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 Marcia Purse

Is Bipolar Disorder Over Diagnosed?

By August 17, 2009

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In a public service announcement that airs pretty regularly on CBS, Mark Harmon shares statistics about bipolar disorder. One in particular is the fact that on average it takes 10 years from onset of symptoms for a person to be accurately diagnosed with bipolar disorder. We talk about this often in our forum discussions and Marcia, in her I’m Bipolar online journal, shares that she was diagnosed with depression years before bipolar disorder.

However, we don’t often talk about the other side of the coin – people being diagnosed with bipolar disorder who don’t actually have it. In recent years, this has been happening with more and more frequency. In June 2008, a research team headed by Dr. Zimmerman at Brown Medical School reported their findings in a study with 700 individuals who had previously been diagnosed with bipolar disorder. Using a self-administered questionnaire, Structured Clinical Interview for DSM-IV (SCID) and a review of family history, the research team found that fewer than half the patients actually had bipolar disorder based on these diagnostic tools.

In July 2009, the research team published a follow-up article regarding the actual diagnosis of 82 patients previously diagnosed with bipolar disorder. The vast majority – 68 of the 82 (82.9%) – had major depression. Other disorders found in this group included borderline personality disorder, anxiety disorders, impulse control disorders and eating disorders.

Amy Norton reported that in an email exchange with Dr. Zimmerman he expressed his concern regarding over diagnosis of bipolar disorder because “it is typically treated with mood-stabilizing drugs that can have side effects -- including effects on the kidneys, liver, and metabolic and immune systems” and “means some patients are likely not getting the appropriate care for the problems they do have.”

I’ve recently talked to a couple of people who have run into this. In each case, the person’s family doctor has insisted they have bipolar disorder without the use of any diagnostic tools. In one case, the person’s primary complaint was difficulty sleeping; in the other, the issue was anxiety. When you were diagnosed, did your doctor complete a full physical and psychological workup to support your diagnosis? ~ Kimberly

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August 18, 2009 at 7:21 am
(1) Chad says:

I really enjoy read your website for information, I’m also Bi-polar 1. It has really help me feeling that I am not alone in this twisted up world.

Chad Staurt

August 18, 2009 at 9:56 am
(2) Anonymous says:

I was diaagnosed as having BIPOLAR I at age 58 when all I had before was severe anxiety with panic attacks and dysthimia. They tried all sorts of medication on me – but they made me sicker. I think the reason was that insurance companies recognize BIPOLAR as serious but severe anxiety (to the point of being suicidal) as not that serious…..Having panic attacks for 50 years of your life severely diminishes the quality of your life – but is still not taken seriously by ANYBODY – they just say cognitive behavioural therapy will help (HAVE THESE PEOPLE EVER HAD A PANIC ATTACK?0

August 18, 2009 at 11:01 am
(3) Dona Wheeler says:

Yes, in my case 13 years on the drugs made me look bipolar, when I now now it was peri menopause, mercury dental fillings: being a superhypersensitive person. Far too many people are diagnosed and medicated, as I have watched in horror, to see anyone who does anything that is not “normal” lables as Bipolar, it fed my recovery, and my desire to see things brought to light, and improved upon from A to Z, in the shady world of mental health.
Lunitics are running the aslyam {sp]

August 18, 2009 at 11:31 am
(4) Anne says:

I think one of the reasons there is so much over & misdiagnosis of Bipolar Disorder comes from male doctors, psychiatrists and PCPs, who don’t fully understand why women act as we do. I also think that situational depression that occurs following traumatic events like divorce, sexual assault, and other family loss impacts how a diagnosis is determined. After being diagnosed 13 years ago with Bipolar 1, I’m still skeptical that I was given the right diagnosis.

August 18, 2009 at 11:33 am
(5) kittyhawk says:

Obviously, its a bad thang to misdiagnose someone-but Im more concerned about that large body of the population who is being undertreated for mood disorders. These sorts of articles concern me, because I fear more people will have to suffer for longer periods of time without a necessary mood stabilizer…guess we need more docs that are trained and familiar with mood sprectrum disorder diseases and less professionals who are unqualified treating these very serious and complex disorders.

August 18, 2009 at 12:50 pm
(6) Lara says:

Kittyhawk,you are so right. Just as gay people find closets, so do mentally ill people. Comments like this hurt. I wish I could shrug off my diagnosis,but I can’t.

August 18, 2009 at 2:05 pm
(7) kimberly says:

holy god. I lived my whole life terrified of ending up in a psychiatric hospital if anyone ever knew what was actually going on in my head. It took 2 stays to finally be diagnosed bipolar at 39- I can’t count how many times and ways I’ve tried to kill myself. I’m amazed I’m alive. The ONLY thing that keeps me that way is lithium. My treatment is not perfect, but the ONLY thing that makes me not want to off myself is lithium. I have to fight suicidal urges even while taking it as prescribed. I don’t know what the answer is, but scaring people by telling them they may not be bipolar seems counterproductive to me.

August 18, 2009 at 5:57 pm
(8) psalm139:7_10 says:

I was taking meds for anxiety & depression and seeing a therapist for 4 years, when I completely lost it for a day and a half of my life. Woke up in a mental ward, scared to death, couldn’t remember anything that had happened, and the other patients said when they brought me in from the ambulance they thought I had killed somebody, I looked so crazy! I was 45, and the bipolar diagnosis and meds scared me and saved my life. It’s been 9 yrs., but I’m kind of glad the onset was so dramatic, cause I’ve never doubted the diagnosis, or wanted to try not being medicated. I so think some people wonder if they bp, or if their kids are, but if they’ve never experienced true mania, they have no idea!!!

August 18, 2009 at 6:24 pm
(9) Gail says:

My daughter spent a year in hell after being misdiagnosed as BPII. The first clue that she wasn;t should have happened after doctors realized BP meds were doing more harm than good. The good news is she has been diagnosed with “possible” ADD and dysthymia. She now takes concerta and is coming back to me as the daughter that went away for awhile but now is back.

August 18, 2009 at 11:12 pm
(10) Meghan says:

I was first diagnosed with depression only. It was after a suicide attempt when I was 15. In my early 20s was diagnosed with social anxiety disorder (true) and a kind of OCD due to the symptom of disturbing intrusive repetitive thoughts (turned out what they were were hypersexual racing thoughts). In my mid 20′s I went to my family physician and said, “I can’t sit still, my thoughts are going a mile a minute, and I can’t sleep. Something’s not right.” She suggested bipolar disorder. It is in the family, along with depression and anxiety disorders. My family doc tried to treat me with 300mg of Zoloft (crazy, I know) that sent me into a mixed episode. By the time I made to the psych unit and was seen by a psychiatrist, I was in the depressive phase of the cycle. I think that my case was pretty straight forward. I think the highs were missed because they presented as hypomania in the beginning and only helped me get excellent grades and be more creative and sociable. Since then I have experience manic episodes with serious euphorias and delusional memories. All my symptoms exist when a mood episode is occurring, otherwise I am myself.

August 19, 2009 at 4:59 pm
(11) Derald says:

I have long believed that Bipolar Disorder has been under diagnosed. You have to look at this in the light of generations. My grandfather showed all the classic signs of Bipolar disorder, but never went to a doctor for ANYTHING! That was his generation and some of the present day statistics are based on that generation. My father and uncles ALL had the classic symptoms that are easy to see, yet when their doctors told them they should see a psychiatrist, they all said NO because in that generation the labeling of Manic Depression was one that made people avoid you and talk about you! These were also another generation of misleading statistics because of “Labeling”. Now we have our generation that seem to have a more “mature” attitude about seeing a psychiatrist, and doctors have a much better description of the illness in all of it’s phases. Put this all together and I think the illness is now being more accurately diagnosed along with a new generation that have less of a problem seeing a psychiatrist. Remember this, my doctor took a very long time to make sure before he gave a diagnosis of B/P. He told me that once someone is diagnosed, your whole life will change, such a insurance, employment, etc… I think the stats are more accurate NOW than THEN!

August 20, 2009 at 12:56 am
(12) ragewithin1954 says:

I think its being too widely diagnosed. What I don’t understand is how can it take 50 years or 40 years before someone is diagnosed with a problem.I am almost 55 and been in treatment since 14 Yrs old…true, an accurate diagnosis wasn’t made but the shrinky dinks from way back did know I had something wrong..It wasn’t until the last 20 years that BP was starting to come around. Nowadays its like people are waking up some morning and going ” Oh I must be mental” run out, find a pdoc and all of a sudden…Bammmm BP…I don’t get it…

October 30, 2011 at 10:20 am
(13) lia says:

you should consider yourself lucky that you received treatment at such a young age. I think I have had bipolar II symptoms since i was a teenager, but was not properly diagnosed until i was 30. if someone suffers from bipolar II, the manic phases are not psychotic like they are in bipolar I, therefore, a person can manage somewhat successfully for years without treatment. people that suffer from bipolar II have hypomanic phases that cause not only an increase in energy, racing thoughts, increased creativity, but also a distorted sense of self image, and issues with anger and irritability. since it does not include psychotic breaks with reality like with the manic phase of bipolar I, it is easily misdiagnosed. many people with bipolar II suffer more from depression than hypomania. a good book to read about why and how bipolars can go for years without or with a misdiagnosis is: bipolar II: enhance your highs, boost your lows, and escape the cycles of recurrent depression by ronald fieve. he explains very well how bipolar II can be easily and frequently misdiagnosed.

as an after thought, perhaps the diagnosis is so prevalent now because there are diagnostic criteria. it’s like with cancer: is it really more prevalent now, or do we just have a better ability to diagnosis it?

August 20, 2009 at 9:43 pm
(14) robbi says:

I was diagnosed when I was about 24, I am now 46. It took alot of time and pain before I got diagnosed. I was hallucinating and had panic attacks. I also felt like hurting my child. I started hallucinated about God telling me to kill my child like Abraham almost did with Isaac. Finally I went to my therapist and tried to tell her what I was going through. I was finally put in the hospital when I cleared her desk. It is hard to get some people to understand.

August 21, 2009 at 2:17 pm
(15) LJ says:

“A self-administered test was used” – Really! One of the most common secondary symptoms of BP is denial and anosognosia – BP people are usually very sharp and can easily answer such atest to get the result that they want – I’ve seen it happen where my wife who is 100% BP-1 persuaded her MD that she was not based on a standard self-administered questionnaire – That led her to being put on completely the wrong medication, a HUGE manic attack followed by hospitalization.

In answer to another comment – Yes women ARE different but many mental health professionals are female – Yes women are affected by hormones etc but those things merely serve to trigger the underlying BP condition if it is present – They do not CAUSE the behavior – See Dr Christiane Northrup’s book “The Wisdom of Menopause” and read the piece in there on “Raging Hormones”

November 9, 2009 at 11:49 pm
(16) NL says:

I think the key thing said in the end of the article was FAMILY DR diagnosed. From my experience, it was my GP and then a series of Mental Health APRN’s that diagnosed me with GAD and threw antidepressants at me and sent me on my way. The biggest problem is that people feel bad and want a pill to make it go away, and a lot of Dr’s just give it to them. Same reason why so many antibiotics don’t work anymore…patient demands a pill when it is not necessary, and the drs comply.

I was misdiagnosed for years and at one point was on 3 antidepressants at the same time, and felt lower than low…until I totally unraveled and found a psychiatrist that actually spent more than 5 minutes with me. NEVER, ever would have believed I had bipolar until I was taken off antidepressants and put on lamictal. What a difference it made in my life – night and day. BTW, I wasn’t diagnosed until age 44. In my case, my mania is mostly the sleeplessness, racing thoughts, and extremely irritable..not the high “I can do anything”, impulsiveness – and I hang in the depressive state much longer. Bipolar is not the same for everyone, which is what I thought before being diagnosed. I was also diagnosed with ADD (not ADHD) at the same time, and I am new person on my meds.

My psychiatrist told me that 70% of the time, bipolar is misdiagnosed as depression…and in some cases, like me, antidepressants make you worse. I think about that everytime I see those drug commercials that ask if you still have symptoms of depression while being on meds. Misdiagnosed perhaps? Would also make sense when they say a side effect of a depr. med is suicidal thoughts…because I sure had them on antidepressants…but not anymore with my bipolar med.

June 18, 2010 at 4:15 am
(17) Sherlin says:

The issue of diagnosing bipolar disorder is a very difficult one. There are, basically, two types of bipolar, I and II. I is the one that is (manageable( for a lack of a better word. II is more difficult, as the sufferer shows high bouts of mania and depression. Bipolar disorders could be very well entrenched in a depression disorder, so a practical course of action would be to treat depression and see how the patient would respond. Depression and bipolar disorders show a very unusual and dysfunctional neurotransmitter levels. Cortisol levels, also could play a key role in both disorders.

July 8, 2010 at 6:40 am
(18) Patti says:

I’m 67 and was diagnosed as having bipolar mania since age 55 (the age I no longer had periods). I’ve had 4 Episodes since age 55 and they occur every 3 years and truly feel I was misdiagnosed bipolar – should have been labeled as going through menopause instead. Have always been “up” and never depressed and have been treated with Depakote all 12 years. I have decided to stay with the Depakote, but to daily also add several wholistic remedies that promise to help my condition mmensely. My doctor has approved adding these natural supplements to the 500 mg. of Depakote and will also continue to check my Depakote level by way of a blood test periodically because I, too, was concerned about possible liver and kidney failure with Depakote.

March 30, 2013 at 9:16 am
(19) Someone says:

Misdiagnosis does occur. I was inappropriately put on Wellbutin (for smoking cessation, not depression), Ultram, a pain killer which has major drug interaction warnings with the Wellbutrin, and Voltaren, an anti-inflammatory – I was put on the latter two meds due to a “bad fix” on a broken ankle. Actually, I was put on this entire bad drug cocktail by a paranoid and unethical PCP who wanted to proactively prevent a malpractice suit because her husband, it turned out, was the “attending physician” at the “bad fix.”

Wellbutrin and other antidepressants now have black box warnings claiming they CAUSE mania. I had withdrawal symptoms from Wellbutrin, worsened by the major drug interaction with Ultram, and ADRs from the Voltaren misdiagnosed as bipolar. And according to the DSM-IV-TR, bipolar is NOT a correct diagnosis if the person is suffering from withdrawal or ADRs from other meds when initially seen. A psychologist misdiagnosed me, and demanded I see a psychiatrist. He went along with the misdiagnosis, gave me a neuroleptic, which resulted in a “Foul up.” The story goes on to tell the tale of the for-profit only hypocritical bottom feeders of humanity.

I recommend a couple books for anyone diagnosed with bipolar, or any “mental illness”: “Mad in America” by Whitaker and “Medication Madness” by Breggin. They’re mandatory reading for anyone labeled with a “man-made disease.”

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