I continue to see numerous clients who have been diagnosed with Bipolar Disorder and placed on medication. They often complain of "mood swings" and state this as the reason for being "Bipolar". Yet when I talk to them I find that what they often are is "emotional". This emotionality can be the result of circumstances in their lives (divorce, death of a loved one, job loss) or from a diagnosis other than Bipolar Disorder. What are these diagnoses and why does this trend to overdiagnose and medicate for Bipolar Disorder concern me?
First of all, let me say that mood swings are normal. Human beings have moods and those moods change, sometimes many times during a day. (See my article, "Mood Swings are Normal" for more on this topic.) At what point do mood swings become "abnormal" and need treatment?
- If your mood swings are unpredictable or seem disproproportionate to the situation
- If your mood swings are threatening your relationships, education, employment or other areas in your life
- If your mood swings are out of your control
- If your mood swings are disrupting your normal functioning, such as sleeping, eating and other self care
The next thing to consider is whether your mood swings are the result of circumstances in your life. If you have recently lost a loved one or experienced a traumatic incident your "mood swings" might be a natural emotional reaction to what you have experienced. Why is this important? Because a normal emotional reaction should not be medicated. It should be experienced. If your emotional response to a situation is threatening your well-being, counseling is indicated to help you adjust to the situation. You do not need to be put on a class of medications (mood stabilizers) which comes with serious warnings and maintained on them for the rest of your life.
If your mood swings are not a reaction to a recent circumstance or situation they could still be something other than Bipolar Disorder. Several psychiatric disorders include symptoms of emotional lability or affective instability (mood swings which are very intense or out of control). The entire diagnostic criteria for each disorder is not listed here, only the emotional criteria. If you click on the name of the disorder it will take you to a page with the entire diagnostic criteria.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria (depression), irritability or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness, worthlessness.
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Rapidly shifting and shallow expressions of emotions.
Other Disorders vs. Bipolar Disorder
Notice that the other disorders do not have a time constraint upon them. This is the important difference between them and Bipolar Disorder. Bipolar Disorder requires that you experience a given mood for at least 1 week and if it's a depressive episode, 2 weeks. Many people I am working with tell me that their moods change "by the minute" or they "suddenly go 'off'". This is not Bipolar Disorder. Manic and Depressive episodes last at least one week and often much longer. See the criteria below for more information.
Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
Criteria for Mixed Episode
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
Criteria for Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
The "mood swings" of Bipolar Disorder are much more severe than average mood swings and last for a significant period of time. The severity and duration of these mood swings can completely and utterly destroy an individual's life. The only treatment for true Bipolar Disorder is medication. It is a biochemical problem and no amount of counseling will rectify it.
By contrast, the other disorders listed above are biochemical by nature and do not respond to medication. They require counseling. This is an important difference. If you have tried several medications and are not responding to them you might be suffering from another, less popular, diagnosis, one which does not respond to medication.
Why do I keep harping on this subject? For two reasons:
- Emotions should not be medicated just because they are uncomfortable. Humans need to experience normal amounts of grief, sadness, loss, frustration, disappointment and anxiety. This is how we grow. This is how we develop coping skills for working through future hurts and losses.
Mood stabilizers (the medications prescribed for Bipolar Disorder) are not in the same league with other psychotropic medications. These are serious medications with serious health risks which often are not adequately explained to the patient.
- The treatments for the various disorders are completely different. By labeling someone's "mood swings" as Bipolar Disorder and placing them on medications, one is denying them the proper treatment if they are actually struggling with trauma or a personality disorder.
Why is Bipolar Disorder overdiagnosed? There are many factors which can be examined here in totality, but I will list a few.
- The Influence of Big Pharma
The pharmaceutical industry profits from people using their latest medications, one class of which are the "mood stabilizers". This class of drug is highly marketed to psychiatrists and has a lot of advertising and money behind it. Counseling does not.
- The Insurance Industry
The insurance industry does not typically cover treatment for personality disorders, and sometimes not even for trauma. It prefers to focus on illnesses which fit within the "medical model".
- The Medical Model
In the United States, psychiatry is heavily influenced by the American Medical Association and the "medical model" of treating psychiatric disorders. This includes diagnosing and medicating rather than psychotherapy or counseling.
As a client or patient struggling with out of control mood swings it is important to educate yourself. Know the criteria on which diagnoses are based and decide for yourself which one is the best fit. Educate yourself about the medication you are being prescribed. And most importantly, trust your gut instinct. If it feels wrong for you, it probably is.
Read more about "Mood Stabilizers for Bipolar Disorder".
Read all of my articles about Mood Stabilizers.
Read my article, "The Medical Model for Treating Psychiatric Disorders".