Is there such a thing as a “bipolar spectrum”? I am undecided on this question and welcome any new perspective. Joel Paris, a personality disorder expert, had written a book on the topic in 2012 and tried to make the case that much of what falls in the “bipolar spectrum” is really a problem with “emotional dysregulation”( borderline personality disorder). He also tries to make the case that Bipolar I,Bipolar II and melancholic depression are diseases despite the lack of any physical tests or genetic evidence.
Its crucial to remember that that the bipolar spectrum is an unproven concept. The alchemy that turns depression, impulsive disorders, childhood behavioral disorders, and personality disorders into bipolarity depends on entirely superficial resemblances between observable behavioral symptom patterns. Its not based on any basic understanding of the disease process.
For the most part the book was a logical and interesting critique of the “bipolar spectrum” concept however I had the feeling that, given the fact that Paris was a personality disorder expert, he might be jealous of all the money that goes to fund bipolar spectrum research and would like to divert some of those resources.
I have been diagnosed with Dysthymia and Psychotic depression and might, according to this book, be labeled with Borderline disorder. To label everyone with mood instability as Borderline or another personality disorder seems just as unreasonable as labeling everyone as bipolar given the fact that personality disorders aren’t defined much better than Bipolar disorder. In my case the instability could be explained by PMS and an extreme diurnal mood variation. According to Paris my personality disorder should have abated by middle age however I don’t think my condition has improved much since it began.
Finally, affective instability has a different outcome from bipolar disorder. It gets better with time, but never completely disappears. It remains the chief complaint of patients with personality disorders who are followed into middle age.
Patients with unstable mood experience daily life differently than bipolar patients according to Paris.
They describe their life as on an “emotional roller coaster.” they wake up feeling normal but get rapidly upset by each and every life event . In the course of the day, they feel sad and hopeless, angry to the point of uncontrollable rage, or happy enough to briefly feel slightly “high”. Each mood lasts for a few hours. These emotional reactions are intense, and can take some time to “come down” from them.
He seems to believe that the only true diseases in the DSM are melancholic depression(severe depression) and Bipolar I/II. One could still argue that the previously mentioned categories are still quite arbitrary and vague in comparison to many other diseases. Further more the definition of severe depression varies between different researchers and “severe” depressives only fared slightly better on antidepressants according to some experts(Moncrieff) who have written critiques of antidepressant research.