Spotlight on Bipolar Disorder Not Otherwise Specified

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What is Bipolar Disorder Not Otherwise Specified?

Bipolar Disorder Not Otherwise Specified (NOS) is a designation for people suffering from bipolar disorder who do not present symptoms that fit into the other sub-types of bipolar. Bipolar disorder is a clinical mood disorder. Bipolar disorder is characterized by at least one period of mania or hypomania, alternating with periods of depression, or mixed episodes combining the symptoms of mania and depression. People experiencing mania may have increased energy levels and trouble sleeping. They might have impaired judgment, and feelings of indestructibility. They may talk rapidly, and feel like their thoughts are rushing, and they may be agitated. Severe mania may involve delusions or hallucinations. People with depression will often feel fatigued, or weak and experience feelings worthlessness and despair. People with bipolar disorder may swing rapidly from depression to mania or back for no apparent reason.

Bipolar disorder often develops in a person’s late teens or early 20’s, although symptoms may be present from childhood. Currently doctors are not sure what causes bipolar disorder, although it may have some genetic factors. There are four sub-types of bipolar disorder, each identified by type of mania and depression a person suffers from.

Bipolar I is characterized by an episode of mania, or mixed episode, that lasts at least 7 days. Bipolar II is characterized by patterns of depression that alternate with periods of hypomania (a milder form of mania). Cyclothymia is characterized by periods of milder depression and hypomania which may last for at least two years.

If a person shows symptoms of mania or hypomania and depression, but the pattern does not fit into the recognized sub-types of bipolar disorder, they may be diagnosed with bipolar disorder NOS.

Diagnosing Bipolar NOS

As bipolar disorder not otherwise specified is used as a diagnosis for those who do not fit into the other categories of bipolar disorder, it can be difficult to define. It is often used by doctors as a method of officially diagnosing a patient as having bipolar disorder when more observation is needed to determine the sub-type. Cyclothymia, for example, requires at least two years of observation before a diagnosis can be made, but diagnosing a patient as having bipolar NOS can enable them to get treatment before the final diagnosis.

Bipolar NOS is used to describe patients whose symptoms may be influenced by a medical condition or substance abuse. It can also be used to describe patients who suffer from other psychiatric conditions, but who still show symptoms of bipolar disorder. People who do not suffer from depression, but only from mania or hypomania may also be diagnosed with bipolar NOS.

Finally, bipolar NOS can be used as a diagnosis for people whose symptoms don’t fit into the timeframe characteristic of other bipolar sub-types. For example, people who suffer from mania and depression similar to bipolar I, but who have episodes lasting less than a week at a time. Or, people who suffer from hypomania and mild depression, with episodes shorter than the criteria for cyclothymia. Generally, if a person is showing periods of mania or hypomania and depression and does not fit into other categories of bipolar disorder, they will be diagnosed with bipolar NOS.

Bipolar disorder not otherwise specified is used as a catch-all diagnosis for people whose bipolar disorder does not fit into the other sub-types. It is a serious diagnosis that should be monitored carefully so that the sufferer can learn to manage it and increase their quality of life.


The National Institute of Mental Health, “Bipolar Disorder”

Bipolar II Disorder, Cyclothymia and Bipolar Disorder NOS, by Rashmi Nemade and Mark Dombeck