Fig. 1

Developmentally informed diagnostic labels for bipolar disorder. This schematic of physiological and psychosocial development provides a timeline against which we have illustrated various descriptions for bipolar diagnoses. Presently, PBD spans all developmental phases up to adulthood. Instead, we propose that this term (PBD) be supplanted with Adolescent Bipolar Disorder, which commences after childhood, typically coinciding with the onset of puberty, and extends to adulthood. In addition, we propose a new term “Prepubertal Miasma”. This refers to symptoms in childhood that may be precursors to bipolar disorder in adolescence and adulthood. For example, symptoms such as irritability may eventuate in a diagnosis of bipolar disorder but can instead follow a trajectory that eventuates in other psychiatric conditions such as attention-deficit hyperactivity disorder (ADHD), or may resolve spontaneously as the individual matures. The term ‘miasma’ reflects the foreboding nature of these symptoms as they create an atmosphere of potential bipolar phenomenology rather than symptoms that reflect a discrete illness. This term holds equivalence to terms such as pre-bipolar risk states, indicative of bipolar antecedents. The diffuse borders of puberty commencement reflect individual variability of its boundaries. For example, males usually start puberty later than females (typical age for males 10–12 years and for females 9–11 years). The diffuse nature of the ‘boundary’ between prepubertal symptoms and those indicative of bipolar disorder reflects the potential permeability of the symptoms and behaviours that constitute the prepubertal miasma