It’s important to remember that manmade diagnoses are approximations of what actually occurs in the real world. This topic of diagnostic accuracy is one that frequently comes up among the experts. Essentially the DSM-IV diagnoses are boxes into which we try to make all, or at least the majority, of a person’s symptoms fit. Sometimes this works, but more often than not we find that people don’t quite meet the criteria or have multiple other conditions.
As we go through this section, we’ll look at various issues related to dual diagnoses, and to the strong relationship between alcohol and substance abuse and bipolar disorder. But there are many other conditions, both psychiatric and medical, that will impact on a given person’s overall symptoms. So while the DSM-IV diagnostic boxes work well for some, for others it’s less clear where bipolar symptoms start and stop and other co-occurring conditions, such as personality disorders, other psychiatric disorders, substance abuse issues, trauma, etc., begin.
This is not to say that the current system of diagnosis is a bad one. It reflects the current state of the science and art of psychiatric diagnosis; it’s a work in progress that has come a long way and has a long way to go.