Contact me now at (255) 352-6258 or complete my booking form to secure your appointment today.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual that defines all mental illness in the US, is being revised and a new version is due out in 2013. One of the proposed changes to the DSM is to the diagnosis of mixed moods. This change is being proposed by a mood disorders workgroup. It aims to reflect clinical practice where doctors already refer to a “mixed” mood that doesn’t officially meet the DSM criteria. (As I noted, mixed moods are only technically recognized in bipolar type 1.)
Changes to the mixed mood diagnosis will help people with bipolar 1, bipolar 2 and unipolar depression get better treatment.
Some of the changes proposed for mixed moods in the DSM include:
To be diagnosed with the “with mixed features” specifier, a person has to meet the full criteria for one mood (depression, mania or hypomania) and have three or more symptoms of the other mood pole.
Symptoms that are common to both mood poles (mania/hypomania and depression) are not included in the possible criteria for a mixed mood, including:
I think a couple of examples will make it clear.
Patient A is diagnosed with bipolar II and is found to meet the diagnostic criteria of hypomania, thus hypomania is the primary mood. Nearly every day during the hypomanic episode the patient is also:
Patient A then meets the criteria for bipolar II hypomania with mixed features.
One more example:
Patient B is diagnosed with unipolar (that’s non-bipolar) depression and meets the diagnostic criteria for a major depressive episode, depression then being the predominant mood. Nearly every day during this depressive episode the patient also has:
Patient B then meets the criteria for unipolar depression with mixed features.
Correctly diagnosing people matters for several reasons. Firstly, mixed moods come with additional risk of suicide and it’s critical to recognize this risk so suicide can be averted. People who get mixed moods will tell you, it can be the scariest mood out there. You feel angry and suicidal and you have too much energy. That energy can easily be translated into things that will kill you.
Also, diagnosing matters for treatment development and insurance coverage. Without a DSM code, the doctor doesn’t have an illness under which to bill. And by not defining mixed states in a way that people actually experience them, you make treatment development impossible. You can’t test a drug on a group of people that doesn’t exist and even if you could find enough people who met the old diagnosis, you would have no idea whether that drug would work on all the people who have subclinical mixed moods, which is most of us.
So, I would suggest the DSM-V changes to the mixed mood specifier are a move in the right direction.
——————————————————————————————————————————
Up next:
Natasha Tracy is an award-winning writer, speaker, advocate, and consultant from the Pacific Northwest. She has been living with bipolar disorder for 26 years and has written more than 2000 articles on the subject.
Find more of Natasha’s work in her acclaimed book: "Lost Marbles: Insights into My Life with Depression & Bipolar" on Amazon.
Connect with Natasha at the social media links below.
Shopping for someone with a mental illness can feel tricky—you want a gift that actually helps, not just more clutter. This guide walks you through 15 thoughtful, low-pressure mental health gifts that offer real comfort, reduce stress, and say, “I see you and I’m here,” during the holidays and all year.
I’m never going to call bipolar pain a “gift.” Most days, I just want it to stop. But emotional and even physical pain aren’t always random torture—they’re often trying to tell us something. This piece digs into what your pain might be saying, how to listen, and how that can make living with it just a little easier.
After 24 of 30 TMS sessions with no meaningful improvement, I wrote the guide I needed: why failed treatment hurts, how to get through the next 72 hours, and what to ask your clinician now.
Subscribe to my monthly newsletter to get the latest from Bipolar Burble, Breaking Bipolar, my vlogs at bpHope, my masterclasses, and other useful tidbits -- plus get a FREE eBook on coping skills.
You have a very sophisticated blog. It’s a pleasure to read it. Thank you for your post on the possible changes in DSM-V regarding mixed moods. I was keen to read it. Do you mind my asking if your background is in psychiatry/psychology or if you are a fellow bipolar sufferer? Many thanks. Sheila
Hi Sheila,
Thank-you.
Sure you can ask. I have little formal background in psychology, just some post-secondary classes in psychology and psychopharmacology. (I have a bachelor’s of computer science.) I simply have spent the last 10+ years researching the disorder so I’m a bit of an expert.
And yes, I am a bipolar sufferer too.
– Natasha Tracy