Lowering the Threshold for Bipolar: “More Harm Than Good”


Researchers publishing in the Journal of Clinical Psychiatry argue that broadening the diagnostic criteria for bipolar disorder would result in a greater increase in “false positives” than in “true” diagnoses, while there are no controlled studies demonstrating the efficacy of mood stabilizers in treating “subthreshold” bipolar disorder. They also assert that an increase in “false positive” diagnoses would go undetected because the absence of future manic/hypomanic episodes would “incorrectly be considered evidence of the efficacy of treatment, and the unnecessary medications that might cause medically significant side effects would not be discontinued.”

Abstract → 


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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Glad to read this, especially given that the agitation caused by SSRI’s routinely gets misdiagnosed as bi-polar “spectrum” opening the door for the add on of anti-seizure meds and anti-psychotics along with their side effects. Every time a new “diagnosis” and medication is added to a treatment plan, the possibility of ever being free of the debilitating effects of psych drugs is severely diminished. My heart goes out to those brave souls who try to manage multiple tapers in an effort to disentangle themselves from the med web. Many give up in despair and remain life long customers of the pharmaceutical industry. But I’m guessing that was the point.

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