"sub-threshold bipolar disorder" posts

(I wouldn’t exactly call this high-quality – rather, I’d call it “strung-out after work” – but it puts together some of the issues that I’ve been thinking about lately.)

There was recently a news article about researchers finding that 2.4% of americans will have subthreshold bipolar disorder (as they defined it) at some point during their lifetime.

Check this post out, in which the author, whose bio states that he is an academic with clinical experience, starts with that article and works up to arguing that anyone who isn’t bipolar type I should not be receiving long-term medication because “there is scant if any research on what appropriate medication is for bipolar II and there is not a damn bit of research attesting to medication for SBD” (subthreshold bipolar disorder).

I do not think he is an academic with training on the research side of psychology. He also seems to have difficulty understanding that different diagnoses of bipolar disorder almost certainly involve similarities in etiology which are relevant to treatment.

A blogger called Furious Seasons links to “>this article, which says: “People with bipolar disorder not otherwise specified (BD-NOS), sometimes called subthreshold bipolar disorder, have manic and depressive symptoms as well, but they do not meet strict criteria for any specific type of bipolar disorder noted in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), the reference manual for psychiatric disorders. Nonetheless, BD-NOS still can significantly impair those who have it”.

Now, check out his later entry where he/she invites readers to rename SBD, in which he/she states that, in comparison to cyclothymia “SBD is like so totally better! Cyclothymia includes alternating periods of low scale hypomania and low scale depression. But SBD is skipping the depression altogether, so we can focus on people who are chronically productive and medicate them until they put on 100 pounds.”
Many of the people responding are equating hypomania to extra nice happiness, which it can involve, but it may also involve severe irritability, racing thoughts, and lots of other fun things.

There are some very interesting things in all this to write about, but they are not being written about well in the blogs I have seen so far. For example, some questions I’m thinking about (most of which I would answer “no”, but at least I’m still thinking about them):

Are our current, DSM-IV views of abnormality the ones that should define what is normal and abnormal? If not, should something else define them (such as, the subjective perceptions of normal/mentally ill that a particular generation on average grew up with)? Should our diagnostic definitions be open to research finding that a set of people formerly included in “normal” have persistent problems that resemble those of people who are currently included in a diagnosis, and bring that information to attention?

On a related note, should our current rates of diagnosis be the “right” ones? (Or, possibly, our rates from the 90s, or the 80s, or what…) Or should we look at population data to see how many people who would benefit from accurate diagnosis and treatment have not received either? (These issues come up all the time with ADD and autism, and to some extent bipolar II and bipolar disorder in general.)

Should people who don’t have “enough” (for whatever definition of enough) problems not receive diagnoses that will help direct them toward the treatment they need to handle those problems effectively?

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Stuff like this makes me so angry – it’s often seems like a failure to admit that someone really could have severe problems, sometimes combined with a need to gatekeep diagnoses so that nobody less troubled can “get in.” It’s not an exclusive club, it’s a set of labels that can help people, but do not currently label all the people they can help.