What Are Specifiers?

Understanding Bipolar Disorder Diagnosis Specifiers

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Specifiers are extensions to a diagnosis that further clarify the course, severity or special features of a disorder or illness.

Specifiers for Mood Disorders

The Diagnostic & Statistical Manual of Mental Disorders (DSM-5) uses specifiers extensively in the diagnosis of mood disorders. Any number of applicable specifiers can be used for the same episode.

For bipolar disorder, there are two categories of specifiers: Those for defining the current or most recent mood episode and those concerning the course of recurrent, or repeating, mood episodes.

The first category, defining current or recent episodes, includes mixed features, anxious distress, melancholic features, atypical features, psychotic features and catatonic features.

The second category, defining recurrent episodes, includes rapid cycling, peripartum onset and seasonal pattern.

Mixed Features Specifier

Bipolar disorder with mixed features means that you have both manic/hypomanic symptoms and depressive symptoms in the same mood episode, rather than one or the other. To be diagnosed with this specifier, your mood episodes, whether defined as manic, hypomanic or depressive, must meet all the criteria for that particular episode AND have at least three symptoms that belong to the opposite type.

So, for instance, if you have a mood episode that meets all the criteria for a manic/hypomanic episode, yet also has at least three symptoms of a depressive episode, this specifier would fit you.

 

Anxious Distress Specifier

Bipolar disorder with anxious distress is specified if your mood episode includes at least two symptoms of anxiety. These symptoms can be restlessness, lack of concentration, worry, feeling tense and fear of losing control.

Melancholic Features Specifier

Bipolar with melancholic features usually happens if you have severe depressive symptoms.

It's defined as severe depression that includes symptoms like feeling significantly worse in the morning, weight loss and/or not wanting to eat, losing pleasure in activities you used to enjoy, waking up early and excessive guilt.  

Atypical Features Specifier

Bipolar disorder with atypical features means that you have the atypical symptoms of sleeping too much, increased appetite, feeling like your arms and legs are heavy, being overly sensitive to rejection and the ability to feel at least somewhat better when you experience something positive.

Psychotic Features Specifier

Bipolar disorder with psychotic features can include mood-congruent or mood-incongruent features. Psychotic features involve hallucinations and/or delusions.

Catatonic Features Specifier

Bipolar with catatonic features is diagnosed if you experience catatonia along with your mood episodes. Catatonia symptoms can include not responding to anything, not being able and/or willing to talk, rigid muscles, repeating what someone just said, grimacing, moving around with no purpose and resisting movement.

Rapid Cycling Specifier

The rapid cycling specifier means that your mood episodes have occurred a minimum of four times in the past year. In between mood episodes, you must have had a stable mood or switched completely to the opposite kind of mood episodes, i.e., from hypomanic to depressive.

Seasonal Pattern Specifier

The seasonal pattern specifier is indicated if your mood episodes only occur at certain times of the year, usually fall and/or winter. This can happen because of light depravation.

Peripartum Onset Specifier

Peripartum onset can be diagnosed if your mood episode, usually depressive, occurs during your pregnancy or up to four weeks after you give birth. These episodes can be accompanied by anxiety or panic attacks. 

Sources:

Janicak, P.G. and Esposito, J. "An Update on the Diagnosis and Treatment of Bipolar Disorder." Table 1: Bipolar Specifiers. Psychiatric Times, November 20, 2015.

Cutler, J.L. Psychiatry: Third Edition. Oxford University Press, New York, NY, 2014.

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