The Bipolar Spectrum and the Importance of Diagnosis

Dan Haupt, M.D. Health Guide
  • One theory of bipolar disorder states that rather than simply consisting of just one or two types of illness (bipolar I and bipolar II), there is in fact a whole spectrum comprising lesser variants of the illness.

    In practice, this spectrum can be invoked 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 related to the fact that some people have more trouble regulating their emotions than others. This apparently abnormal emotional regulation gets misinterpreted as the ups and downs of bipolar disorder.
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    While the bipolar spectrum is a useful concept for diagnosis and management, it can also confound the evaluation of someone’s complaints. Many patients are diagnosed with bipolar disorder by a clinician that has mistaken normal, but troublesome, behavior with symptoms of bipolar disorder, due most likely to the difficulty of finding psychiatrists in most parts of the country.

    For example, while anger and irritability can be associated with bipolar mania, many people are angry and irritable, but they don’t have bipolar disorder.

    The risk of misdiagnosing bipolar disorder can be twofold: 1) Otherwise healthy people are exposed to the risks of medications that are unlikely to benefit them, and 2) Some people may view the diagnosis as an excuse for not modulating their behavior, instead blaming their diagnosis for their behavior.

    An evaluation by a skilled psychiatrist can separate symptoms that should be counted toward a diagnosis of bipolar disorder from those that are part of the normal human experience. Given the importance of identifying the presence or absence of bipolar illness to a person’s well-being, I would recommend getting the opinion of a respected, board certified psychiatrist if you or someone you know is suspected to have bipolar disorder. Even if it means traveling some distance or paying out of pocket, a single diagnostic visit is likely to be very helpful in clarifying a diagnosis.

    Nevertheless, there are many people with bipolar II or “less” whose lives are clearly improved by medication. The important fact is to know where you are on the spectrum, be confident in your doctor and your diagnosis, and comfortable that the benefits of your treatment outweigh its risks.

    Keep sending your questions about bipolar disorder to me at

Published On: March 12, 2007