Beyond Mania and Depression: The Bipolar Spectrum

Beyond Mania and Depression: The Bipolar Spectrum

When we go to a doctor, we expect a diagnosis. We expect expertise. We expect them to recognize our symptoms and diagnose us accurately. We expect proper treatment based on the diagnosis we receive. What we do not expect, is an incomplete diagnosis. When it comes to mental illness, going to the doctor for help can be difficult. To go through the whole process of accepting that you need help, and then reaching out, is extremely difficult. When the doctor’s appointment that was supposed to provide relief to the endless questions you have about yourself ends with an inconclusive diagnosis, it can be extremely confusing, and discouraging.


For people diagnosed with bipolar disorder–not otherwise specified (BP–NOS), the feelings of uncertainty and confusion can be significant. Bipolar disorder itself exists on a complex spectrum. Bipolar disorder is generally described as “periodic changes in mood, alternating between periods of elevated mood (mania or hypomania) and periods of depression” (Cagliostro, 2019). This disorder has many different symptoms ranging from near-total mania to depression with infrequent episodes of hypomania. The current definition of BP–NOS is quite broad, including any disorders that have “bipolar features.” The criteria for BP-NOS includes distinct periods of abnormally elevated or irritable mood that lasts a significant part of the day or more, at least two manic symptoms associated with bipolar disorder, and a change in functioning. Oftentimes, BP-NOS is described as having the same symptoms as bipolar disorder, just not as severe. Hearingthis can be disheartening, especially when the symptoms can be debilitating for the person experiencing them. 


The symptoms and treatments of bipolar disorder, and specifically BP-NOS, can be completely different from person to person. One person with BP-NOS can be experiencing the exact opposite of what someone else diagnosed with the same disorder is experiencing. Because of this, it is hard to come up with a uniform criteria to diagnose it. Without the proper diagnosis, people cannot begin to receive the proper treatment. As a result, many people who have BP-NOS are not diagnosed and do not receive proper treatment. Currently around 4% of the population is diagnosed with some form of bipolar disorder. It is estimated that an additional 2% of the population could be suffering from bipolar disorder undiagnosed (Bader and Dunner, 2007). Up to 155 million people could have a form of bipolar disorder and not even know it, bringing the total number of people with bipolar disorder to an estimated 450 million (Bader and Dunner, 2007). 


Bipolar I and II are described as “the main types of bipolar disorder,” when in reality, they are the more extreme cases, while the spectrum is much larger. By including people with BP-NOS in the statistics as part of the number of people struggling with this disorder, more attention and awareness can be brought to this issue. Although this disorder impacts so many people, there is still a stigma surrounding bipolar disorder and a general lack of knowledge about it. Despite the variety of symptoms people with this disorder experience, there is still only four official types of bipolar disorder and corresponding treatment plans. There is not much known about the bipolar spectrum, even by the medical community and mental health professionals. 


Oftentimes when people struggling with BP-NOS receive a diagnosis, it is not for bipolar disorder at all, but for depression (Ozcan, Sheikh, and Suppes, 2003). This is because many people fail to report or don’t experience manic or hypomanic symptoms right away. Getting the wrong diagnosis can be dangerous and have strong negative effects on the person because treatment for depression is different from the treatment for bipolar disorder. Bipolar disorder is serious, and often requires serious treatment. Recent studies have shown 17% of people diagnosed with BP-NOS have attempted suicide (Bader and Dunner, 2007). Although it is commonly regarded as less severe than other forms of mental illness, BP-NOS can be devastating for an individual. 


Many of those diagnosed with BP-NOS, are children. The diagnosis is often given to children just beginning to show symptoms of bipolar disorder. A third of children between the ages of eight and twelve with BP-NOS are later diagnosed with bipolar I or II (Martinez and Fristad, 2012). With the consideration of family history, the diagnosis and proper treatment for bipolar disorder tends to come earlier (Bader and Dunner, 2007). The family’s medical history often confirms the diagnosis of BP-NOS as opposed to depression (Martinez and Fristad, 2012). In the case of BP-NOS in children, the earlier the diagnosis, the better. With an earlier diagnosis, treatment can be implemented earlier and ise more effective. Learning to cope with the symptoms of mental illness and establishing a routine and treatment plan earlier, can change the course of a person’s life. 


For Sabrina, a 34 year old living with BP-NOS, receiving treatment helps to establish her version of “normal” and “have a better handle on her emotions.” Prior to taking effective medication, she experienced unpredictable moods and felt as though she had access to every possible emotion. Although she still experiences many of the struggles of having BP-NOS, she is doing better due to medication. She often feels alone in her struggle with bipolar disorder, and doesn’t have many friends or family. Sabrina is an example of how bipolar disorder can manifest itself in many different ways depending on the individual and how the proper treatment can help alleviate some of the symptoms associated with the disorder. 


Each and every kind of bipolar disorder is impactful and deserves appropriate awareness. The effects of bipolar disorder stem beyond just mania and depression, but truly impact each individual differently. Sabrina is an example of why we need to listen to the individuals struggling with all forms of bipolar disorder, as they all need the proper attention. Sabrina says she wants “‘people to know that bipolar isn’t as ‘big’ as it appears on TV. Manic episodes don’t necessarily mean hopping around the house or harassing people or going ‘crazy.’ And depression associated with bipolar doesn’t necessarily manifest as sadness. For many people, myself included, it’s an unrelenting and insidious apathy.’” (Miller, 2017). 



Bader, C. D., & Dunner, D. L. (2007). Bipolar disorder not otherwise specified in relation to the bipolar spectrum. Bipolar Disorders, 9(8), 860–867. Retrieved from

Cagliostro, D. (2019) Bipolar Disorder. Retrieved from

Gregory, C. (2019) Bipolar Spectrum Disorder. Retrieved from

Martinez, M., & Fristad, M.A. (2012) Conversion from bipolar disorder not otherwise specified (BP-NOS) to bipolar I or II in youth with family history as a predictor of conversion. Journal of Affective Disorders, Volume 148, Issue 2, Pages 431-434. Retrieved from

Miller, T. (2017) This is What It’s Actually Like to Live With Bipolar Disorder. Retrieved from

Towbin, K., Axelson D., Leibenluft E., & Birmaher B. (2014) Differentiating Bipolar Disorder-Not Otherwise Specified and Severe Mood Disregulation. Journal of The American Academy of Child and Adolescent Psychiatry, Volume 52 Issue 5. 466-48. Retrieved from

Ozcan, M. E., Shiekh, M., & Suppes, T. (2003). How rare is bipolar disorder not otherwise specified? Bipolar Disorders, 5(3), 226–227. Retrieved from

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