Introduction

There are two general functions of the diagnostic criteria of a mental or psychiatric disorder which are: the clinical differentiation of the disorder from disorders having clinical presentations; and the differentiation of the disorder from normal non-disordered features. A standard guide and language available for researchers, clinicians as well as public health officials is available for characterizing mental health disorders – known as The Diagnostic and Statistical Manual of Mental Disorders (DSM) – whose 5^th edition, the most recent revision (DSM-5), was published in May 2013 (“Chapter 8 – Presumptive and Confirmatory Blood Testing,” 2017; First & Wakefield, 2013). According to the DSM-5’s designation, a mental or psychiatric disorder is defined as a syndrome which leads to a significant clinical disturbance in the cognition, behavior and emotional regulation thereby resulting and consequently being reflected by a dysfunction of the mental functioning (Black & Grant, 2014).

Bipolar disorder – alias manic depression or manic depressive mental disorder – is typically characterized and known by the unusual episodes of mood shifts, activity and energy levels, disturbances in concentration levels and a failure to carry out daily tasks. Other symptoms include an increased grandiosity, sleeplessness, inflated talkativeness, easy distraction and vying thoughts. The diagnosis of a bipolar illness usually begins with a thorough physical examination of an individual by the respective mental health physician so as to rule out the possibility that there is a physical illness behind it. Then, a comprehensive mental health evaluation is done to assess the symptoms in accordance with DSM-5 (Angst, 2013; NIH – National Institute of Mental Health; PSYCOM; Tandon, 2015).

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Controversial diagnosis of bipolar disorder

In contemporary psychiatry, the bipolar disorder as well as its diagnosis stands in the hub of one of the most complex mental disorders. Despite being a disabling brain illness, it is often misdiagnosed based on the initial demonstration of its symptoms, which thus leads to various controversies about its proper diagnosis.

Bipolar spectrum case

The case being described here is taken from a study on the diagnosis of a 25-year old woman who is also a university graduate. The main complaints presented by this patient were: inability of express herself and incapacity to interact socially with others. She has also told about the psychiatric treatment being received from the past 5 years. Moreover, despite receiving medications i.e., lamotrigine and moclobemide from the last 1.5 years, the symptoms of volition lack, worthlessness thoughts, depression and anorexia still persisted. Additionally, the other behavioral symptoms included tense feeling and irritability for no apparent reason, lack of concentration, moving around restlessly, avoiding going home, and walking during the midnight despite objections from the family. During this, the patient also told about the elevated self-confidence, sociable behavior with strangers, talkativeness, irritability, tenseness, aggressiveness, and a burst into laughter sometimes, described as being quite unfamiliar and strange for her (Koçbiyik et al., 2016).

The patient further reported that the first appearance of her symptoms occurred during her early childhood after she began wearing glasses. During that time, the symptoms were mainly oriented around a fearful feeling of being disgraced, unhappiness even if something good is happened. Later on, when she joined college, these symptoms became more pronounced with increasing limits in being socially active, lack of motivation and energy as well as felling of worthlessness. It was during this period that she had gone for a psychiatric treatment and started having prescribed drugs (Koçbiyik et al., 2016).

Diagnosis and its controversies

The diagnosis of patient came out to be unspecified bipolar disorder of mood in accordance with DSM-5 criteria. The main reason for giving this diagnosis was based on the observation of the following: onset of symptoms during adolescence; episodes of depression; chronic symptoms; hypomanic symptoms as well as psychomotor agitation. However, these criteria are not completely in line with the DSM-5 criteria for bipolar disorder causes. Moreover, the diagnosis also pointed out the presence of social anxiety disorder due to the presence and prevalence of anxiety experience by the patient during the social gatherings as well as avoidance of similar situations and people around her (Magill, 2004; Okasha et al., 1996; Swann et al., 2003).

The presence of personality disorder has been suggested by the presence of the mood swings, declines in self-worth, low adherence of prescribed treatments accompanied with higher frequency of changing the therapists, and not being able to develop trust in people. However, again, despite so many symptoms referring to the presence of a personality disorder, the specific criteria for a particular personality disorder was not met. Moreover, there was also an evaluation of the dysthymia but due social phobia and hypomanic episodes. Therefore, the diagnosis of bipolar spectrum deemed most clinically appropriate under the current situation (Ruggero et al., 2010; Swann et al., 2000).

 

Experiences of mental health consumers

The psychosocial and lifestyle influences on the mental health are one of the highest primacy areas. Another group of researcher found via a qualitative experiment that there are two major challenges, that have been derived from the experiences of the consumers of the bipolar disorder treatments. Some of these, along with the respective reasons of the consumers are discussed in the paragraphs that follow (Banfield et al., 2014).

The dilemma of finding the right treatment

The first of the challenges is getting the appropriate treatment. According to the qualitative experiences of the mental health consumers, it was found to be difficult of the patients to find the right medicine in accordance with a dosage that is both effective with side effects that could be acceptable. According to a participant the confusion remained in the choice of being either depressed or being overweight if medication is taken (Maassen et al., 2018).

The thought of indefinite medication use

Other times, the consumers of mental health illnesses have reportedly identified of the struggles felt in case of the indefinite medication use accompanied with the medical checks associated with it. This also leads to the need for more research about the long term side effects of medications, their off target effects, their mechanism of actions and ultimately the better development of the targeted drugs. This is because patients often prefer to have a thorough knowledge – in terms of adverse and side effects – as it helps them comply better to the therapies then (Chakrabarti, 2016; Gaudiano et al., 2008).

Difficulty in finding non-pharmacological therapies

Another challenging aspect of mental health consumers came out to be finding appropriate non-pharmacological therapies which fit the patient’s need. It was also mentioned that most of the caregivers could not suggest the non-pharmacological therapies apparently due to the lack of knowledge about them in health care professionals. Then, the mental health consumers had to do this effort for themselves. Moreover, the non-pharmacological therapies found most useful by the patients included cognitive behavior therapy (CBT), social-rhythm training, light and running therapy, psychoeducation and mindfulness, various psychotherapies and trainings of mood swings. Additionally, they also indicated the need for more research in these areas too (Delmonte et al., 2013; Mirabel-Sarron & Giachetti, 2012; Phelps, 2016).

Conclusion

The disturbances of the behavior and mood swings of an individual hold serious consequences for the individual but also poses terrible disturbances for the family too. The situation can be further exacerbated in case of controversial diagnoses of the underlying mental health as the treatment with a definitive therapy becomes vague then with escorting perplexity posed by the complicated situation. Also, it can be understood that despite the difficulty in achieving greater clarity in diagnoses in such situations, it is better to have an ill-fitting diagnosis than no diagnosis at all. Moreover, some DSM diagnoses are also more helpful in getting patient’s the care services they are in dire need of.

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