Bipolar Disorder NOS

bipolar disorder nos
Bipolar Disorder NOS. What the hell does that mean? I know NOS stands for “Not Otherwise Specified.” But again, I ask, “What the hell does that mean?”

My first introduction to NOS was when I was attending a support group in Long Beach. A couple of people had that diagnosis and they weren’t happy about it. I didn’t give it much thought at the time, but now I understand how they felt. It’s awfully damn vague.

My Diagnosis

Let me backtrack a bit to my earliest visits to a psychiatrist. My first pdoc was Dr. Rose, who was finishing her last year of residency. Those early appointments were insane. One week I was told I was BP I, then BP II, then ADHD, then back to BP I. The final diagnosis I got from her was BP II…but maybe not.

After Dr. Rose completed her residency, I was assigned to my current pdoc. It was about two years into our relationship that it hit me one day that I should ask what my final diagnosis is. He smiled at me and said, “Does it matter as long as the meds are working?” Well, it did matter. I wanted a name, but he quickly changed the subject. That was about eight years ago. I didn’t give it too much thought, but occasionally I’d wonder why he was so vague.

Fast forward to last month’s appointment. My pdoc turned his computer monitor to show me something and I happened to see my diagnosis. You guess it – it said Bipolar Disorder NOS. I was immediately pissed off, but I didn’t know why so I went home and started doing some research.

Bipolar Disorder NOS

So, what exactly is BP NOS? Here’s what the National Institute of Health had to say:

Bipolar Disorder–Not Otherwise Specified (BP-NOS) and Severe Mood Dysregulation (SMD) are severe mood disorders that were both defined to address questions about the diagnosis of bipolar disorder (BD) in youth. SMD and BP-NOS are distinct phenotypes that differ in clinical presentation and longitudinal course.

If you can figure that out, you’re a better person than me. The rest of the article is long and even more confusing, so be cautious if you care to read it. As for me, I needed something in layman’s terms. My search was difficult. I had a hard time finding anything that I could easily understand.

I’m not real familiar with, but it took all the crazy definitions I found and made it simple enough for me to understand. It’s definition is:

Bipolar disorder NOS is more of a catch-all category then an actual type of bipolar disorder. Your doctor may use this diagnosis to document that you have symptoms of bipolar disorder, but your symptoms do not meet the requirements for a diagnosis of bipolar 1 disorder, bipolar 2 disorder or cyclothymic disorder.

I don’t know about you, but to me that sounds like it’s a diagnosis you get when your doctor isn’t sure what you’ve got. How can that possibly be? I’ve been blogging about living with bipolar for eight years. I’ve been published regarding my disorder and I’ve been interviewed by about a dozen websites and magazines. Have I been telling a lie all this time? No. I don’t think so. At least not, based on what I read further in the article. In a list of examples of what an NOS might look like it states:

You are having symptoms of a manic episode or a depressive episode but the episodes are too short to qualify as an actual episode. In bipolar disorder NOS there is often a rapid change between these two types of episodes, usually occurring within days of each other.

That is me. I have never been one to go months in one mood state. My moods typically only last a week or so. Sometimes only days. Sometimes only hours. I’m confused, though. Isn’t that a definition of a rapid cycler? I’ve been told I’m a rapid cycler. I’ve said I’m a rapid cycler. What’s the difference?

Rapid Cycling

To find the difference between NOS and rapid cycling, I did more searching in the verywell website. Here’s their definition:

People who have at least four mood “episodes” (times where they’re in hypomanic, manic, depressed or in a mixed state) over the course of a year are considered to have rapid cycling bipolar disorder. However, in some “rapid cyclers,” the mood swings can come even more quickly — weekly, daily or even hourly.

Nice, simple easy to understand definition. AAAAHHHHHH!!!! What the hell is the difference? Based on that definition I am definitely a rapid cycler. Yes, I have rapid cycling BIPOLAR DISORDER! Would I rather not have bipolar disorder? Of course I would, but I definitely have something. For now, I’m comfortable saying I have bipolar disorder. I’m comfortable saying I have rapid cycling bipolar disorder. Hell, I’ll even say I have Bipolar Disorder Not Otherwise Specified. But if you’re going to take away my bipolar label, you better replace it with something good, and it sure as hell better be something I understand.

9 comments on Bipolar Disorder NOS

  1. I have never been told “officially” what I have either (Other than just Bipolar). I have just assumed it was BP II because of all the depression I have dealt with. I have always thought NOS was just plain ol bipolar, not a lot of mania to be 1 and not enough depression to be 2. But reading the NOS description, I believe I could fall into that category. I see my pdoc in two weeks and I am going to ask her where I fall. I think it is not only important, but your right to know as a patient what you are diagnosed with.

    1. It is your right to know your diagnosis is. I’m angry my pdoc wouldn’t tell me. Part of the reason I’m looking for a new one and I hope I find one soon.

  2. Hi, I relate to your frustration having a similar experience although my psychologist and psychiatrist disagreed over my diagnosis until recently. Some people say, as your dr that a diagnosis doesn’t matter. But I’m with you – I want to know how I’m labelled. And yes you’re right again – it’s such a complex thing to understand! Wishing you well xx

    1. For whatever reason, giving it (whatever “it” is) a name is important. It makes it less scary.

      1. I agree. It belongs to a framework you can relate to others who share. Personally I think a bit patronising not to be given your own diagnosis. It’s something to work from.

  3. I absolutely understand. I feel like nos is a cop out when they’re done trying. I also feel less validated, because it shows I have symptomology, but it feels less than, somehow. This was a great article though:)

    1. Thank you, Michelle. Someone did put it in perspective for me. If they aren’t 100% sure, should they just slap a label on it just to make everyone feels better? Probably not. It still sucks, though.

  4. My diagnosis was Bipolar NOS because I cycled several times in a week and even several times in a day. It just didn’t fit the norm of Bipolar I or II. After I had a disturbing hypomanic episode, and my cycles had calmed down, my Pdoc said I was more like Bipolar ll. I never asked him if he changed the diagnosis in my record. I know that I’m Bipolar II rapid cycling without my meds or if they stop working but it would be interesting to find out if he changed it. I might ask him when I see him next month. I’m just happy my meds are working along with my coping skills. But it is our right to know–your doctor should give you an answer and an explanation .

    1. “I know that I’m Bipolar II rapid cycling” is exactly what I always thought I was until I saw the NOS on my diagnosis. It bugs me that the NOS is there, but I guess I’m going to be okay.

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