Bipolar disorder is difficult to diagnose. There is currently no definitive medical test for this disorder. Furthermore, there are a number of physical conditions and quite a few psychiatric disorders which present symptoms that can be confused with those of bipolar disorder. And just to complicate things a bit more, a great many psychiatric disorders can occur in tandem.

Mark Zimmerman et al with Department of Psychiatry and Human Behavior at Brown University School of Medicine discuss this in an article, "Performance of the Mood Disorders Questionnaire in a Psychiatric Outpatient Setting," published in the November edition of Bipolar Disorders. "Bipolar disorder is a serious illness resulting in significant psychosocial morbidity and excess mortality. During the past few years a series of research reports, reviews, and commentaries have suggested that bipolar disorder is under recognized, and that many patients, particularly those with major depressive disorder (MDD), have, in fact, bipolar disorder. Even for those patients diagnosed with bipolar disorder, the lag between initial treatment seeking and the correct diagnosis is often more than 10 years."

To facilitate and improve the diagnosis of bipolar disorder, researchers and practitioners have developed a number of screening questionnaires and assessments. One of these is the Mood Disorder Questionnaire (MDQ) developed by a team of psychiatrists, researchers and consumer advocates led by Robert M.A. Hirschfeld with the University of Texas Medical Branch. The MDQ is one of the most commonly used of these assessment tools. You can view the full questionnaire on the Depression and Bipolar Support Alliance website.

Unfortunately there is growing evidence that the utility of the MDQ might not be as strong as is needed for accurately diagnosing bipolar disorder. In the most recent research report about the MDQ, Mark Zimmerman and his team found the results of this questionnaire to be more limited then initial research indicated. "A screening measure needs to have high sensitivity, and each of these three studies found that the sensitivity of the MDQ was less than 70% when the scale was scored according to the developers recommendations."

So what does this mean for us? It means that we shouldn't accept a diagnosis of bipolar disorder based on a brief questionnaire. If your doctor or a therapist uses the MDQ or another similar screening tool, you should simply consider this a starting point towards an accurate diagnosis. Your physician should proceed with a full clinical evaluation for bipolar disorder. How Is Bipolar Disorder Diagnosed? discusses what this process involves. ~Kimberly

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I read a comment this evening that really struck me. In response to Marcia's Addictive Personality blog, Sarah brought up the topic of avoidance - what she termed an escapist personality.

"I have an escapist personality, not an addiction. My escapist personality causes me to sabotage regular activities like going for coffee with a friend, turning off my phone and ignoring/avoiding life.

"I can get into a book and days will pass without a shower or a proper meal. I can watch 8 movies in a day. I can sleep for 18 hours at a time and feel absolutely guilty about all of the above. But that won't stop me from doing it again and again."

I think Sarah has expressed a common theme for those with bipolar disorder, with any severe mental illness really. Avoiding ... attempting to escape those situations or things that make us uncomfortable. Do you actively avoid normal life activities? Do think you think it is a viable coping strategy or more maladaptive behavior? I tend to lean towards maladaptive behavior.

There are certainly some specific situations that are in our best interest to avoid - drunk dialing your boss, streaking through the neighborhood park, spitting on a cop. However, facing something that makes us uncomfortable and expanding our comfort zone is a growth point. I know! Easier said than done.

Sarah shares, "I want to know if others out there feel like they sabotage their happiness and what I can do about it." Thoughts? ~Kimberly

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For those who have been following the anti-stigma campaign of BringChange2Mind, Glenn Close and her sister, Jessie Close as well as other members of the BringChange2Mind.org team will be on NBC Nightly News TONIGHT, Wednesday, November 11, at 6:30PM EST.

Beth Lee, commenting on our blog Stigma - A Toxic, Deadly Hazard to Be Eliminated shares, "I was able to see Glenn Close and her sister interviewed on The View. It was an excellent interview. Glenn Close said that there was a history of bipolar and other mental illnesses in her family. They asked her if she had ever had symptoms herself. She said it has affected her in the form of perfectionism. One can tell she and her sister are very close and they support one another. Her sister also mentioned that a person with bipolar has to accept some side effects from the medications and that it may take a while to get the right combination of meds to help."

Miss the interview? It is available from NBC Nightly News. If you catch this interview or another, share your thoughts. ~Kimberly

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There are lots of legitimate reasons a doctor may refuse to treat a patient, ranging from unpaid bills to insurance problems to realizing a patient is falsely complaining of pain only to get prescription drugs. A patient who is disruptive or hostile, or who demands a treatment the doctor believes is not what that patient needs, may well find that the doctor will not continue treating him or her.

Then there's the patient who is non-compliant with treatment. In her article Doctors Reject Difficult Patients, Patient Empowerment Guide Tricia Torrey gives the example of an overweight woman with diabetes who makes no effort to lose weight, which is critical to her health. Are psychiatric patients any different?

Many of you have talked about this in our forums. You believe that a drug is not helping you, or the side effects are too difficult, and stop taking the drug without your doctor's approval. Whether you find you were right or wrong about the problems, your doctor may simply feel you are uncooperative and refuse to continue seeing you.

Some of you say that your doctor is arrogant, believing that the drugs prescribed are the only ones that are right for you, no matter what you say. Tricia has written guidelines for dealing with arrogant doctors that may help you.

But sometimes a doctor will refuse to see a patient who never understands why. Do you see yourself in any of these common doctors' complaints?

If you've had a doctor "fire" you, what was the reason? And were you better or worse off afterward? Leave a comment and tell us your story.
~Marcia