[starshinelady]

Hi everyone,

As some of you may remember, last week my psychiatrist officially diagnosed as being on the Bipolar Spectrum. This week, she gave me my category: Bipolar Disorder, Not Otherwise Specified. I'm currently taking Lamictal and was prescribed Olanzapine for my manic episodes, and Diazepam for sleep.

I love my psychiatrist, especially because she treats my episodes as troubling as I find them. However, when I did some quick googling, most sites say that bipolar disorder not otherwise specified, is sub-threshold and not a cause for concern. Is this true? It doesn't feel mild to me and my psychiatrist isn't treating it as being less important. What are your thoughts?

[wildflowerchild25]

I think any form of bipolar would be troubling, else you wouldn’t seek treatment, would you? Try not to get too hung up on the label and deciding whether yours Is “better or worse” than others. If your pdoc treats you with respect and dignity, that’s a plus in my book. As long as she takes your concerns seriously I wouldn’t worry about a label.

Your psychiatrist is probably trying to figure out if you're type 1 or type 2, hence the "NOS" label. Lots of psychiatrists do this, so try not to worry about it.

[Blueberrybook]

I agree that your pdoc is pondering between types I and II right now. I recently got medical records from my old pdoc (retiring, saw her for 10 years), and on some of my visitation sheets, she would write bipolar I, II? so she was pondering in between until I had a super bad manic episode in her office & waiting room, at which point she definitively put her diagnosis as bipolar I on her visitation sheets.

Any type of bipolar is a lot to deal with in my opinion too, whether it is Type I, Type II, or Type NOS.

[Gabyunbound]

As has been said, I think this diagnosis can sometimes give pdocs the opportunity to decide, over time, which flavor of BP you have.

I was initially diagnosed NOS I think because the pdoc was going purely on the history I told him, but he had not actually witnessed an episode. Once he had, he diagnosed me as I.

I don't know how common that is (waiting to actually witness an episode) but that's how it worked for me.

I was also diagnosed Bipolar NOS before the doc was sure it was type I.

I agree with everyone above. My first dx was bipolar 2 because I never described any past manic episodes with the psychiatrist who originally dxd me. Only depression and anxiety. He dxd me bipolar 2 when he himself saw me hypomanic. I refused the Lamictal he wanted to prescribe and didn't return to him for about a year when the you know what hit the fan. In the hospital the first time, I had bipolar NOS. Then later hospitalizations I was so manic (some with psychosis), exhibiting every symptom in the book, that I became unequivocally bipolar 1. I've had many full blown manias since then.

You may never reach full blown mania. Or maybe you will. But I imagine your illness course will provide additional information about your "flavor" of the illness.

[starshinelady]

Thank you so much for your very helpful responses. For whatever reason, the information I read on Bipolar-NOS being sub-threshold alarmed me. I think I'm just looking for validation that my struggles really and truly are struggles. But your explanation that Bipolar-NOS can be sort of a precursor to official Bipolar I or II diagnosis makes sense. My psychiatrist did mention in our first appointment that she was still noodling over where to place me.

I did reach out to my psychiatrist because I was concerned. Here is her reply:

Good question, more when we sit together.
Briefly, the DSM diagnoses are limited in their foundations and utility. The origin was for record keeping and billing type purposes! So "NOS" becomes the catch all category for things that are clearly cyclical and biological in pattern but that do not meet the established criteria for the mail diagnosis. It does not imply anything about the distress or dysfunction associated with the diagnosis. Some diagnoses have "severity qualifiers" to better capture disruption.

Does this response reflect your personal understanding?

[*Laurie*]

Originally Posted by starshinelady

Thank you so much for your very helpful responses. For whatever reason, the information I read on Bipolar-NOS being sub-threshold alarmed me. I think I'm just looking for validation that my struggles really and truly are struggles. But your explanation that Bipolar-NOS can be sort of a precursor to official Bipolar I or II diagnosis makes sense. My psychiatrist did mention in our first appointment that she was still noodling over where to place me.

I did reach out to my psychiatrist because I was concerned. Here is her reply:

Good question, more when we sit together.
Briefly, the DSM diagnoses are limited in their foundations and utility. The origin was for record keeping and billing type purposes! So "NOS" becomes the catch all category for things that are clearly cyclical and biological in pattern but that do not meet the established criteria for the mail diagnosis. It does not imply anything about the distress or dysfunction associated with the diagnosis. Some diagnoses have "severity qualifiers" to better capture disruption.

Does this response reflect your personal understanding?

I don't understand what "mail diagnosis" means.

It sounds like she is exploring the "flavor" of your disorder. She is aware that you are in discomfort doe to the way you're feeling, but she's not yet clear on how severe the actual disorder is.

Be cautious. Be prepared. She might go with the BD NOS, then add another diagnosis on. That diagnosis could be anything - OCD, GAD, or (commonly) borderline personality disorder. I encourage you to keep questioning her.

[BipolaRNurse]

My first diagnosis was BP-NOS. It stayed that way for a couple of years until the psychiatrist I saw in the hospital diagnosed me with bipolar 1. I have received the same label three more times by three different mental healthcare professionals. It just took awhile to "flesh out" the picture of BP I presented with, as my mood patterns became more established with time. (I have a habit of becoming manic in the early spring and very early fall, and depressed in the late fall and winter.)

Try not to get too hung up on a number. It often takes years to figure out. I hated the NOS diagnosis because I felt it didn't take my symptoms seriously enough, even though I was on multiple psych meds and my pdoc definitely took them seriously. As he said the other day, bipolar is a complex disorder that requires complex treatment. Personally, I think NOS is the hardest to treat...we went through a number of meds in a number of combinations before landing on the right one, and even so, meds often have to be adjusted because symptoms return or change.

[starshinelady]

Originally Posted by *Laurie*

I don't understand what "mail diagnosis" means.

It sounds like she is exploring the "flavor" of your disorder. She is aware that you are in discomfort doe to the way you're feeling, but she's not yet clear on how severe the actual disorder is.

Be cautious. Be prepared. She might go with the BD NOS, then add another diagnosis on. That diagnosis could be anything - OCD, GAD, or (commonly) borderline personality disorder. I encourage you to keep questioning her.

Do you think an added diagnosis would replace Bipolar-NOS or would it be supplemental?

Try not to get too hung up on a number. It often takes years to figure out. I hated the NOS diagnosis because I felt it didn't take my symptoms seriously enough, even though I was on multiple psych meds and my pdoc definitely took them seriously. As he said the other day, bipolar is a complex disorder that requires complex treatment. Personally, I think NOS is the hardest to treat...we went through a number of meds in a number of combinations before landing on the right one, and even so, meds often have to be adjusted because symptoms return or change.

That's precisely why I've been having trouble. The Bipolar-NOS diagnosis feels exactly as you described. Like it doesn't take my symptoms seriously. I do rapid cycle, could that be why I'm given a Bipolar-NOS?

My psychiatrist also described my "manic" episodes as hypomanic. That would make me think Bipolar II, but I'm not a doctor.

[*Laurie*]

Originally Posted by starshinelady

Do you think an added diagnosis would replace Bipolar-NOS or would it be supplemental?

That's precisely why I've been having trouble. The Bipolar-NOS diagnosis feels exactly as you described. Like it doesn't take my symptoms seriously. I do rapid cycle, could that be why I'm given a Bipolar-NOS?

My psychiatrist also described my "manic" episodes as hypomanic. That would make me think Bipolar II, but I'm not a doctor.

In my experience as a patient and as someone who has worked with mentally ill teens and adults for many years an additional dx - if you are given one - would likely be in addition to your BP dx. That said, only your pdoc can decide upon your full diagnosis.

Bipolar 1 usually means that the person experiencing symptoms has much more hypomania and/or mania (or exclusively hypomania and/or mania) than they do depression. In addition, BD1 can manifest as some type of mania along with hallucinations, delusions, etc.

BD2 generally indicates that the patient experiences both hypomania and depression, either equally or (oftentimes) with more depression than manic symptoms.

BD NOS is not intended to, in any way, belittle the symptoms you are experiencing. Absolutely not. I know someone with severe symptoms that torment her; her dx is BD NOS (and Generalized Anxiety Disorder).

As has been pointed out in this thread it is very likely that your pdoc is giving it some time so she can give you a more specific and all-encompassing dx. Another example (and I am not at all suggesting that this is the case with you; it is only one example) would be the fine line between BD1 and Schizoaffective Disorder. They can sometimes look alike; therefore, it takes time for a pdoc to decide which dx is the prominent dx.

I strongly suggest that you share your concerns with your pdoc. Tell her that you are concerned that the dx of BD NOS doesn't acknowledge the extreme discomfort you are feeling from the symptoms you have. Hopefully, she will explain her plan to you, and her reasoning for diagnosing you the way she has.

Lastly, please try not to ruminate over the dx you have right now. They can change over time, and they can change - at least somewhat - with different pdocs...although more commonly (from what I've experienced), a diagnosis fluctuates over months/years. Ideally, your pdoc will work with you frequently enough, and over enough time (usually a few months) before s/he firmly decides on which dx best fits your symptoms.

[Unrigged64072835]

If you're rapid cycling, it may be harder to determine what type of bipolar you are. It's really up to the pdoc.

Regardless, you're getting treatment for your symptoms and that's what matters.

[~Christina]

When was the last time you had a physical with full blood work ?

Thyroid problems can often be a problem with mood too

Just wanted to add this to all the great advice given.

[all74]

I'm still "officially" diagnosed with BP-NOS. I used to feel like it was a consolation prize - "you're not that bad but you're definitely not normal! Here, have this lovely NOS as a parting gift!"

Over time, I've been able to come to some realizations. First, the DSM isn't definitive. It's the best we've got at this point, but it is far, far from perfect. And some stuff in it was essentially pulled out of a hat. There's no real medical reason that at least four days is the magic number to qualify something as a hypomanic episode. They just chose that by consensus. That's the first reason I was diagnosed with NOS; my euphoric hypomanic episodes typically only last two or three days.

The second realization is that diagnosis is a human process, and thus flawed. Questions don't get asked, stuff gets missed. That's the second reason I was diagnosed with NOS; my wife and I didn't think to tell the psychiatrist about all the times that I was angry and irritable and was so keyed up I felt like putting my head through a window. Those times would last for weeks, which is why I've now figured out I actually have BP2.

End point - your doctor believes you're in distress enough to give you a diagnosis. She's human, the process involves a lot of art, and the diagnostic system is imperfect. So focus instead on looking after yourself instead.

You have bipolar disorder. This is not an easy road, but if you can accept it and focus on your self-care you'll do well.