article by Marwaha et al (2012) says there is a "lack of a clear, accepted and well-validated definition". However, the impression given when people are prescribed so-called mood stabilisers is that we know what we are talking about.
13.9% of the population aged over 16 in the 2007 Adult Psychiatric Morbidity Survey answered yes to the question "Do you have a lot of sudden mood changes?" Marwaha et al take this as their definition of mood instability. And, patients referred to mental health teams commonly complain of this symptom (without perhaps being very clear about what they mean). For example, Gilbert et al (2005) found that 83.8% of patients referred to two city CMHTs in Derby ticked mood instability on a checklist and this was the most commonly endorsed symptom of any on the list.
In an article this month in BJPsych, Bilderbeck et al (2014) interviewed 28 patients referred to secondary mental healthcare teams (including a specialist mood disorder clinic) in Oxfordshire and Buckinghamshire. Mood instability had been cited as a reason for referral. What was found was that patients placed a primary emphasis on finding an explanation for their problems. Not everyone was helped by a formal diagnosis of, say, bipolar disorder. For example, receiving a diagnosis could be experienced as dismissive, in a way that was linked to a perceived lack of adequate explanation and/or support. What may be more important than a diagnosis is a good professional relationship with the doctor.
In an accompanying editorial, Robert Dudas makes the common statement that "few people would now challenge the view that it [bipolar disorder] is a major mental illness with a strong biological vulnerability" without being clear whether he is being more than trite in referring to the biological dimension. Nor does he discuss the expansion in the diagnosis of bipolar disorder (eg. see previous post).
Dudas also makes reference to another qualitative study of the process of making sense of a diagnosis of bipolar disorder. This study again notes the ambivalence about the diagnosis. More should be made of this finding. Maybe patients are right to be uncertain about psychiatrists focusing too much on mood instability as a mental disorder. I am, of course, not saying that 'tranquility of the mind' may not be important for wellbeing but mood instability is not uncommon and may clearly be a reflection of personal difficulties rather than necessarily a mental illness as such.