title: The bipolar spectrum: conceptions and misconceptions.
abstract: OBJECTIVE
  This review aims to address concerns about the potential overinclusiveness and vagueness of bipolar spectrum concepts, and also, concerns about the overlap between bipolar illness and borderline personality.
  
  
  METHODS
  Narrative review based on historical and empirical studies.
  
  
  RESULTS
  Bipolar disorder (BD) and major depressive disorder (MDD) came to be separate entities with the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III), in contrast to the Kraepelinian manic-depressive insanity (MDI) concept, which included both. The bipolar spectrum concept is a return to this earlier Kraepelinian perspective. Further, very different features differentiate the disease of bipolar illness (family history of bipolar illness, severe recurrent mood episodes with psychomotor activation) from the clinical picture of borderline personality (dissociative symptoms, sexual trauma, parasuicidal self-harm). The term 'disorder' obfuscates an ontological difference between diseases, such as manic-depressive illness, and clinical pictures, such as hysteria/post-traumatic stress disorder/dissociation/borderline personality.
  
  
  CONCLUSIONS
  Bipolar spectrum concepts are historically rooted in Kraepelin's manic-depressive illness concept, are scientifically testable, and can be clearly formulated. Further, they differ in kind from traumatic/dissociative conditions in ways that can be both historically and scientifically established.
authors.affiliation: 1Mood Disorders Program, Tufts Medical Center, Tufts University School of Medicine, Boston, USA.
authors.forename: S Nassir
authors.initials: SN
authors.lastname: Ghaemi
authors.forename: Shannon
authors.initials: S
authors.lastname: Dalley
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis*; D001883:Borderline Personality Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans
keywords: Akiskal; DSM-5; Koukopoulos; Kraepelin; Leonhard; bipolar spectrum; borderline personality; mixed; temperaments