Bipolar Disorder Overdiagnosed?

Study Shows Many People Who Are Told They Have the Disorder Don't Meet Standard Criteria

(WebMD)  Many people who have been told by their doctors that they have bipolar disorder don't really have it.

So say researchers who used a standardized, comprehensive, psychiatric diagnostic interview to evaluate 700 adult psychiatric outpatients.

About 20% had previously been diagnosed with bipolar disorder. But only 13% met the criteria, says Mark Zimmerman, MD, associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University in Providence.

"In about half of patients previously diagnosed with bipolar disorder, we couldn't confirm the diagnosis," he tells WebMD.

There are real dangers to overdiagnosis, chief among them unnecessary exposure to mood stabilizers and all their powerful side effects, Zimmerman says. There's also the stigmatization of having a serious, possibly lifelong mental illness.

The study is being published online by the Journal of Clinical Psychiatry and presented at the annual meeting of the American Psychiatric Association.

Why Is Bipolar Disorder Overdiagnosed?

Bipolar disorder used to be called manic depression because it is characterized by bouts of depression and bouts of mania. Patients experience dramatic mood swings between euphoria and severe depression; they may have hallucinations or delusions.

Patients with anxiety , agitation, irritability, and restlessness that does not persist are sometimes misdiagnosed with bipolar disorder, Zimmerman says.

"These could be symptoms of bipolar disorder. But they really have to be accompanied by other criteria, such as hyperactivity, feeling energetic despite just a few hours of sleep, or inflated self-esteem," he says.

Ironically, one reason the disorder is being overdiagnosed is "because so much has been written about it being under-recognized," Zimmerman says.

"It's difficult to go to a lecture on bipolar disorder that doesn't begin with, 'Make sure you don't miss...,'" he says. "So clinicians are loathe to miss it."

The increased availability of medications for the treatment of bipolar disorder may also play a role in overdiagnosis, Zimmerman says.

"Physicians have a tendency to diagnose something that they feel they comfortable treating," he says.

So what should you do if you think you've been misdiagnosed with bipolar disorder?

"If you're at all uncertain about the diagnosis, speak to your doctor and make sure you understand why you've been given that diagnosis. If you remain unconvinced, get a second opinion," Zimmerman says.

What you shouldn't do, he stresses, is just stop taking your medication.

Children Misdiagnosed, Too

For the study, psychiatric outpatients completed a questionnaire that asked whether they had ever been diagnosed with bipolar or manic-depressive disorder by a health care professional.

Then, without knowing the responses, the researchers used a tool called the Structured Clinical Interview for DSM-IV (SCID) to determine if the patients met the criteria for bipolar disorder.

"The standardized nature of the SCID interview forces the clinician not to miss things that could be missed in an unstructured interview," Zimmerman says.

National Institute of Mental Health Director Thomas Insel, MD, says misdiagnosis of bipolar disorder is a problem in children as well as adults.

"In children, it can be even more difficult to recognize and diagnose because it does not fit precisely the symptom criteria established for adults," he tells WebMD.

[cajetano]

I can smell some pharmaceutical involvement in this picture. With each new medication that''s pushed out, doctors must find more guinea pigs. It''s not about your health, it''s all about fattening that bottom line $$$$$$$
What a sorry state, err I mean nation.

[susanh6]

That%u2019s a most amazing statement: (Dr. Zimmerman: %u201CPhysicians have a tendency to diagnose something that they feel comfortable treating." ) It seems to be true in my experience, and if physicians are taking the easy way out and diagnosing what is comfortable to treat then that is blatant malpractice. I have seen several children misdiagnosed as ADHD because it is easier to treat and monitor, rather than the bipolar meds with labs and complicated side effects. The fact that the diagnosis is wrong and the ADD meds only serve to make the child worse is of no concern to these doctors. One of the more honest doctors I have met said once, when asked to take on a child already diagnosed as bipolar, %u201CI don%u2019t do bipolar; I have too many grey hairs already.%u201D Honest, but no more true to decency that the others who can%u2019t be bothered doing careful diagnosis and treatment. This survey?You can''t UNdiagnose bipolar disorder with a questionaire--it''s a cyclical illness and diagnosis needs long folllow up, often involving the family or friends of the patient. The underdiagnosis of bipolar disorder occurs with this little canned survey type of thinking.

[valentin73]

Not only that, but the few people that are seriously BD diagnosed are NOT given proper treatment. More needs to be done with patients who do suffer from this dreaded disease, perhaps mandating them, much like a criminal offender, to undergo continuous psychiatrict treatment (and that includes proper medication maintenance).
My ex-girlfriend is diagnosed with BD and had stop taking her medications before I started seeing her. She literally went ballistic on me one day over a comment I made while we were having dinner in a restaurant...had she had a handgun in her possession, she would have emptied it on me.

[carlylaine]

Doesn''t misdiagnosis boil down to money and fancy vacations? Sure it does.

[extremophil]

You know what else is waaaaay overdiagnosed, Mr WebMD?? PTSD!!!

We could sure use some competent practitioners these days.

[tangledsynap]

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.

[tangledsynap]

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.

[tangledsynap]

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.

[Syndicate]

How funny. Someone is going to ask me a bunch of questions which I may or may not answer honestly and tell me whats wrong with me. With a little research and balls I bet you could get some cool meds.

[cyberus-2009]

Anything that allows for a *fuzzy diagnosis* AND requires expensive daily medication is over diagnosed.
How do you think that big pharma keeps their profit margin so high year after year?

[jnr1005]

I think you''re getting bipolar confused with multiple personality disorder dragonwagon...