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What Should You Know About Other Specified And Unspecified Bipolar And Related Disorders?

by — Last updated: 2020-05-21 in Mental Health

It’s hard enough to live with a lifelong illness that will likely require ongoing treatment, but it’s even harder to live with the burdens of the least known subtype of bipolar disorder. What should everyone know?

Bipolar disorder affects about 2.8 percent of the American population, and it’s the sixth leading cause of disability in this country.

Many people, especially children and adolescents, experience bipolar-like symptoms that don’t fit to any of the three main categories:

This is why a fourth category – other specified and unspecified bipolar and related disorders — was introduced.

What are the defining symptoms of bipolar disorder?

Bipolar disorder is fairly hard to diagnose. People with bipolar disorder tend to consult at least three medical experts and spend about eight years looking for symptom relief before they get the right diagnosis. Although there is no specific pattern of symptoms that every individual with bipolar disorder goes through, there are two main mood episodes that repeat over the course of the illness — (hypo)mania and depression.

Mania or manic behavior usually starts with increased energy and creativity. People going through mania feel like they’re on top of the world. The hype is highly enjoyable and, without the proper treatment, the episode is soon blown out of proportion. A person going through manic behavior is unlikely to seek help because they don’t see these enjoyable moments as a problem, but the lack of self-awareness and control can lead to family disputes, job loss, and even huge financial problems. Besides euphoric behavior, you can recognize mania through the symptoms such as:

  • Decreased need for sleep
  • Talking too fast
  • Being easily distracted
  • Having a big ego
  • Reckless behavior without any concern about the consequences

Hypomania is similar to mania, only a lot milder. Hypomania rarely causes impairments in personal or social lives. People going through hypomania can have elevated mood and energy levels, but they're just exceptionally productive and this is why it’s not rare that people intentionally stop taking medication to feel this boost.

Depression comes with deep sadness, irritable behavior, sleep changes (from insomnia to sleeping too much), loss of appetite, and difficulties concentrating on everyday tasks. Together, the symptoms of depression lead to low self-esteem and even thoughts about suicide. In fact, the NAMI shares that one in five people with bipolar disorder are likely to complete suicide. According to data, men are likely to start with hypomanic or manic episodes, while females often start with depression.

So, what are 'other specified and unspecified bipolar disorders'?

This subcategory of bipolar disorder is also known as bipolar disorder not otherwise specified (BD-NOS) and it’s given when a person does not fall within the three other established categories of the disease. The diagnosis is usually not final; it’s often an indicator of a problem that has to be acknowledged but is likely to be better diagnosed in the future when more symptoms emerge and more information becomes available.

Other specified bipolar disorder

Patients who fall under this category experience various symptoms characteristic to bipolar disorder. Those symptoms cause impairments in their everyday lives, but they never meet the full criteria for any of the three main categories of bipolar disorder. According to the DSM-5, some different scenarios include:

  • Short-term hypomanic episodes with longer depressive periods. Someone goes through a long depressive episode, followed by short symptoms of hypomania that never last longer than two or three days.
  • Hypomanic-like episodes with insufficient number of hypomania symptoms but with major depression. A person goes through one or multiple episodes of hypomania, but the symptoms are "subthreshold" and they cannot be diagnosed with hypomania.
  • Hypomania without any prior sign of depression.
  • Cyclothymia that lasts less than two years. Someone goes through one or more episodes of hypomanic as well as depressive symptoms without a major hypomanic, manic, or a depressive episode, and no longer than two years (one for children and adolescents).

Unspecified bipolar disorder

This diagnosis exists for cases when a doctor chooses not to give a more specific diagnosis or it can’t be done due to a lack of information in a specific situation (such as when there’s no known medical history, or in emergency rooms).

How are other specified and unspecified bipolar disorder cases diagnosed and treated?

An informed diagnosis of this type of bipolar disorder involves ruling out other possible medical conditions. The doctor is likely to perform blood tests, drug tests, as well as other available diagnostic techniques such as neurological imaging to find possible injuries or malignancies that might cause symptoms that resemble those of bipolar disorder.

No specific guidelines are available when it comes to the treatment of other specified and unspecified bipolar disorders. A small study found no effect in treating this form of bipolar disorder with divalproex sodium. Some smaller studies have found that individuals can benefit from family-focused psychoeducation, especially when it comes to children and adolescents, and it is recommended as the best possible option. If psychosocial treatment is not available and a person is not able to perform everyday activities, the next best option is medication.

It’s important to note that without proper trials, no treatments can be recommended based on science.

Bipolar disorder is a lifelong condition that comes with increased risk of mortality that can be 20 times higher than that of the general population. Studies have concluded that a person diagnosed with bipolar disorder around the age of 25 loses about 14 years of effective functioning, so more research on how to better treat this chronic and disabling condition is sorely needed.

  • Photo courtesy of SteadyHealth

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