Brief History of the BPD Diagnosis
Written records of symptoms related to what is termed bipolar disorder in the 21st century have existed in medical texts since Ancient Greece and Medieval Persia. However, in 1952 the Diagnostic and Statistical Manual of Mental Disorders (DSM) coined the term “Manic-Depression,” to form a conception that serves as the modern origin of BPD today. In 1968, the diagnosis evolved to “Manic-Depressive Illness,” and in 1980, it was again changed to bipolar disorder. In the 2023 version (DSM-5), there are three diagnoses:
Bipolar I disorder: diagnosed after one manic episode
Bipolar II disorder: diagnosed after one depressive episode and one hypomanic episode
Cyclothymic disorder: diagnosed after shifting between hypomania and depressive symptoms more frequently, and with less intensity, than in bipolar I or II disorders
To better understand the differences, it helps to know how the DSM-5 defines episodes.
Manic episode: period of at least 1 week of extreme highs or irritability, in addition to other behavioral changes
Hypomanic episode: less severe mania that need last at least 4 days
Major depressive episode: period of at least 2 weeks with a set number of specific depression symptoms
For a full breakdown of the history and understanding, search for a copy of the DSM-5 online.
BP1 vs BP2: Breaking Down the Differences
The Mayo Clinic offers a great chart that summarizes the DSM-5 presentation of BPD1 and BPD2 well.
The BP Harmony Interpretation of BP1 and BP2
BP Harmony represents a collection of voices ranging from medical professionals, people who have received the diagnosis, and families who support loved ones who live with BPD. A few observations must be stated:
For the lay reader, texts on BP1 and BP2 can be misinterpreted. It is imperative to work with a licensed medical professional who is legally authorized to offer a diagnosis.
There are no quantitative measures to determine if one has BP1, BP2 or any diagnosis at all. Notice the chart above does not have any measurements from typical markers such as the blood, saliva, urine, fecal matter, tissues, bones, etc. Rather, a diagnosis depends on the training, experience, and biases of the medical professional who simply observes the behaviors and reports of the patient. Hence, it is advisable to get a variety of opinions.
Understanding the differences between BP1 and BP2 is useful to identify the stage of mental illness the individual is in and can help the individual craft a recovery plan with medical support, therapy, and mental health services like BP Harmony. However, the diagnoses are NOT the permanent station the person is stuck in forever. Individuals can receive a diagnosis of BP1 one year, BP2 another year, additional diagnoses another year, or even no mental health diagnoses in later years. In other words, one does not have to live with these labels forever.
Modern Psychiatry uses these distinctions to decide which medication and dosages to give the patient. One must take precautions in accepting a diagnosis as they nearly always come with highly addictive drugs that harbor strong side effects. Moreover, psychiatrists receive little to no training on how to get individuals off safely. More posts related to this challenge are coming soon.
In conclusion, The DSM-5 is an important resource for anyone trying to understand BPD; however, seeing that the diagnosis was coined only in 1980, there is much room to continue to evolve the understanding of BPD from medical professionals, wellness leaders, and the people who have intimately lived the acute phases of BP1 and BP2 and found their way out.
