"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.