Currently, there is much disagreement about the boundaries in the classification of affective disorder subtypes such as bipolar disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association uses specific criteria in order to classify the recognized mental health illnesses. Major Depressive Disorder (MDD) is the most common and easily recognized illness and so dominates the affective disorder area. But most physicians and psychiatrists believe that many so-called .major depressive. states are, in reality, a result of bipolar disorder. The DSM basically recognizes the unipolar and bipolar distinction, but has a strong bias in favor of non-bipolar conditions. While it is true that the DSM has formally created the categories of bipolar I, bipolar II and bipolar NOS (not otherwise specified), these categories are difficult to use in diagnosis because the definitions of mania and hypomania are phrased in nearly identical language (except mania is described as a psychosis and hypomania is describes by a relative lack of disability), bipolar NOS is basically left undefined, and a related illness called cyclothymia is likely to be misclassified as an erratic personality disorder. The entire spectrum of bipolarity in the less-than-manic range may be attributed and misdiagnosed as being MDD and/or Axis-II, Cluster B. Two decades ago, the main diagnostic errors were in favor of schizophrenia over mania, but this appears to have been overcome.
The definition of bipolar spectrum is basically a theory that bipolar disorder does not just consist of one or two types of illness (bipolar I and bipolar II), there is in fact a whole spectrum comprising lesser variants of the illness. Even though the various sub-categories of spectrum disorders are not specifically classified in the DSM, doctors are aware of them and treat them all the time. In fact, this spectrum is used by doctors to diagnose bipolar symptoms in people that likely are not mentally ill, but rather are behaving within the range of normal human behavior. This is due to the fact that some people have more trouble regulating their emotions than others, thus, apparently abnormal emotions can get misinterpreted as the ups and downs of bipolar disorder. Sometimes patients are diagnosed with bipolar disorder by a clinician that has mistaken normal, but troublesome, behavior with the symptoms of bipolar disorder. For instance, anger and irritability can be associated with bipolar mania, but many people are angry and irritable, and do not have bipolar disorder.
A simple letter classification system was introduced in 1978 to more easily classify the degree of individuals’ affectedness within the spectrum of bipolar disorder. Using this classification, points on the spectrum are denoted using the following codes: M = severe mania, D = severe depression (unipolar depression); m = less severe mania (hypomania), and d = less severe depression. In this system, mD represents a patient with hypomania and major depression. A further distinction is sometimes made in the order of the letters to represent the order of the episodes, such as when a patient’s normal state is euthymic (neither manic nor depressed), but is interrupted by episodes of mania which are followed by depression (MD) or episodes of depression which are followed by mania (DM). By employing this system, major depression would be denoted as D, unipolar mania as M, and unipolar hypomania as m.
Misdiagnosis of bipolar disorder can create problems such as healthy people being exposed to the risks of medications that are unlikely to benefit them, and also that some people may view the diagnosis as an excuse for their behavior by blaming their diagnosis for their behavior. An extensive evaluation is crucial to the correct diagnosis of all spectrums of bipolar disorder.