Soft Bipolar Spectrum and Staging in Bipolar Disorder

At present, the classification of mental disorders is tightly rooted in categories despite the fact that a dimensional approach may present some clear advantages. In this review, we compare two dimensional approaches that have been put forward in bipolar disorder. On one hand, the “soft” bipolar spectrum focused on the presentation of affective symptomatology and on the other, the staging model based on the progression of the disorders and impairment in functioning in more severe cases. At a first glance, these concepts may sound as difficult to integrate. However, we hypothesize that a common underlying foundation based on the concept of allostatic load may help to integrate the crossectional phenomenology of the soft spectrum and the progressive neuropsychological and functioning impairment which is experienced by many bipolar patients.