2013 and … Pediatric Bipolar Disorder

The biggest news in 2013 on Pediatric Bipolar Disorder (PBD) centered on a new diagnosis in the DSM-5 – Disruptive Mood Dysregulation Disorder (DMDD) – introduced in part to prevent the overdiagnosis of bipolar disorder in youth. The idea was to provide a separate diagnostic category for kids who have explosive emotional outbursts and severe disruptive behavior without other signals of PBD.

This situation represents another lightning rod in the debates on how we diagnosis psychiatric disorders in youth. Some applaud the attempt to reduce misdiagnosis of PBD. Some argue that while this is a good thing, it’s a bad thing to introduce yet another diagnosis that can lead to medicating kids who may not “have” a disorder.

The fact is that research has validated the use of a PBD diagnosis in youth via clinical and longitudinal studies – but it is very difficult to diagnose at any one moment in time in youth. There is no substitute for evaluation performed by a team that includes substantial experience in assessing PBD – I have personally seen clinicians with little experience with PBD applying the diagnosis inappropriately. What is disconcerting is that the DMDD category was introduced in DSM-5 without the typical platform of studies examining the reliability and (especially) predictive validity of the diagnosis.

Let’s anticipate that the discussions about PBD and DMDD will spur intensive studies focused on differential diagnosis and clinical utility of each diagnostic category.

Question Mark in Brain via Shutterstock.com

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