ABSTRACT
The implications of our diagnostic tools are not inconsequential. If a psychiatrist unthinkingly uses the DSM to find a diagnosis for a person consulting for “depression,” a mistaken diagnosis of a depressive disorder is often chosen, leading to problematic treatment. Looking at symptom patterns however, and recognizing dysphoria in particular, can reveal previously unseen mood dysregulation, leading to more appropriate treatment with improved outcome. People with mood dysregulation experience negative moods which, for want of a better description, they report as “depression.” But these people are typically irritable, agitated, reactive, and anxious: these are the negative symptoms of dysphoria characteristic of the activated/energized state that points toward hypomania. Dysphoria is a clue to the relationship between mood dysregulation and bipolar disorders. Such a similarity in phenotype (the visible expression of a gene) suggests shared biologic underpinnings. Some have proposed that all mood disorders arise from “affective temperaments,” genetic vulnerabilities that are variously expressed depending on environmental influence. The commonality between bipolar disorders and mood dysregulation might be on the subterranean, genetic level of affective temperaments. In this invisible way, mood dysregulation might be tethered to bipolar disorders in the ultraviolet space just beyond the visible bipolar spectrum. Yet mood dysregulation should not be regarded as a diagnosis but as a characteristic pattern of symptoms that is present across a spectrum of diagnoses: it is a transdiagnostic phenomenon.
