Bipolar disorders in the new DSM-5 and ICD-11 classifications

The DSM-5 and ICD-11 classifications, the latter still under development, are aimed at harmonizing the diagnoses of mental disorders. A critical review is presented in the issues that can converge or separate both classifications regarding bipolar disorders, and those conditions–included in depressive disorders–with special relevance for bipolar (e.g. major depressive episode). The main novelties include the incorporation of dimensional parameters to assess the symptoms, as well as the sub-threshold states in the bipolar spectrum, the consideration of new course specifiers such as the mixed symptoms, the elimination of mixed episodes, and a more restrictive threshold for the diagnosis of hypo/mania. The most noticeable points of convergence are the inclusion of bipolar II disorder in ICD-11 and the additional requirement of an increase in activity, besides mood elation or irritability, for the diagnosis of hypo/mania in both classifications. The main differences are, most likely keeping the mixed depression and anxiety disorder diagnostic category, maintaining bereavement as exclusion criterion for the depressive episode, and maintaining the mixed episode diagnosis in bipolar disorder in the forthcoming ICD-11.

Since DSM-5 has already been published, changes in the draft of ICD-11, or ongoing changes in DSM-5.1 will be necessary to improve the harmonization of psychiatric diagnoses.