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Why Bipolar Disorder Is Often Misdiagnosed

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Bipolar disorder is missed in some people and mistakenly diagnosed in others. Find out why.

About four percent of people in the United States arediagnosed with bipolar disorder at some point in their lives, according to the Centers for Disease Control and Prevention. In recent years, however, some researchers have called some of those diagnoses into question, while others have maintained that the number of people with bipolar disorder is actually greater.

In 2008, the Journal of Clinical Psychiatry published a study that suggested bipolar disorder is often diagnosed in people who don’t actually have the condition. The researchers determined that fewer than half the people in the study who said they had been diagnosed with bipolar disorder met the clinical criteria for the illness, which causes severe swings in energy levels and mood.

Mark Zimmerman, MD, the lead researcher on that study and a professor of psychiatry and human behavior at Brown University in Providence, Rhode Island, says the study also revealed that some people who met the criteria for bipolar disorder had never been diagnosed with it. But far more people had been given the bipolar label by mistake, he says. Dr. Zimmerman believes part of the reason for this overdiagnosis trend is aggressive marketing to doctors by companies that produce the drugs used to treat bipolar disorder.

“When a pharmaceutical company repeatedly says, ‘Don’t miss bipolar disorder, don’t miss bipolar disorder, and when you diagnose it, here are some medications you can use to treat it,’ there’s a tendency to expand the concept,” Zimmerman says. He says he’s replicated the 2008 findings of overdiagnosis in a more recent study that has not yet been published.

In addition, Zimmerman says, bipolar disorder shares some symptoms with borderline personality disorder, a condition marked by impulsive behavior and problems relating to other people — and because of this, people who have borderline personality disorder are often misdiagnosed as bipolar. Indeed, a review published in The Scientific World Journal in 2013 pointed to borderline personality disorder as a factor in the overdiagnosis of bipolar disorder

People misdiagnosed with bipolar disorder may experience health setbacks as a result of the drugs used to treat it. Medications including atypical antipsychotics can increase the risk for high cholesterol and diabetes, Zimmerman says. Some have also been linked to thyroid and kidney problems, he adds.

Up to 20 percent of people with bipolar disorder may be mistakenly diagnosed with depression by their primary care doctors, according to a study published in theBritish Journal of Psychiatry in 2011. A study published in Acta Psychiatrica Scandinavica in February 2013 found a gap of almost 10 years, on average, between the participants’ first onset of bipolar symptoms and their first treatment with a mood-stabilizing medication

These findings aren’t surprising, says Jeremy Schwartz, a psychotherapist in Brooklyn, New York. Bipolar disorder can be hard to diagnose, he says, because people often seek professional help only during their down periods and neglect to mention their up, or manic, periods.

“The manic side of bipolar disorder isn’t always bothersome to people,” Schwartz says. “They have more energy, more motivation to do things. So the mental health professional doesn’t always hear about it.”

As a consequence, Schwartz says, those with bipolar disorder are often misdiagnosed with depression and may be given inappropriate treatment.

“When bipolar disorder is missed, people can be put on medications that actually worsen the manic symptoms,” Schwartz says. “So people end up waiting much longer to get the stability in their life that they’re looking for.”

What You Can Do

The debate over diagnosing bipolar disorder may seem like an argument best left to the medical community, but people who are wondering whether they have the condition can take steps to increase their chances of receiving an accurate diagnosis. When seeking help, it’s important to talk with your doctor about all of your emotions, Schwartz says, the good ones and the bad ones. “It helps to create a fuller picture of your experience,” he explains.

If you receive a diagnosis of bipolar disorder that you aren’t sure about, Zimmerman says, feel free to ask your doctor about his or her reasoning.

“Ask the doctor why they have made the diagnosis,” Zimmerman says. “A good doctor should be willing to discuss the reasons and to explain if they’re uncertain about it.” If you don’t receive satisfactory answers, he adds, an opinion from another doctor may be in order.

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