The Challenge of Accurately Diagnosing Bipolar Disorder



You’ve read up on bipolar disorder and think it may be causing your intense mood swings and problems with relationships at school or work.

But you aren’t sure. Your symptoms—or those of the spouse, child, or friend you’re worried about—also resemble those of other mental disorders, such as depression, borderline personality disorder, anxiety disorder, schizophrenia, or attention deficit hyperactivity disorder (ADHD).

Your confusion is understandable. Bipolar disorder can be difficult even for mental health professionals to diagnose, because many of the symptoms overlap with those of other mental illnesses, says S. Nassir Ghaemi, MD, the director of the Mood Disorders Program at Tufts Medical Center in Boston.

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Roughly half of people with bipolar disorder see at least three mental health professionals before getting a correct diagnosis, according to a 1994 survey by the Depression and Bipolar Support Alliance (then known as the National Depressive and Manic-Depressive Association). According to the same survey, about one-third of those with bipolar disorder received their diagnosis more than a decade after they sought treatment.

Here are some of the symptoms and treatments for other disorders that are sometimes mistaken for—or occur alongside—bipolar.

Bipolar disorder is marked by extreme shifts in mood that can vary between deep depression and mania, an abnormally elevated mood.

About 40% of patients with bipolar disorder are initially diagnosed with major (or unipolar) depression, which does not involve mood swings or mania, Dr. Ghaemi says.

There are several reasons for the confusion. Most people with bipolar disorder experience an episode of depression before an episode of mania. Often it’s the depression that drives people to seek medical treatment. And sometimes the person has never actually experienced a manic episode when he or she seeks treatment for depression.

In addition, studies show that about half of those experiencing mania don’t realize they’re manic. “The patients often don’t have insight into their manic symptoms. They either don’t remember it, or they deny it,” Dr. Ghaemi says. To diagnose bipolar disorder, psychiatrists may enlist the assistance of family members who will share details about suspected mania or hypomania, a milder form of mania that’s much less noticeable.

Symptoms of depression include a loss of interest in normal daily activities, feeling sad or down for an extended period, feeling hopeless or worthless, crying spells for no reason, sleep problems, trouble focusing or concentrating, unexplained weight gain or weight loss, irritability, and fatigue.

People who go on to receive a diagnosis of bipolar disorder are more likely to have postpartum depression, psychosis during their depression, and recurrent episodes of depression, Dr. Ghaemi says.

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In addition, about 60% of those who go on to receive a diagnosis of bipolar also have some symptoms that mimic mania during their depressive episodes. This is called a “mixed” episode.

Symptoms of a “mixed” episode may include agitation, irritability, racing thoughts, hyperactivity, and anxiety. Only about 20% of those with major depression have such “mixed” episodes.

Complicating diagnosis even further, more than 40% of those with bipolar disorder experience what’s known as a mixed episode, in which the symptoms of mania and depression occur simultaneously. And studies have shown that about a quarter of those with major depression experience a form of agitation that can resemble a mixed episode.

Depression is treated with prescription talk therapy, antidepressant drugs, or both. Antidepressants may bring on a manic episode, which is why it’s critical to tell your doctor about any unusual “up” periods that might suggest a manic or hypomanic episode.

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