psychiatrists who agree with me.
Dr Phillip B Mitchel who is the head of the department of Psychiatry at the University of South Wales in Sidney Australia voiced his concern about the changes in the criteria. In his article he says, “The increasing rates of diagnosis have largely related to BD II (Bipolar Disorder 2), for which there has been a dramatic broadening of the criteria.”
Dr Mitchel goes on to say that this change really matters because it will result in over-treatment with medications that have significant side effects. He also believed that the process of making the diagnosis would be oversimplified and“de-skilled” with a loss of credibility for psychiatry. And, finally, Mitchel feared that “etiologic research” for bipolar
disorder would suffer. In the field of medicine, when we find what we think is the cause of a “disease,” the result will be a decrease in research in that area. This is devastating if the discovered “cause” is not correct because it stops research.
I believe that Mitchel is correct on all the points he makes. We are over-diagnosing bipolar disorder in the Bipolar 2
category because the criteria have been reduced to the point that it is easier to qualify. This same process has affected the way we make the diagnosis of depression. In 1980, the criteria for making the diagnosis of depression were changed removing cause as a one of the important markers of the disorder. Until then, an individual was considered to have a disease called depression only if there was no obvious cause. If the struggler could identify a loss in their life that made them sad or sorrowful, then they would be considered normally sad. Depression was disordered sadness that had no cause.
The treatment of people labeled as depressed who had simple normal sadness led to another unintended consequence. People struggling with normal sadness were then treated with medication that had side effects. Those side effects could be interpreted as hypomania which is a necessary criterion for the diagnosis of bipolar disorder 2.
The combination of the changes in criteria for depression, and the relaxation of the criteria for bipolar disorder is the
source for the explosion of the diagnosis of bipolar disorder. In Good Mood Bad Mood, I have said that the best way to help reduce this epidemic is to help people deal with sadness over loss before they get to a disease diagnosis.
Paul spoke of the role of normal sadness in our lives and noted that it was a good thing. “For the sorrow that is according to the will of God produces a repentance without regret, leading to salvation, but the sorrow of the world produces death.” (2Co 7:10 NASB) You can find more information on how sadness relates to the current diagnosis of
depression and how the Bible can help in the book “Good Mood Bad Mood.”
As I always say when I write about medical subjects, no one should change the medication they are taking or change the dosage without first consulting their physician.
The parenthesis is my addition to explain author’s BDII
Can J Psychiatry, 2012 Nov, 57(11):659-65