Controversial DSM diagnosis of bipolar disorder

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Introduction

There are two general functions of the diagnostic criteria of a mental or psychiatric disorder which are: the clinical differentiation of the disorder from disorders having clinical presentations; and the differentiation of the disorder from normal non-disordered features. A standard guide and language available for researchers, clinicians as well as public health officials is available for characterizing mental health disorders – known as The Diagnostic and Statistical Manual of Mental Disorders (DSM) – whose 5th edition, the most recent revision (DSM-5), was published in May 2013 ("Chapter 8 - Presumptive and Confirmatory Blood Testing," 2017; First & Wakefield, 2013). According to the DSM-5’s designation, a mental or psychiatric disorder is defined as a syndrome which leads to a significant clinical disturbance in the cognition, behavior and emotional regulation thereby resulting and consequently being reflected by a dysfunction of the mental functioning (Black & Grant, 2014).

Bipolar disorder – alias manic depression or manic depressive mental disorder – is typically characterized and known by the unusual episodes of mood shifts, activity and energy levels, disturbances in concentration levels and a failure to carry out daily tasks. Other symptoms include an increased grandiosity, sleeplessness, inflated talkativeness, easy distraction and vying thoughts. The diagnosis of a bipolar illness usually begins with a thorough physical examination of an individual by the respective mental health physician so as to rule out the possibility that there is a physical illness behind it. Then, a comprehensive mental health evaluation is done to assess the symptoms in accordance with DSM-5 (Angst, 2013; NIH - National Institute of Mental Health; PSYCOM; Tandon, 2015). 

Controversial diagnosis of bipolar disorder

In contemporary psychiatry, the bipolar disorder as well as its diagnosis stands in the hub of one of the most complex mental disorders. Despite being a disabling brain illness, it is often misdiagnosed based on the initial demonstration of its symptoms, which thus leads to various controversies about its proper diagnosis. 

Bipolar spectrum case

The case being described here is taken from a study on the diagnosis of a 25-year old woman who is also a university graduate. The main complaints presented by this patient were: inability of express herself and incapacity to interact socially with others. She has also told about the psychiatric treatment being received from the past 5 years. Moreover, despite receiving medications i.e., lamotrigine and moclobemide from the last 1.5 years, the symptoms of volition lack, worthlessness thoughts, depression and anorexia still persisted. Additionally, the other behavioral symptoms included tense feeling and irritability for no apparent reason, lack of concentration, moving around restlessly, avoiding going home, and walking during the midnight despite objections from the family. During this, the patient also told about the elevated self-confidence, sociable behavior with strangers, talkativeness, irritability, tenseness, aggressiveness, and a burst into laughter sometimes, described as being quite unfamiliar and strange for her (Koçbiyik et al., 2016). 

The patient further reported that the first appearance of her symptoms occurred during her early childhood after she began wearing glasses. During that time, the symptoms were mainly oriented around a fearful feeling of being disgraced, unhappiness even if something good is happened. Later on, when she joined college, these symptoms became more pronounced with increasing limits in being socially active, lack of motivation and energy as well as felling of worthlessness. It was during this period that she had gone for a psychiatric treatment and started having prescribed drugs (Koçbiyik et al., 2016).

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