Diagnosing Bipolar Disorder Not Otherwise Specified

DSM Criteria for Bipolar Disorder NOS vs Bipolar I and II

Diagnosis of Bipolar
What is meant by the term bipolar disorder not otherwise specified (NOS)?. Getty Images - Science Photo Library - MOLEKUUL

What is meant by the term "bipolar disorder not otherwise specified," when is this used, and how is it treated? Does the diagnosis of "NOS" tend to change over time?

What is Bipolar Disorder Not Otherwise Specified (NOS)?

Bipolar disorder NOS is more of a catch-all category then an actual type of bipolar disorder. Your doctor may use this diagnosis to document that you have symptoms of bipolar disorder, but your symptoms do not meet the requirements for a diagnosis of bipolar 1 disorder, bipolar 2 disorder or cyclothymic disorder.

If you are diagnosed with bipolar disorder not otherwise specified, you are likely to be re-evaluated for one of the other types of bipolar disorder when you have another episode.

In general, the term NOS is most commonly used for those with a mood disorder characterized by depression alternating with short (only a few days) episodes of hypomania. It's important to note that despite characterizing this disorder as "NOS" it remains a serious condition which requires careful and diligent mental health treatment. Many of the people initially given this diagnosis will be given a definitive bipolar diagnosis in time.

What are the Criteria for Bipolar Disorder NOS?

There are no specific criteria for a doctor to use when she considers diagnosing you with bipolar disorder not otherwise specified (NOS).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) gives a few examples for when this diagnosis may be indicated.

These include when:

  1. You are having symptoms of a manic episode or a depressive episode but the episodes are too short to qualify as an actual episode. In bipolar disorder NOS there is often a rapid change between these two types of episodes, usually occurring within days of each other.
  2. You’ve had many episodes of hypomania, but you’ve not had a depressive episode.
  1. You are having a manic or mixed episode but you were previously diagnosed with a psychotic disorder or schizophrenia.
  2. You’ve had symptoms of hypomania and depression, but they don’t last long enough to qualify as cyclothymic disorder.
  3. If it looks like you have bipolar disorder but your doctor thinks your symptoms might be caused by drugs, alcohol or a general medical condition (see physical symptoms of bipolar disorder).

As noted above, these criteria have been established through the DSM published by the American Psychiatric Association. It is the primary system used to classify and diagnose all mental disorders.

Classification of Bipolar Disorder

As per this formal classification system, bipolar disorder is a clinical disorder within the category of mood disorders. The manual recognizes four types of bipolar disorder. Each specific type of bipolar disorder is distinguished by the others through the nature of episodes experienced. As noted above, many people who are initially given the diagnosis of bipolar disorder NOS will later be given a more specific diagnosis.

The following articles list the criteria for the three remaining types of bipolar disorder:

Treatment

The treatment of Bipolar Disorder NOS does not have a well established treatment plan as with other types of bipolar disorder, but usually includes a combination of mood stabilizing drugs, antipsychotic medications, and psychotherapy.

An exception may occur if it's felt that bipolar disorder symptoms may be due to an easily correctable cause such as a medical condition or substance abuse. In this case providers may hold off on prescribing treatment until a diagnosis is more certain.

Follow-Up Coping with Bipolar Disorder NOS

The diagnosis of bipolar disorder NOS can be frustrating given its wide variety of symptoms. This diagnosis is more common in children and adolescents who haven't lived long enough to make an accurate diagnosis as of yet. In fact, it's been postulated that many of the younger people with this diagnosis are on the spectrum of bipolar I disorder. It is frustrating to patients and clinicians alike since the treatment options and prognosis depend on an accurate diagnosis. With research looking at the neuropsychological basis of the disorder it''s hoped a clearer understanding of this unclear type of bipolar disorder will occur in time.

Sources:

Joyce, P., Light, K., Rowe, S., and M. Kennedy. Bipolar Disorder not Otherwise Specified: Comparison with Bipolar Disorder I/II and Major Depression. Australia and New Zealand Journal of Psychiatry. 2007. 41(10):843-849.

Towbin, K., Axelson, D., Leibenluft, E., and B. Birmaher. Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation. Journal of the Academy of Child and Adolescent Psychiatry. 2013. 52(5):466-481.

Continue Reading