Diagnosis? Rulebooks or a "Spectrum" Approach

last updated 11/11/24

The DSM (Diagnostic and Statistical Manual) is the rulebook for psych’ diagnosis. “Rulebook”? Yes. The criteria for each diagnosis are agreed upon by a committee of the American Psychiatric Association. The ICD (International Classification of Diseases) is similar.

These rulebooks allow only two options: you either have the diagnosis or you don’t. No “almost”, no “sort of”. But psychiatry is finally recognizing that mental illnesses are not yes-or-no; they occur on a spectrum from zero to extreme symptoms.

(This used to be controversial. Not anymore. Skeptics, note the title of Figure 3 from recent international treatment guidelines is “The spectrum of mood disorders”).

The DSM has names for parts of the mood spectrum. But there are people all the way along this rainbow. Indeed, there are more people in the middle than there are at the fully “bipolar” end.

People in the middle don’t have “manic-depressive illness”. But they don’t have plain depression either. They have “mood swings without mania”, or “Mixed States. ” (The yellow-orange part of the spectrum, where up-mood symptoms don’t reach fully manic, also has a DSM name: “Bipolar II“, with symptoms of “hypomania“.)

Mixed states –the combination of depression with agitation, anger, anxiety, attention problems and/or other manic symptoms — are also easier to understand as a spectrum, rather than a yes-or-no approach. For more on that, see the Mixed States page.

Links

References
Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry. 2015 Dec;49(12):1087-206.