Commentary by Gabrielle Carlson, MD, About Definition of Bipolar Disorder Published in World Psychiatry

In a commentary published in the October edition of World Psychiatry, Gabrielle Carlson, MD, Director of Child and Adolescent Psychiatry at Stony Brook University, describes some of the factors that have broadened the definition of bipolar disorder and created new difficulties for researchers and clinicians.

Commenting on an article on the benefits and risks of broadening the diagnosis of bipolar disorder by Stephen Strakowski et al., Dr. Carlson notes that changes made in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have broadened the definition of bipolar disorder either by design or by accident. She cites as examples changes that relaxed the definition of an episode of mania (by not specifying its duration or relationship to the individual’s usual mood and behavior) and uncertainties about whether irritability in children should be classed as a symptom of depression or mania.

Changes in DSM criteria and in the way children and adults are assessed for mood disorders, she argues, often make it impossible for readers of scientific articles to know if the researchers used narrow or broad criteria in their diagnoses. She agrees with Strakowski that the issue of whether the definition of bipolar disorder should be broadened is an important research question, but laments the fact that “there is no way to resolve the question because of how we collect and how we report the data.”