The authors' primary objective is to outline the phenomenology,
importance, and available data on issues concerning the boundaries between
bipolar disorder and diagnoses such as schizophrenia, unipolar depression,
and personality disorders. In addition, by illuminating the many
difficulties with the boundaries of one of psychiatry's more robust
diagnoses, they hope to awaken in the reader a healthy skepticism about
current psychiatric nosology. For a topic of this scope, a literature
review must be selective. For each boundary area, a mixture of classic and
recent papers covering a range of validating criteria is included whenever
possible. Good summary data are cited when available, as are a selection of
relevant theoretical papers. The review indicates that current diagnostic
criteria for bipolar disorder are generally reasonable, but there are many
problem areas, most of which cannot be solved by changes in criteria.
Notable among these are 1) the possibility of future manic episodes in
unipolar disorder, 2) schizoaffective disorder, bipolar type, and 3)
borderline personality disorder with prominent mood swings. The disputes
concerning the boundaries of bipolar disorder illustrate the limitations of
categorical diagnosis which result from the implementation of diagnostic
criteria, the criteria themselves, the fundamental nosologic process, and
the phenomena themselves. If these limitations are to be extended, it may
be necessary to explore alternative ways of defining psychiatric diagnoses
for different settings in research and clinical practice.
Abstract Teaser