Bipolar Disorder Not Otherwise Specified (NOS)

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Bipolar disorder not otherwise specified (NOS) is one of those psychiatric terms that can cause more confusion than clarity, especially to the person being diagnosed. Bipolar disorder NOS is usually diagnosed when a patient shows some symptoms of bipolar disorder but doesn’t necessarily meet all the criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders.

The term bipolar disorder NOS was used in the fourth edition of the DSM (DSM-IV); however, the DSM-5 actually uses the terms “unspecified bipolar and related disorder” or “other specified bipolar and related disorder” to diagnose conditions that were previously called bipolar disorder NOS.

What ‘Not Otherwise Specified’ Means

Bipolar disorder NOS is more of a catch-all category than an actual type ofbipolar disorder. Your doctor may use the classification to document symptoms which are consistent with bipolar disorder but fall short of the criteria needed to make a definitive diagnosis.

From a psychiatric standpoint, bipolar disorder NOS is taken just as seriously as any other form of mood disorder. It presumes that there is a concern and that it likely will be more definitively diagnosed in the future.

By assigning the NOS diagnosis now, the person will be less likely to slip through the cracks should another mood episode occur.

Still, there remains contention in the psychiatric community as to whether bipolar disorder NOS is a valid diagnosis or if it may lead to the premature treatment orover-treatment of an otherwise presumptive illness.

Unspecified vs. Specified Bipolar Disorder

As mentioned, the American Psychiatric Association (APA) prefers the terms unspecified or other specified for bipolar disorder to better reflect the uncertainty of the diagnoses. (The terms unspecified and other specified are also used for types of depressive disorders in the DSM-5).

Other specified bipolar disorder may be diagnosed when a person displays specific symptoms of bipolar (such as manic and/or depressive episodes), but the full criteria for those symptoms aren’t met.

Unspecified bipolar may be the diagnosis when a person’s symptoms resemble the symptoms of bipolar disorder, but the clinician chooses not to specify the reason the criteria are not met for a specific bipolar disorder, such as in an emergency room where there is insufficient information to make a more specific diagnosis.

Unspecified Depressive Disorder in the DSM

Diagnostic Criteria

Differential Diagnoses

Any informed diagnosis of bipolar disorder NOS would involve areviewof all other possible causes.

In the event that substance abuse or an undiagnosed medical condition is suspected, further investigations may be ordered, including blood tests, a drug screen, neurological imaging, or other diagnostic techniques to identify an infection, injury, or malignancy.

Treatment

Specific treatments for bipolar disorder NOS are not as well researched. However, they are generally the same as for other bipolar and related disorders—includingmood stabilizersandpsychotherapy.

Most experts agree that psychotherapy can be beneficial to anyone deemed at risk of developingsymptoms of bipolar disorder, ideally starting early.

A Word From Verywell

While the NOS diagnosis can be frustrating for anyone looking for a more definitive diagnosis for their mood symptoms, it is often about your clinician trying to be precise in the application of established diagnostic criteria for particular disorders. Often, the diagnosis will become clearer over time. For example, it is not uncommon that someone initially diagnosed with a depressive disorder may ultimately turn out to have a bipolar and related disorder diagnosis at some point down the road.

4 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Parker G.DSM-5 and psychotic and mood disorders.J Amer Acad Psychiatry Law.2014;42(2):182-190.American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.National Alliance on Mental Illness.Bipolar disorder.Swartz HA, Swanson J.Psychotherapy for bipolar disorder in adults: A review of the evidence.Focus (Am Psychiatr Publ). 2014;12(3):251–266. doi:10.1176/appi.focus.12.3.251Additional ReadingLeboyer M, Kupfer D.Bipolar disorder: new perspectives in health care and prevention.J Clin Psychiatry. 2010:71(12):1689-95. doi:10.4088/JCP.10m06347yel.

4 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Parker G.DSM-5 and psychotic and mood disorders.J Amer Acad Psychiatry Law.2014;42(2):182-190.American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.National Alliance on Mental Illness.Bipolar disorder.Swartz HA, Swanson J.Psychotherapy for bipolar disorder in adults: A review of the evidence.Focus (Am Psychiatr Publ). 2014;12(3):251–266. doi:10.1176/appi.focus.12.3.251Additional ReadingLeboyer M, Kupfer D.Bipolar disorder: new perspectives in health care and prevention.J Clin Psychiatry. 2010:71(12):1689-95. doi:10.4088/JCP.10m06347yel.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Parker G.DSM-5 and psychotic and mood disorders.J Amer Acad Psychiatry Law.2014;42(2):182-190.American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.National Alliance on Mental Illness.Bipolar disorder.Swartz HA, Swanson J.Psychotherapy for bipolar disorder in adults: A review of the evidence.Focus (Am Psychiatr Publ). 2014;12(3):251–266. doi:10.1176/appi.focus.12.3.251

Parker G.DSM-5 and psychotic and mood disorders.J Amer Acad Psychiatry Law.2014;42(2):182-190.

American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.

National Alliance on Mental Illness.Bipolar disorder.

Swartz HA, Swanson J.Psychotherapy for bipolar disorder in adults: A review of the evidence.Focus (Am Psychiatr Publ). 2014;12(3):251–266. doi:10.1176/appi.focus.12.3.251

Leboyer M, Kupfer D.Bipolar disorder: new perspectives in health care and prevention.J Clin Psychiatry. 2010:71(12):1689-95. doi:10.4088/JCP.10m06347yel.

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