not elsewhere classified) which seems a bit silly to me to keep changing the name when people already have a hard time understanding these sorts of disorders. However, there are a few subcategories of NEC and a couple of “pace-holder” sorts of subcategories which may prove useful to some.

Mixed episodes are now proposed to be categorized by a manic or depressive episode (whichever is the dominant episode) with the label ” with mixed features” tagged onto it. The criteria is much more specific, and I’m not sure if this change is really for better or worse. Personally, I find mixed episodes to be some of the most confusing states I’ve ever experienced, so I don’t know if I believe the new criteria will make them easier to spot or will just exclude mixed sorts of episodes that don’t meet the full criteria for being “mixed features”.

Anyway, this is just a taste of the revision, and since we are approaching the end of the commenting period I’d definitely urge you to take a look at the website, you can find Bipolar and related disorders here, and consider shooting a few comments their way if you feel so inclined!

8 responses to “DSM-5 Draft Criteria Open for Final Public Comment

  1. You know, I really actually like the revision. I think it makes a lot of things clearer. In the DSM-IV, it was not possible to have Bipolar II and mixed episodes. That is precisely the problem that I had been encountering throughout the last few months. I was having mixed moods, but not full blown mania. Now, they’ve included bouts of hypomania into mixed episodes.

    It made it difficult for me to know whether I was experiencing full-blown mania or not. It’s not a matter of diagnosis as much as it’s a matter of treatment options and knowing what to expect or look for in terms of symptoms. Now that the definitions for each episode are a little more clear, I can get an idea of where one starts and another begins.

    For instance, right now I’m experiencing what I would usually think of as hypomania. Except, the episodes have been getting longer and more intense each time I experience one. So, the question for me has been where do I draw the line between hypomania and mania? This diagnostic criteria makes it a little easier to do that. Severity of dysfunction. Which is still entirely subjective, but that’s a different story entirely.

    Thanks for the post! I’m glad you linked it!

    • Sarah @ bi[polar] curious

      What is funny to me is that since (before) you couldn’t have bipolar II and mixed episodes I just lumped myself into type I. The fact that type II can now have mixed episodes undoes that logic I used for the most part, making things a bit hazy for me again. I guess my concern is that by requiring a handful of of each depressive & manic/hypo symptoms for mixed features could potentially create a whole other group of episodes that aren’t quite recognized as episodes (namely those that don’t meet all of the criteria). I have definitely had situations of intense hypomania with the sudden addition of suicidally, so what would that be? Still just hypomania, based on what I read, though much more dangerous and intense.

      The symptoms I experience are so wildly different from time to time that most of the time I do not fit any of the categories or criteria particularly well, and if the majority of bipolar patients now are NOS… are the changes helping shuffle those people into categories, or is it shuffling them the other direction into the NEC category?

      Just a thought. I will be interested to read what happens with the final revision!

      I agree with you 100% on the unclear lines between hypomania & mania, and that is the number one concern I’ve heard from everyone I’ve talked to. Thanks for your two cents!

  2. Very interesting – I have a hard time picking out what the differences are from the current version, so thanks for highlighting the energy change.

    This does clarify to some degree where the line is between hypomania and mania, but I still can’t tell where I fall. When I’m hypomanic, I can usually function reasonably well, but it takes extraordinary effort in some areas because some of the hypomania symptoms are severe enough to really interfere with parts of my work. Normal occupational functioning is not what I’d call it, though. Just because I can usually whip out a ridiculous amount of work during a hypomanic episode doesn’t mean I’m keeping up with what I should be doing, so I guess it depends on how you define occupational functioning.

    I can see that the MDD description includes the full range of depression symptoms, but I think it’s worth calling out that bipolar II may more often involve atypical depression symptoms.

    • Sarah @ bi[polar] curious

      The things I listed were just a few of the changes, and for the most part I agree that some of the changes were difficult to detect -I think because some are so minute.

      And I agree that the line is still somewhat fuzzy between hypomania and mania. That is one area where there are many people I know who have trouble discerning where the threshold is for them.

  3. I am glad I found this. I don’t even know what I am other than a rapid cycling, sometimes manic, sometime depressive…but hypomanic the rest of the time freak! LOL. I have learned to live with it, considering that GOD made me differently but not necessarily less than. I have had adverse reactions to typical meds and, when I tell my drs, they say, “Well, you should be feeling the opposite. Double your dosage.” The meds steal all the passion from my life and I am either empty (as in a painful sucking emptiness) or angry because I can’t feel anything.

    Maybe the revision will help these idiots come up with something better than, “That doesn’t make sense to me.” No kidding, asshole drs. It doesn’t make sense because I am crazy. I have papers to prove it and I am entitled.

    Pardon me. My tongue sort of loosed itself for a minute.

    P.S.-just to be clear, throw in paranoia and anxiety, too…maybe another thing or two.

    • Sarah @ bi[polar] curious

      I have similar issues with medications (though namely that they simply don’t work on me) so I can definitely identify with doctors telling you that you should be feeling the opposite. Once I took klonapin (for anxiety) and had a panic attack for no apparent reason 10 minutes later! Talk about opposite!

      Thanks for sharing!

  4. Thank you very much for the update. My counselor refers to the DSM as the Big Bible of Problems…

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