Background. Data are presented on the general population
epidemiology of DSM-III-R bipolar I disorder in the United States.
Methods. Data come from the US National Comorbidity Survey
a general population
survey of DSM-III-R disorders. A modified version of the Composite
International Diagnostic Interview was used to make diagnoses.
Results. A small (N=59) clinical reappraisal study
showed that the only manic symptom profile
that could validly be assessed with the CIDI is characterized by euphoria,
grandiosity and the ability
to maintain energy without sleep, which described approximately half of
all clinically validated
bipolar I cases in the NCS. Further analysis focused on this symptom profile,
which involved N=29 cases in the total sample. Lifetime prevalence
was estimated to be 0·4% and 12-month prevalence
only slightly lower. Caseness was negatively related to income,
education and age, positively related
to urbanicity, and elevated among the previously married, never married
and non-whites. All cases
reported at least one other NCS/DSM-III-R disorder and 59·3%
reported that their episode of
bipolar disorder (either mania or depression) occurred at a later age
than at least one other
NCS/DSM-III-R disorder. Although 93·2% of lifetime cases
reported some lifetime treatment,
only 44·7% of recent cases were in treatment.
Conclusions. The type of bipolar disorder examined here is
highly chronic, co-morbid and
impairing. Increased efforts are required to attract current cases into
Methodological research is needed to develop more accurate measures of
other bipolar symptom
profiles for use in general population epidemiological studies.