Subthreshold Bipolar Disorder: Update

The internet is abuzz with discussion about subthreshold bipolar disorder. There seem to be two camps forming (with some slight variations within each group).

One group is skeptical about this new disorder and not impressed with the new study which suggests SBD is not being treated appropriately.

Another group appears to believe that the newly minted SBD is legit and doubting it is a sign that you might be a "pop psych pundit." Here are some snippets and links to each camp, along with my occasional commentary [in brackets].

Skeptical posts...

• Polarcoaster said:
  

  Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

  No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway. [I agree that many mental conditions exist on a spectrum and agree that the line in this case is too inclusive.]
  

• Dr. X said:

  My prediction: treatment will be good for pharmaceutical stocks and will cause patients to gain a lot of weight. [Cynical, but I have no evidence that Dr. X is wrong]
  

• Bipolar Chicks Blogging said:
  

  We're not doctors here; but we do have years of combined experience and you may read stuff here that you won't hear from your physician or on television and more and more, what you hear coming from your doc's mouth mimics what is spewed from drug advertising; and the bitch is, none of it is hard science. [Good point -- especially in the latest SBD study, the argument for treating SBD is currently science-free]
  

• Ruth at Off-Label hilariously wrote:
  

  "The problem is all inside your head", he said to me
  The answer is easy - you just take it orally
  I'd like to help you in your quest for normality
  For there are 21 ways to be subthreshold bipolar
  
  Have you increased your goal-directed activity?
  Are you subject to distractibility?
  Engaged in an unrestrained buying spree?
  There are 21 ways to be subthreshold bipolar
  
  You been flat on your back, Jack
  Making grand plans, Stan
  Cheatin' on your boy, Roy
  Well, listen to me
  Hop on the shortbus
  We don't need to discuss much
  Just drop this off at the pharmacy
  And get yourself free... [And it goes on further -- you must read it!]
  

Skeptics are wrong...

• Empirical Insanity said:

  Check this post out, in which the author, whose bio states that he is an academic with clinical experience, starts with that article and works up to arguing that anyone who isn't bipolar type I should not be receiving long-term medication because "there is scant if any research on what appropriate medication is for bipolar II and there is not a damn bit of research attesting to medication for SBD" (subthreshold bipolar disorder).
  
  I do not think he is an academic with training on the research side of psychology. He also seems to have difficulty understanding that different diagnoses of bipolar disorder almost certainly involve similarities in etiology which are relevant to treatment. [If anyone can locate a single study showing positive treatment results for SBD, I'd love it see it.]

• Maddy said:

  ...I'm BPI but this kind of thing still pisses me off. How can they completely discount another persons condition? Calling it "Life's little ups and downs" is such bullshit. Don't they realize how they are contributing to the mental health stigma? Not to mention the fact that by not controlling mania/hypomania can cause even more serious issues down the road?
  
  AARRRGGGHHH! I just want to rip these idiots a new asshole or two![I question whether people should receive meds for a questionable diagnosis in the face of no evidence and thus I'm an idiot who needs to be ripped a new orifice.]

• reddog said:

  Maddy: they already ARE assholes. *sigh* (i keep having issues with a coworker who believes 'stress' causes MI..that you 'snap' and develop schiz or bp or MD or whatever. *sigh*) [Thanks. Of course stress has nothing to do with one's mental well-being(?,?)]

• herrfous said:

A relatively newly-adopted but pervasive maxim of modern allopathic medicine is "treat the patient, not the symptoms".

It seems that these pop-psych pundits (and perhaps a few doctors) haven't yet gotten past "treat the symptoms, not the DSM-coded diagnosis". [And if someone has one minor symptom of hypomania [i.e. has SBD], these symptoms require treatment?]

Well that was fun. Please feel free to read my original post on the topic as well as a couple of followups (1, 2). Also check out posts at Furious Seasons on the topic (1, 2). Be warned, however, that Philip Dawdy, author of Furious Seasons, like myself, is a "pop-psych pundit," an "idiot," and is in need of a new anal orifice or two.