DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis – A narrative review from the ECNP bipolar disorders network

Research output: Contribution to journalReview articleContributedpeer-review


  • Lars Vedel Kessing - , University of Copenhagen (Author)
  • Ana González-Pinto - , CIBER - Center for Biomedical Research Network (Author)
  • Andrea Fagiolini - , University of Siena (Author)
  • Andreas Bechdolf - , University of Cologne (Author)
  • Andreas Reif - , University Hospital Frankfurt (Author)
  • Ayşegül Yildiz - , Dokuz Eylul University (Author)
  • Bruno Etain - , Université Paris Cité (Author)
  • Chantal Henry - , University Hospital Service (Author)
  • Emanuel Severus - , University Hospital Carl Gustav Carus Dresden (Author)
  • Eva Z. Reininghaus - , Medical University of Graz (Author)
  • Gunnar Morken - , Norwegian University of Science and Technology (Author)
  • Guy M. Goodwin - , Oxford Health NHS Foundation Trust (Author)
  • Jan Scott - , Newcastle University (Author)
  • John R. Geddes - , Oxford Health NHS Foundation Trust (Author)
  • Marcella Rietschel - , Heidelberg University  (Author)
  • Mikael Landén - , University of Gothenburg (Author)
  • Mirko Manchia - , University of Cagliari, Dalhousie University (Author)
  • Michael Bauer - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Monica Martinez-Cengotitabengoa - , University of the Basque Country, Psychology Clinic of East Anglia (Author)
  • Ole A. Andreassen - , University of Oslo (Author)
  • Philipp Ritter - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Ralph Kupka - , Vrije Universiteit Amsterdam (VU) (Author)
  • Rasmus W. Licht - , Aalborg University (Author)
  • René Ernst Nielsen - , Aalborg University (Author)
  • Thomas G. Schulze - , Ludwig Maximilian University of Munich (Author)
  • Tomas Hajek - , Dalhousie University, National Institute of Mental Health (Author)
  • Trine Vik Lagerberg - , University of Oslo (Author)
  • Veerle Bergink - , Icahn School of Medicine at Mount Sinai, Erasmus University Rotterdam (Author)
  • Eduard Vieta - , University of Barcelona (Author)


This narrative review summarizes and discusses the implications of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and the upcoming International Classification of Diseases (ICD)-11 classification systems on the prevalence of bipolar disorder and on the validity of the DSM-5 diagnosis of bipolar disorder according to the Robin and Guze criteria of diagnostic validity. Here we review and discuss current data on the prevalence of bipolar disorder diagnosed according to DSM-5 versus DSM-IV, and data on characteristics of bipolar disorder in the two diagnostic systems in relation to extended Robin and Guze criteria: 1) clinical presentation, 2) associations with para-clinical data such as brain imaging and blood-based biomarkers, 3) delimitation from other disorders, 4) associations with family history / genetics, 5) prognosis and long-term follow-up, and 6) treatment effects. The review highlights that few studies have investigated consequences for the prevalence of the diagnosis of bipolar disorder and for the validity of the diagnosis. Findings from these studies suggest a substantial decrease in the point prevalence of a diagnosis of bipolar with DSM-5 compared with DSM-IV, ranging from 30–50%, but a smaller decrease in the prevalence during lifetime, corresponding to a 6% reduction. It is concluded that it is likely that the use of DSM-5 and ICD-11 will result in diagnostic delay and delayed early intervention in bipolar disorder. Finally, we recommend areas for future research.


Original languageEnglish
Pages (from-to)54-61
Number of pages8
JournalEuropean neuropsychopharmacology
Publication statusPublished - Jun 2021

External IDs

PubMed 33541809
ORCID /0000-0003-4286-5830/work/149796254
ORCID /0000-0002-2666-859X/work/149797544


Sustainable Development Goals


  • Bipolar disorder;DSM-5;ICD-11;Validity of diagnosis;Diagnostic delay;Delayed early intervention