Bipolar disorder: a troubled diagnosis

Bipolar disorder is indeed a troubled diagnosis. Conceived from manic-depressive illness, bipolar disorder is a much narrower concept by virtue of the emphasis placed in modern psychiatric taxonomy on polarity rather than recurrence of mood episodes. At first, this "new diagnosis" floundered and received little attention, but once it established itself, it steadily gained interest throughout the "decade of the brain." By the beginning of the new millennium bipolar disorder was perfectly poised for a phenomenal expansion. Its rapid growth led to a proliferation of bipolar subtypes, each of which quickly gained disorder status, wrongly insinuating a disease entity. Prompted by the recent launch of DSM-5 and the imminent arrival of ICD-11, questions are being asked about this complex diagnosis, which has been so problematic, especially in children. This chapter discusses the evolution of bipolar disorder, in the hope that an understanding of its origins will shed light on why it remains such a troublesome diagnosis.