Bipolar Disorder In The Dsm
In the previous version of the DSM , bipolar disorder was categorized in the section that included depressive disorders, substance-induced mood disorders, and mood disorders due to a general medical condition. The most recent version of the DSM, the DSM-5, now places bipolar and related disorders in their own disorder class. This category includes bipolar I, bipolar II, and cyclothymic disorder.
A number of additional specifiers also exist:
- Bipolar disorder with mixed features
- Bipolar disorder with anxious distress
- Bipolar disorder with melancholic features
- Bipolar disorder with atypical features
- Bipolar disorder with psychotic features
- Bipolar disorder with catatonic features
Specifiers are diagnostic extensions that help clarify the course, features, or severity of the condition.
Are There Different Types Of Bipolar Disorder
There are a few types of bipolar disorder, including:
Bipolar I disorder: With this type, you have extreme erratic behavior, with manic âupâ periods that last at least a week or are so severe that you need medical care. There are also usually extreme âdownâ periods that last at least 2 weeks.
Bipolar II disorder: With this type, you also have erratic highs and lows, but it isnât as extreme as bipolar I.
Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms arenât as intense as bipolar disorder I or bipolar disorder II.
“Unspecified” or “other specified” bipolar disorder is now used to describe conditions in which a person has only a few of the mood and energy symptoms that define a manic or hypomanic episode, or the symptoms may not last long enough to be considered as clear-cut “episodes.”
Rapid cycling is not a type of bipolar disorder, but a term used to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.
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Diagnosis For Bipolar Disorder
Bipolar disorder is diagnosed by a physician or mental health professional. Symptoms of bipolar disorder are cyclical with an irregular pattern of depressive and manic episodes over time because of this, it sometimes takes time to come to the correct diagnosis. In addition, the symptoms of this disorder can mimic other disorders , so its important to seek medical attention in order to rule out other medical conditions.
Bipolar disorder can also masquerade as a problem other than mental illness , and in its milder forms it can go unrecognized by family, friends and even health professionals. Once other medical disorders are ruled out, typically a mental health professional will be consulted for specialized assessment and to provide appropriate ongoing care.
Diagnosis is through face-to-face evaluation by a psychiatrist or other allied health care professional with specialized expertise in mood disorders, often using clinical tools such as the Diagnostic and Statistical Manual of Mental Disorders . There is no simple diagnostic test available at this time – for example a brain scan or blood test that specifically identifies bipolar disorder.
Qualifying For Disability Benefits Based On The Bipolar Disorder Listing
To qualify under the SSA’s official listing for bipolar disorder, you must have a diagnosis of bipolar disorder I or II and a history of specific, severe symptoms causing a decrease in your abilities. This listing was updated signficantly in January 2017. Now, you must have at least three of the following symptoms:
- unnaturally fast, frenzied speech
- quickly changing ideas and thought patterns
- inflated self-esteem
- distractibility
- involvement in risky activities with painful consequences that are not recognized, and/or
- increase in physical agitation or in in goal-directed activity .
You must also meet “functional” criteria to show that you have a loss of abilities due to these symptoms. Generally, you must have an extreme limitation in at least one of the following areas, or a “marked” limitation in at least two of the following areas:
- understanding, remembering, or using information
- interacting with others
- concentrating and maintaining pace in performing tasks , and/or
- adapting or managing oneself .
Note that “marked” is seriously limiting it is worse than moderate. Extreme is less severe than a complete loss of an ability, but worse than marked. Marked and extreme are matters of professional judgment used by a SSA psychiatrist or psychologist when reviewing the medical evidence.
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Can My Therapist Put Me On Disability
First and foremost, you must have a solid diagnosis from a qualified psychiatric professional before you can qualify for Social Security Disability payments. You cannot just tell the SSA that you have bipolar disorder. You must have clinical evidence that you actually suffer from the condition. ,
The Ada And Psychiatric Disability In The Workplace
- Definitions. The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities. When job applicants or employees have a mental health condition that meets this criteria, they have workplace rights under the ADA. The ADA Amendments Act of 2008 recently broadened the definition of disability to provide legal protections against employment discrimination for more individuals with disabilities, including people with psychiatric disabilities.
- Record of psychiatric disability. The ADA also prohibits discrimination against individuals who have a record of a psychiatric disability or are regarded as having a psychiatric disability. This means, for example, that qualified individuals who have a history of psychiatric disability cannot be discriminated against just because of that history. Also, employers cant take actions because they believe a qualified applicant or employee might have a psychiatric disability.
- Rights under the ADA. Applicants and employees with psychiatric disabilities have two main rights under the ADA. First, they have a right to privacy. Except when asking for an accommodation, they can choose whether to tell the employer about their disability. Second, they have a right to a job accommodation unless this causes undue hardship for the employer.
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Psychiatric Disability Or Mental Illness
The words psychiatric disability and mental illness are often used interchangeably. The term mental illness is typically used in a medical context to refer to a wide range of conditions related to emotional and mental health. The term psychiatric disability is typically used in a legal or policy context to refer to impairments covered under the ADA
Consideration Of Your Residual Functional Capacity
If the SSA says you don’t meet the disability listing, the SSA will consider what you can do. It does this by writing up your mental residual functional capacity . An MRFC is a description of what tasks you can do in a work setting it explains your communication skills, your ability to relate to others, your ability to speak to the public, and whether you can be reliable in showing up to work.
For instance, say you have bipolar disorder and there is evidence in your medical records that you have moderate impairment in your social functioning caused by mood swings and you have a moderate level of difficulty with concentration. Your RFC might look like the following: you have no limitations in walking/standing/sitting, you are unable to work with the public, and you are limited to simple 1-2 step instructions. This RFC would prevent you from working in many occupations, but you still would not be found disabled since there are simple unskilled jobs that do not require working with the public. Read more about how the SSA makes this decision in our article on how the SSA evaluates an RFC for disability.
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About The Numbers: Mental Illness In The Workplace
- Examples of psychiatric diagnoses include anxiety disorder, depression, attention deficit/hyperactivity disorder , bipolar disorder and schizophrenia.
- Overall, about 44 million adults in the U.S. report having had any mental health condition during the past year, representing about 18.5% of the U.S. population.
- Among these U.S. adults, the National Institute of Mental Health estimates that:
- 18% have an anxiety disorder
- 9.5% have depression
- 4% have attention deficit/hyperactivity disorder
- 2.6% have bipolar disorder
- 1% have schizophrenia
Understanding Manic And Hypomanic Episodes
In a manic episode, patients are likely to experience feelings of extreme elation or on a high, see an increase in activity and energy, have difficulty sleeping, do risky things such as engaging in reckless sex or spending lots of money, and believe they can do many things at the same time. They may also feel quite wired or extremely jumpy, talk incredibly fast about many different topics, become easily agitated, feel ‘keyed up,’ and may also feel as if their thoughts are moving quite quickly.
Hypomanic episodes can have many of the same markers as manic episodes, such as seeing an increase in energy or having difficulty sleeping, but these markers will be less severe. Also, during one of these episodes, the patient may be highly productive, feel quite good, and overall will likely function well. However, family and friends may recognize the mood swings as being out of the norm for most individuals.
Continue reading to understand what depressive episodes in bipolar disorders are and what behaviors patients are likely to exhibit.
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What Are The Causes Of Bipolar Disorder
There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.
For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists arenât exactly sure how or why.
What Are The Disabling Symptoms Of Bipolar Disorder
Bipolar disorder is a disabling condition caused by a chemical imbalance in the brain resulting in severe mood swings. It is characterized by periods of manic activity punctuated by exceptionally bad periods of depression. Both the highs and lows of bipolar disorder are intense and can interfere with all aspects of your daily life.
You can absolutely qualify for long term disability benefits due to bipolar disorder. However, you will need to provide strong evidence to your insurance company of your disabling symptoms to get your claim approved.
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Applying For Disability Benefits With A Mental Illness
Mental and psychological disabilities are among the conditions that can qualify for benefits from the Social Security Administration . You may qualify with severe depression, bipolar disorder, an anxiety disorder, or another mental illness that prevents you from maintaining gainful employment.
Social Security disability benefits can cover everyday living expenses, medical bills, and other financial obligations. Benefits are paid monthly and can alleviate many of your financial worries, making it possible for you to get by without income from employment.
Maintain Gains And Prevent Setbacks
Every individual has a unique recovery journey. The road to well-being is a process that is supported by hope, inner strength, perseverance, and the involvement and support of others.
If you are living with bipolar disorder, its important to remember that you can and should be an active participant in your own treatment and recovery.
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How Would A Service Provider Or Employer Know That I Am Disabled
It isnt possible to tell from looking at someone that they have a mental illness. This may affect you when you apply for a job or try to use a service.
The person you are dealing with is unlikely to know that you have a disability. This means they may not know that you might need reasonable adjustments.
Services
You may not want to tell anyone about your mental illness when you are using services such as shops. But you may have more problems than others because of your mental illness.You can tell services about your condition. If you tell them, the Equality Act may protect you from discrimination.
Employers
You may think that your employer needs to know about your mental illness. It is up to you whether to tell them.
But there are some jobs where you need to tell your employer. This is because of the regulations which cover these jobs.
The Equality Act stops most employers asking questions about your health before offering you a job.
At work, your employer doesnt have to make reasonable adjustments if they do not know, or cant be reasonably expected to know, that you have a disability. This applies during the application process, at interview and at work.
You can find more information about Work and mental illness by clicking here.
What if everyone at work finds out about my condition?
You may decide to tell your employer about your mental illness. They should keep this information as private as possible.
What Are My Chances For Eligibility
To get protection under the ADA, you have to prove that a disability like bipolar disorder severely limits your ability to work. The ADA covers companies with 15 or more employees.
Getting Social Security benefits can be trickier. You need to have a disability and be a part of a low-income household or have worked for a certain number of years.
Not everyone with bipolar disorder qualifies. About two-thirds of applications for disability benefits are denied at first.
To get Social Security benefits, the SSA will ask you to show that:
- youve lived with bipolar disorder for at least 1 year
- your condition is severe enough to prevent you from doing your job or any other job
- your disability will last for more than a year
To qualify for SSDI, you need to have worked at a job where you paid Social Security taxes for a certain number of years.
The older you are, the more years you need to have worked. A 42-year-old must have worked for 5 years, while a 30-year-old only needs 2 years of work.
To qualify for SSI, you need to earn less than a certain amount of money. That amount varies by state. You also cant have more than $2,000 in assets .
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Impairments That Qualify For Bipolar Disorder Disability Benefits
The Social Security Administration has established that a claimant with Bipolar Disorder must have a history of consistent symptomatic manic episodes, depressive syndromes, or a combination of both. Additionally, the claimants bipolar disorder should result in two of the following restrictions:
- severe limitation of daily activity,
- inability to interact with others in a normal way, or
- recurring episodes of decompensation, which last for an extended period of time.
If a claimant does not meet the aforementioned criteria, he/she may still qualify under a section in the Blue Book, which states that any individual with a medical history documenting at least two years of any chronic affective disorder, including Bipolar Disorder, can be granted disability benefits, despite the support of medication, if the impairment or ailment has resulted in:
- limitations of the capacity to perform basic work action, even when symptoms are controlled with psychosocial support and medication.
- the claimants condition must lead to persistent decompensation periods, or
- the residual illness process has caused a subsidiary adjustment that even a nominal boost in mental demands would cause the claimant to decompensate.
Because applying for disability benefits with a Bipolar Disorder diagnosis can be a complex and intimidating process, hiring a qualified Social Security Disability lawyer or disability advocate may be in a potential claimants best interest.
Medical Evidence Required For Disability Based On Bipolar Disorder
At the SSA’s request, your treating doctor should submit to the SSA your psychiatric medical record showing the entire history of your bipolar disorder, including documentation of any severe or violent manic episodes. Your psychiatric record should include all treatments attempted, including any mood-stabilizing medications that you’ve tried, such as lithium, carbamazepine, or valproic acid, what your current prescribed therapy is, and whether you regularly comply with the prescribed therapy . Your medical record should also include the efficacy and side effects of each medication, and how their side effects, along with your symptoms, affect your daily activities, your functioning, and your ability to hold a job.
If there is evidence in your medical file that your doctor suspects your use of alcohol or drugs compounds your emotional problems, this can affect your claim. Learn more in our article on how alcoholism and drug dependence affect disability claims.
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What Are The Symptoms Of Bipolar Disorder
In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.
How severe it gets differs from person to person and can also change over time, becoming more or less severe.
Symptoms of mania :
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Excessive happiness, hopefulness, and excitement
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Sudden changes from being joyful to being irritable, angry, and hostile
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Restlessness