About the DSM-IV   an introduction
 Disorders :
    DSM-IV criteria		   Bipolar I, Bipolar II, Cyclothymia, etc.
 Episodes :
    DSM-IV criteria		   Manic Episode, Major Depressive Episode, etc.
 Specifiers :
    DSM-IV criteria		   most recent episode, course of recurrent episodes (e.g. rapid cycling)
 Diagnostic Codes   (DSM-IV and ICD-10)
    wonder what your doctor put on your chart?
 Multiaxial Assessment   comprehensive and systematic evaluation technique
 Glossary   frequently used psychology terms
 Sources   bibliography

ABOUT THE DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)[2] defines the criteria for a wide array of mental illnesses. Most psychiatrists use it as a basis for diagnosing patients since insurance companies and hospitals like nice, orderly forms. Yet, they tend to focus more on alleviating symptoms with medication and other therapy than on attempting to fit people into strictly defined categories.

Researchers frequently use the criteria as defined in the DSM-IV to ensure consistency across clinical trials. However, some researchers wanting more flexibility use a modified form of the DSM-IV criteria, such as creating a new diagnostic category. (You may see some people mention Bipolar III, IV, etc. and other categories not part of the DSM-IV).

The DSM-IV chapter on Mood Disorders begins with a list of episodes. It then defines the various diagnoses in terms of these episodes. Finally, it defines a set of specifiers which further detail a patient's current state and how they cycle. Throughout the DSM-IV, the authors give diagnostic codes (e.g. 296.40) for each possible diagnosis.

We have provided a summary of the information provided in the Mood Disorders chapter to allow someone diagnosed with a mood disorder or a loved one to better understand the terminology and concepts.

DISORDERS

See the page containing DSM-IV Mood Disorders Criteria.

The DSM-IV specifies a number of mood disorders. For example, someone with the mental illness manic depression (bipolar) can be diagnosed with Bipolar I Disorder or Bipolar II Disorder. For each of these disorders, the person must have experienced one or more mood episodes to qualify for the diagnosis (except Dysthymic Disorder, for which there is no corresponding DSM-IV episode). The DSM-IV criteria include enough detail to contrast one disorder from another

The following table summarizes the relationship between episodes and DSM-IV disorders. Episodes are indicated on the outer border, while disorders are in the internal rectangle. For example, a person experiencing hypomanic episodes and major depressive episodes would be diagnosed with Bipolar II Disorder. Click on the disorders and episodes to jump to a full description of the item selected. Click on items in quotes for some relevant notes.

 

Unipolar Mania (part of DSM-IV Bipolar I Disorder)
Research has found scant evidence for the existence of "unipolar mania," in which a patient has only manic episodes and no depression or mixed states. For almost all examples (1) only a short history exists since onset, so over time depression may occur; or (2) patients do not recognize their own depression, though others do. [3] Other sources claim that unipolar mania exists, but is extremely rare. 90% of people who experience one manic episode go on to have further mood episodes.

In general, the manic episodes of "unipolar mania" seem to be the same as manic episodes of typical Bipolar I Disorder (mania and depression). The DSM-IV criteria for Bipolar I Disorder requires only manic episodes, so "unipolar mania" is classified as Bipolar I Disorder.

Hyperthymia (not part of DSM-IV)
A person may experience hypomanic episodes, with no depressive episodes or symptoms and not fall under any DSM-IV disorder criteria (except, possibly Bipolar Disorder, Not Otherwise Specified (NOS) or Mood Disorder, NOS). Goodwin and Jamison classify this as hyperthymia or "chronic" hypomania, a subset of cyclothymia. [4] In one study, 10% of cyclothymic patients were classified as hyperthymic. [5]

Euthymia (not part of DSM-IV)
This is the "normal" state for moods. The term euthymia is generally used to describe the mood of a patient who has stopped experiencing manic or depressive symptoms, either due to medication or during the general course of their illness.

 

Major Depressive Disorder

A person with Major Depressive Disorder (MDD) suffers from the worst type of depression, without any (hypo)manic episodes. This is often called unipolar depression, or just unipolar, when there are multiple episodes.

This illness is more common among women (10% to 25% over a lifetime) than among men (5% to 12% over a lifetime).

Those with MDD may have a family history of bipolar disorder (1.5 to 3 times as likely as the general population). This has led some researchers to hypothesize that unipolar depression and bipolar disorder are the same illness, in different forms. [6] Research has not yet found a simple genetic link.

Dysthymic Disorder

Noteworthy DSM-IV Specifiers:
Early Onset
Late Onset
 

People with Dysthymic Disorder suffer from mild depression, without any (hypo)manic episodes.Previously known as depressive neurosis, dysthymia could be considered a minor depression, except the depressive symptoms last for at least two years without a break. Approximately 6% of the population will have Dysthymic Disorder in their lifetimes.

When someone has had Dysthymic Disorder for two years, he or she may be diagnosed as having Dysthymic Disorder and Major Depressive Disorder, at the same time, if the criteria are met. This is sometimes called double depression, as the patient suffers from the worst severity and longest duration of both.

 

Cyclothymic Disorder

 

Cyclothymic Disorder involves alternating hypomania and depressive episodes. Like bipolar, cyclothymia involves cycling between highs and lows, but it never reaches full mania or major depression. It was previously called cycloid personality. Over a lifetime, the chances of having Cyclothymic Disorder are from 0.4% to 1%.

Since it can be so mild, it frequently goes undiagnosed. Quite often, people diagnosed as Bipolar II recall cyclic symptoms before their diagnosis which could qualify as cyclothymia. Clinical trials show a tendency for those with Cyclothymic Disorder, particularly those with an early onset, to develop bipolar disorder over time.[4] From 15% to 50% will develop bipolar disorder.

 

 

Bipolar II Disorder

Noteworthy DSM-IV Specifiers:
Hypomanic
Depressed

 

Bipolar II Disorder involves Major Depressive Episodes and Hypomanic Episodes. Since a significant portion of those suffering manic depression did not have full manic episodes, the classification was divided into Bipolar I and Bipolar II. However, Bipolar II is often a first step to Bipolar I. Over 5 years, between 5% and 15% of those will Bipolar II will change diagnosis to Bipolar I. Approximately 0.5% of people will develop Bipolar II in their lifetimes.

 

Bipolar I Disorder

 

Bipolar I Disorder is the classic form of manic depression, with full Manic Episodes and Major Depressive Episodes. (A person does not need to experience depression to qualify as Bipolar I : see Unipolar Mania.) The lifetime occurrence of Bipolar I Disorder is estimated between 0.4% and 1.6%.