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Am J Psychiatry 1992; 149:1473-1483
Copyright © 1992 by American Psychiatric Association
Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry
D Blacker and MT Tsuang
Program in Psychiatric Epidemiology, Harvard School of Public Health, Boston, MA.
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.
This article has been cited by other articles:
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