"I'm Sorry - Again"
"The Patient is Noncompliant"

Overdiagnosing Bipolar Disorder

"A new study by Rhode Island Hospital and Brown University researchers reports that fewer than half the patients previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on a comprehensive, psychiatric diagnostic interview--the Structured Clinical Interview for DSM-IV (SCID)." Why is this important?

The overdiagnosing of Bipolar Disorder is especially disconcerting due to the serious side effects of the drugs which are prescribed for Bipolar Disorder.  As cited by Dr. Mark Zimmerman, who headed the research project, potential side effects can include "possible impact to renal, endocrine, hepatic, immunologic and metabolic functions."  These are very serious side effects indeed.  Why would doctors put patients at such risk based on a misdiagnosis?

Dr. Zimmerman cites two possible causes:

"Clinicians are inclined to diagnose disorders that they feel more comfortable treating.  We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive."

This is very true.  Psychiatrists like to diagnose something they know how to treat.  Something concrete, that is easily documented and can be fixed with a prescription.  They don't typically like to deal with issues like trauma or Borderline Personality Disorder or nebulous, emotional issues that require talking rather than prescribing.  How do you document and treat: "patient struggling to break out of victim role, develop healthier relationship patterns while addressing traumatic symptoms from childhood abuse"?  In their defense, a lot of clinicians don't like to deal with trauma, whose emotional lability can easily be mistaken for Bipolar's "mood swings". 

"This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder."

Once again we see the heavy hand of the pharmaceutical companies.  And once again we see the very real implications of allowing pharmaceutical companies to dictate good medical practice.  Patients are placed on medications and heavily tranquilized which gives them immediate results, but does not address the underlying problem if the issue is not Bipolar Disorder.  These medications also have long term side effects which can put the patient's physical health at serious risk, as noted by Dr. Zimmerman above.  And having found that research performed by pharmaceutical companies is not accurately reported or conducted, how do we actually know that there is a "delayed and underrecognition of bipolar disorder"?  If it is now being overdiagnosed, and I have seen that it is, then perhaps the original levels of diagnoses were accurate. 

I see two additional causes:

A third reason is funding coverage.  Whether at a publically-funded outpatient clinic or an insurance driven private practice the practitioner has to consider which diagnoses the funding source will pay for.  Bipolar Disorder, being classified as a major medical issue, is almost always covered.  Trauma symptoms, marital issues, dysfunctional relationship patterns, etc. are often much more difficult to document in a way which can be billed for.

The fourth reason can be training.  Medical doctors are taught to diagnose and treat, not to listen and empower.  Identify the sickness and dictate the prescribed treatment to fix it.  And this means the doctor has to find the solution, not the patient.  I talk more about this philosophical viewpoint and its effect on interviews with clinicians in the article, Listening to Diagnose vs. Listening to Hear and Understand

Bipolar Disorder is a very serious illness, with very serious symtoms and requires a very serious class of medication to be prescribed.  To blithely hand out this diagnosis and label people with "Bipolar Disorder" is at best irresponsible.  If you or someone you love have been diagnosed with this illness it is important to read the diagnostic criteria, understand the symtoms required to make the diagnosis, talk to your doctor about why they diagnosed you with Bipolar Disorder and think for yourself.

See "Bipolar Disorder Overdiagnosed" at the Science Daily website.

Comments

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Melissa

Four years ago I dropped out of treatment for bipolar disorder. After years of meds, hospitalization, frustration and suicide attempts, I figured it couldn't get any worse. Since then, I divorced an emotionally abusive husband who blamed everything on my bipolar disorder, finished a bachelor's degree, completed half of a master's degree, maintained steady employment, worked in the same workplace for three years without incident, received promotions, paid off medical debt and raised my credit score by 150 points. Everyone in my family thought I took meds. I called it faking stability and then I realized that if you are successful, it isn't faking. I keep expecting disaster because I've been conditioned to expect it. But four years of success is tough to discount. I think my problems stemmed from a childhood of abuse at the hands of an older sibling. When I cut off all ties, I started getting better. To think I may have taken all those drugs with the side effects and the expense for no real reason saddens me. Thanks for the post.

Kellen

Melissa,

That is amazing. I'm sure you are right about the source being the childhood abuse. I see that so often. Trauma from childhood abuse with its emotional lability and self destructive behaviors is so often seen as "mood swings", diagnosed as "Bipolar Disorder" and medicated. I am so happy to hear that you are dealing with the actual abuse - by leaving it.

And you are absolutely right. If you are succeeding, it's not faking it. And you are certainly succeeding! Work, college, leaving an abusive marriage, and getting financial stable - any one of these things is a major accomplishment and you have managed them all.

I too am sorry you had to take those drugs, but I'm happy to learn you are doing so well without them. Thank you for your comments. Your story is certainly an inspiration for others.

pariah

There are two types of Bipolar conveniently Types I and II. They have different presentations and clinical courses. I have Bipolar II. You mention that it has been over-diagnosed. Perhaps a better description of it is that it has been misdiagnosed. The problems with Bipolar is that the presentation of a patient to the doctor may be at two diametrically opposed states. When one sees the physician in depression and the doctor has no reference to the cyclic nature of the patient they will be labeled as Clinical Depression. If suicidality is involved, this will be called Major Depression. This was what happened in my case. On the other hand if one presents in mania with delusions and psychosis, often Schizophrenia is diagnosed. In my case, antidepressants were prescribed for depression and they precipitated an episode of mania and thus I was Bipolar II. In general, I've read that on average, it takes 10 years before the correct diagnosis in made.

Jim Sibley

In a sense, this is a betrayal to those of us who legitimately have bipolar. I wasn't diagnosed until I was 34. It was another 20 years until we found a combination of drugs that does work. I've been hospitalized 3 times, my marriage was destroyed, my children became distant.

So, I reget those that minimize the effect of bipolar. Rather, I wish you would proclaim it to the world if it gets enough scientists and doctors working on the problem.

Kellen

Hi pariah and Jim,

I certainly didn't mean to minimize and I apologize if it came off that way. In my humble opinion, saying that "mood swings" are Bipolar Disorder greatly diminishes the idea of the total destruction that Bipolar Disorder does to the client's life. I have worked with clients who have completely destroyed themselves financially or accumulated serious legal charges which are forever on their criminal record while manic. It destroys careers, marriages, friendships and families. It is a much more serious issue than mere "mood swings".

Pariah also makes a good point and perhaps "misdiagnosed" would have been a better term. I think a lot of PTSD is "misdiagnosed" as Bipolar Disorder and that the extremely painful emotions and emotional lability that go along with PTSD are simply medicated away with "mood stabilizers" rather than brought forth, experienced, processed and integrated. This condemns the patient to stay on psychiatric meds forever and allows the trauma to continue to dominate their life.

Correct diagnosis is important in order to prescribe the correct treatment. Bipolar medications work for Bipolar Disorder. When a chemical imbalance is the issue it takes medications to correct it. But these same medications only numb someone from all of their emotions (even happiness and joy) when the problem is trauma and don't allow the trauma to be processed and for healing to occur.

By the way, I recently saw an excellent movie, "Mr. Jones" which fairly accurately demonstrates manic episodes with the free wheeling spending, grandiosity, impulsivity and euphoria. See what you think...

Thank you both for your comments.

Christine-helen-clarke

All these drugs are dangerous,and sometimes are given to people without knowing the root causes for their illness.

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To blithely hand out this diagnosis and label people with "Bipolar Disorder" is at best irresponsible.

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ou are absolutely right. If you are succeeding, it's not faking it. And you are certainly succeeding! Work, college, leaving an abusive marriage, and getting financial stable - any one of these things is a major accomplishment and you have managed them all.

Rodninelan

I was diagnosed with bipolar disorder in my early twenties. I was actually given a blood test that tested for levels of some kind, it has been so long I really do not remember the specifics. I was put on lithium. I went off lithium within six months. My crazy family was ecstatic they finally had proof I was 'crazy'. I have never taken lithium in all these years (well over 20 years later). I have never had a manic phase in my life. I have had short bouts of being prescribed anti-depressants but the last time was over ten years ago when I briefly went on wellbutrin but didn't like that it seemingly affected my ability to concentrate. I am now in my mid-forties and have come to realize I have all the symptoms of asperger syndrome. This is after two and a half decades of knowing that *something* was wrong. However I have never been very emotionally demonstrative, dramatic, and certainly never been manic. The symptoms of asperger are somewhat different from psychological disorders, in particular I have face blindness, lack of discernment of subtext and all the other symptoms of someone with a very unsophisticated childlike mind in certain ways. So for the last five years I have been content to know I fell into the austism spectrum though there is no way I can afford the neurological testing for a diagnosis. However I recently re-experienced in memory a rape that occurred in very early childhood that I was unaware of (I was told of my internal scarring on my first visit to a gynecologist at the age of 18 but had no explanation for it). At this point it would not surprise me to find out my diagnosis is complex post-traumatic stress disorder as I have learned on autism forums that there is so much similarity between the symptoms of PTSD and AS that many people are diagnosed with both at one time or the other. It just never seems to be 'the end'...I just wanted to underscore what you have said about the over-diagnosis of bi-polar because many female autistics/aspies have been dx'd as bi-polar, borderline, whatever, before they even get an accurate diagnosis.

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