Diagnosing Bipolar Disorder
Thirty years ago, bipolar disorder—a mental illness characterized by deep mood swings from mania to depression—went widely unrecognized. But since the mid-'90s, thanks largely to greater awareness and research, the number of adults being treated for the condition has nearly doubled. Now the trend may be going too far, with so many people being diagnosed that some experts fear bipolar disorder is becoming the new catchall disease. A recent study suggests this may be the case.
After re-examining 145 men and women who said they'd been diagnosed with bipolar disorder, researchers at Brown Medical School and Rhode Island Hospital found that more than half (57 percent) were misdiagnosed. "We believe a number of these people were suffering instead from major depression and a personality disorder, such as borderline, whose characteristic mood swings can be mistaken for bipolar," says Mark Zimmerman, MD, lead author of the study. One possible reason for this, he says, is the fact that "we have very good drugs for bipolar disorder but no clear-cut medications for these other personality disorders. Doctors, and even some patients, may look to bipolar disorder because it's something that's easier to treat."
Kay Redfield Jamison, PhD, a leading researcher in the field and author of An Unquiet Mind, the 1995 best-selling memoir about her own struggle with the disorder, points out that many people remain undiagnosed but also agrees with Zimmerman: "Anytime an illness comes along for which there's an effective treatment—and it's naïve to think the pharmaceutical industry, which spends a lot of money educating doctors, hasn't had some influence on this—there's going to be a tendency for more people to be diagnosed with that condition for a while."
To help avoid a misdiagnosis, Jamison advises evaluation by a psychiatrist or psychologist. That doctor should follow the specific criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and be willing to go through the list with the patient and explain why her or his symptoms fit this diagnosis and not something else, says Zimmerman. (You can take a preliminary screening yourself, at DBSalliance.org.) Also make sure a family member is present. "This is essential," says Jamison, "because someone who is depressed won't remember that they were ever manic." If you're not satisfied with your clinician's answers, get a second opinion.