The Dangers of Misdiagnosing Bipolar Disorder
Bipolar disorder has the simultaneous problem of being both underdiagnosed and overdiagnosed. While there’s little literature on overdiagnosis, what is clear is that the right people aren’t getting the right diagnosis all of the time. And while no one wants a false positive when diagnosing a mental illness, it’s also absolutely imperative that a diagnosis of bipolar disorder not be missed.
And unfortunately, all too often, bipolar disorder is misdiagnosed as Dr. Prakash Masand, CEO and Founder of Global Medical Education, says, "Missing the diagnosis of bipolar illness is all too common in clinical practice with devastating consequences for patients and families."
Misdiagnosis of Bipolar Disorder
In Misdiagnosis of Bipolar Disorder, published in Psychiatry (Edgmont), authors Dr. Tanvir Singh and Dr. Muhammad Rajput report that:
- 69% of people with bipolar disorder are initially misdiagnosed
- More than 1/3 of patients remain misdiagnosed for 10 years or more
- On average, patients remain misdiagnosed for between 5.7-7.5 years
- Rates of misdiagnosis do not appear to be getting better
And the effects of misdiagnosis can be life-threatening.
Effects of Bipolar Misdiagnosis
About 40% of people with bipolar disorder are initially misdiagnosed with unipolar depression (myself included). This type of depression is normally treated with antidepressants. Unfortunately, prescribing antidepressants alone to a person with bipolar disorder can be disastrous. Antidepressants can send a person with bipolar disorder into hypomania, or, worse yet, a life-threatening mania. Antidepressants can also make a person with bipolar disorder cycle from depression to mania over and over again – a condition that is very difficult to treat.
Doctors Singh and Rajput note that other impacts of misdiagnosis include:
- Incorrect treatment and delay in effective treatment
- An increase in the chance of recurrence and a worsening of the disease; more chronicity
- Increased healthcare costs
- Increased suicide attempts
Reasons for Bipolar Misdiagnosis
Some of the reasons people with bipolar disorder are misdiagnosed are easily addressable while others are more complicated. Likely, bipolar disorder is missed due to lapses in patient history-taking. According to Masand, "A family history of bipolar disorder is a huge red flag for bipolarity in patients presenting with depression, but a thorough history must be taken in order to find this flag."
The limitations of diagnostic criteria are another reason bipolar may be misdiagnosed as is the presence of psychiatric and medical comorbidities – which are common. Finally, Singh and Rajput estimate that 50% of people with bipolar disorder are initially treated before their first manic or hypomanic episode has occurred – making an accurate diagnosis of bipolar disorder near on impossible.
Avoiding Bipolar Misdiagnosis
Misdiagnosis can be avoided and lives can be saved, but not without the help of conscientious physicians. The first step in avoiding misdiagnosis of bipolar disorder is thorough and accurate history-taking and this can be improved by talking to the family members of the person with the mental illness – a step that is often not taken. Family members can be in the best position to talk about symptoms, both current and historic, as they see them from the outside.
In addition, careful screenings for co-occurring disorders such as substance use disorders must also be a priority as should screening for hypomanias, which can be often overlooked by the patient but should never be by the physician. Patient education can also improve screening as the patient learns what to look for in themselves. According to Masand, "Psychoeducation should be an integral part of treatment for all bipolar patients but it rarely is."
New diagnostic tools such as brain scans will hopefully improve our accuracy in the future, but until they become routine practice, it’s critical that patients be diagnosed carefully and considerately as an inaccurate diagnosis can literally change the course of a person’s life.
Author: Natasha Tracy
Of course, I can't say what your diagnosis might be and no one can unless they are your doctor. What I will say is that bipolar disorder _is_ a mood disorder. You may wish to look into the specifics of whatever your diagnosis is and discuss any concerns with your doctor.
- Natasha Tracy
Actual bipolar disorder - is a very UNCOMMON medical condition.
It used to be, until psychiatrists led by Big Pharma created new categories because drug patents expired and they needed to drug folks like her (antipsychotics, what has disabled her and manipulated her into her "bipolar 2" label), and those like you if you are not educated and smart enough to seek alternative soutions. Be smart.
Research. I actually do have a history of the illness Manic Depression and have been helped to heal.
PTSD is NOT undiagnosed bipolar - don't listen to this misinformation, there are many things that can help you.
There are MANY causes of mood disorders.
Take charge of your health. Heal, find ways to be well.
I won't self promote - this comment may be deleted as I am stating the truth they can't deal with...
You are welcome to read Molly's opinion and agree or disagree, but please understand she seems to have a personal issue with me and you should take her thoughts in that light.
- Natasha Tracy
The side effects of the medications include weight gain, urination in sleep ,and sleeping during class (pretty embarrassing) as well as slurred speech. This ruined the first part of my life, but I know enough not to linger on past events. With proper inspiration anything is possible, even changing your future.
I am 49 years old, all my life iI have suffered from depression, and bouts of mania all my life I have tried suicide twice and when in a depressed state think of it daily. I am in a deptessed state at the moment there is no ryme reason but I get aggitated and angry and sometimes i throw things i am not violent to others but verbally i can be vile. I went to my go a year a go saying i can no longer cope before this i found it hard to accept choosing to stduggle on with what i can only describe a living hell for me to accept I have a problem takes a lot of courage my mother came with me to have my assesment voicing her concerns that she thought i was bipolar. I was sent a letter say they did not think my symptoms were that of bipolar I have done much research and I know that this is the case and just want answers while i mask it well changing my train of thought this is both tiring and deblitating for me. Now I find i can no longer do this emotionally or physically I need help and quickly and i am scared for my well being. After this asesmentvI was offered cbt workshops but suffering from a bad bout of depression and anxiety i as unable to attendwhen i finally rang for help i found they had discharged me again i returnedcto my gp with suicidal thoughts I have just had another assesment to be told that i have to attend cbt workshops i am so frustrated Why wont anyine listen to meU am so scared because of the way im thinking i want to end my life coz noone listens whats the point when noone will help i can not di group therapy becauae of my anxiety. So again i will not go I have contacted mind i am desperate i feel i need to be sectioned why wont no one help me what do i have to do to make everyone listen attemp suicide again no wonder people take their own lives the system letscthem down.
I'm sorry people aren't listening to you. I know how difficult that is. If you feel you need to be in a hospital, walk into a hospital and tell them so. Tell them that you feel you are a danger to yourself and that if you're not put into a safe space you're worried you may die. I have done this. It's not easy, but if you say that you are a danger to yourself, they should not turn you away.
You may also want to call your country's helpline which I believe you'll find here: http://www.suicide.org/hotlines/international/netherlands-suicide-hotlines.html They list interantional suicide hotlines so you can always find yours there (I believe there is online chat at your country's site as well.)
Please reach out in one of these ways for help. People will help you. I know that hasn't been your experience so far, but there are others out there who will.
- Natasha Tracy
We stop attentrol 40 mg & giving resperidone 1mg as per previous doctor advice.
But still we can see mode swings,aggressive & crying sometimes .Pls help
I'm beyond trying anymore. I'm left to ride the dark waves till I crash on the shore.
Here we are 5 years later and I actually have borderline personality disorder, not bipolar. How did you mix the two up?
I started on an antidepressant which swung me into hypomania immediately after. I thought I was miraculously cured.
Then came the subsequent crash, and the rises and falls until my hospitalization.
I said it was likely I had bipolar from the get-go, but the doctor refused to listen. Only after my second hospitalization did he admit that I "maybe had cyclothymia" (which is also a misdiagnosis).
My current psych understood me within 5 minutes of meeting me. I described my history and symptoms and treatment from the other psychiatrist, and he said that I had been treated wrong from the start.
I have Bipolar II with rapid cycling and mixed states (which I guess could also be bipolar I). I am on medications which have helped me to control my moods, and it's thanks to a proper diagnosis.
Sorry your all ill but at least im not on my own any more, you all totally get it. Very weird that no One understands me for years but here reading other posts your just the same.
I thought everyone had violent mood swings, bouts of intense agitation etc. But after intense research and several arguments with multiple doctors I came to the conclusion I either have borderline personality disorder or BP both are similar in nature, I know now its bipolar spectrum, idk which specific type but I know Its not psychosomatic.
I don't trust doctors. The ones I've seen in the past few years are beyond useless. I've been forced to self diagnose and self medicate. Its stressful enough without having to fight every inch of the way.
Seasons don't affect me. It happens more often than the seasons change. Through all of this, the doctors and everyone would say oh you're just a teen, oh you're just hormonal, or you're just a girl. I begged and screamed and pleaded for help. Finally, in December after a really rough depression, I went to a nurse practitioner and she rudely told me oh the holidays will do that and put me on birth control. I said you help me or I will act wreckless and get forced help. She sent me to a social worker. After a month of having to talk to her and her note taking I flipped out in a fit in her office. I asked her if migraines could be connected to me mental health and rapid mood shifts. She said I wasn't 'dangerous enough in what would be my manic state' to be bipolar. I had a meltdown asking wth it would take to get help. She had me in the psych's office the following week to be evaluated by a nurse. The following week (yesterday) I saw the psych for the first time. We talked well over an hour about everything, in such detail, and he kept shaking his head, and by the end he said what medicine have you been on? I said I HATE antidepressants and I will not take another one because they do not help me. He smirked and said you've never seen a psychiatrist? I said no. He said normally he NEVER mentions a diagnosis on a first meeting because usually it takes time to get to know a person and their history. But my medical history was very detailed and well documented and my symptoms were detailed enough from ten years of saying the SAME THING OVER AND OVER. He looked at me and said, " I really think you are dealing with bipolar ii. Your not reaching mania, but the way you describe your 'energy' sounds like hypo mania. It is uncomfortable for you BC you cannot sleep or concentrate, etc." It felt good to have someone understand .. Finally. While it feels to to know he has an idea of a diagnosis that fits me (especially since bipolar ii people suffer migraines often) I am kind of put off at how quickly he was willing to jump to a diagnosis. But it is a fitting one. And is further than Ive ever been. And he is getting me off the antidepressants. Instead he is wanting to see how lithium works. I see a long road ahead of me. But at least now, I can actually see a road.
I too was misdiagnosed... Sadly part of the "criteria" is questioning whether or not you actually have bipolar disorder.. :: insert eye roll here ::
After several trials of unsuccessful medications, the last gave me bouts of vertigo, which my Pdoc swore was not due to the medication...
The bright side was that a tumor on my right balance nerve was found & removed... 6 months later I was STILL having bad bouts of vertigo. After a fall resulting in a Broken nose, the ER doc said it was likely due to a medication... Called Pdoc, he agreed to discontinue & as that was the last med I could take... He said "If you really do have Bipolar disorder, we'll know it pretty quick".. No more vertigo... No Bipolar disorder.
I asked to have it removed and explained to my new doctor everything she seemed to understand yet 3 months have gone by and I still have this diagnosis.
Anyone know what I can do about this? I don't think it's right to diagnosis someone like that I mean if my doctor honestly felt I had this she should have been a big enough person to inform me and my counselor as well as properly treat me. I am wrong to be really upset about this? Some people think I am overreacting but it's my life she's messing with! I don't have an issue with being
Bipolar I know a few people personally who are and I love them dearly I have issue with the dr. Diagnosing something not telling me or treating me for it I mean it's not like a zit or anything it's a major diagnosis right?!?
One reason isn't a doc's fault: I am bp type 2. I only went to the doc when I was deeply depressed. When I was hypomanic, I saw no reason to go to a doc because I was feeling well. I thought the new antid & therapy were working and I had emerged from the latest depression. I saw no reason to tell a doc (though none ever asked)about the too good moods.
I thought my chronic depressive illness was under control again, which it was, sort of. I wasn't correctly diagnosed til 2009 and it wasn't by a doc! It was my long time PhD. therapist who had known me well for at least five years.
As yet there is no cure for a bipolar mentality, only adaptation to the illness with the help of chemicals and people who post some understanding - not an easy topic for discussion. Gratitude for your continued effort.
I can only hope that doctors know that the stigma of mental illness exists in some families, it is a Thing of Shame; and that the doctors will be correspondingly aggressive in asking mothers or fathers or grandparents of a patient about the history of mental illness in the family. I also hope that doctors know that parents may lie on medical histories, as apparently my mother had lied. I hope this is also addressed in the study ... the reluctance, shame, unwillingness to discuss, a belief that mental illness is just bad behavior that the doctor may have to deal with ...
I'm so sorry that happened to you. It's not fair and it's not right. You _should_ have gotten better help.
But what I will say is that I agree with you that many doctors don't know how to listen. I've seen it myself so many times and I know how often people leave their doctor's offices not feeling listened to.
All I can say is, thankfully you finally got some decent help. I know it took far too long and it's totally okay to feel angry about that, but at least now you can move forward with wellness.
I'm still angry about this doctor 35 years later; but truly, this scene played out many many times over the years. Eventually, a doctor heard the part about not being able to get out of bed and prescribed an anti-depressant ... but when I demurred a bit and said, "the thing is, the depression lasts for a week, and then it seems to go away and then it comes back again ... so it can't be just despression ... "
I haven't read the study, but I think doctors don't know how to listen, and they don't know how to interpret symptoms nor how to ask questions to establish the severity of symptoms. They instead hear a buzzword, because maybe they've attended an on-going education seminar, and wa-lah, they make a diagnosis.
So, age 13 my bipolar symptoms start, at age 15, I go to see the doctor and accurately explain my symptoms, am rebuffed and it took 20 more years of accurately explaining my bipolar cycles in even more detail to doctors to get a diagnosis.
Well, that's not true, it was a suicide attempt that landed me in a psych ward, where I was diagnosed. When I explained my cycle to the pdoc, he said, "you've been explaining it that way since you were 15?" and I said, yes, of course. He looked down at his notepad, and wouldn't look at me for a while. And I finally said, realizing what he was asking ... "You mean, I gave text book definition of bipolar disorder ...? Unsubjective?" And he sighed a little bit. To his credit, he did not tell me that bipolar disorder is often first treated as unipolar depression, especially since, through the years, I had corrected or more accurately, argued with doctors who said I had clinical depression.
Listening, asking questions: basic skills a doctor needs but doesn't always have.