Frequent Misdiagnoses of Bipolar Disorder
Diagnosing bipolar disorder is not an easy endeavor—even the best diagnosticians have a difficult time. Currently, a diagnosis still relies on a mental health clinician’s interview with a patient, where they work on painting a clear picture of the patient’s symptoms and determine the correct diagnosis.1 When a mental health clinician meets with a patient for the first time, all they are truly able to see is his/her behavior and mood state in the present—and this often excludes about 90 percent of the additional information that is required to ascertain the diagnosis for bipolar disorder.1 To obtain that 90 percent, the clinician must ask the right questions and the patient must be able to provide comprehensive and accurate answers, which can be difficult depending on their mood state.1
Bipolar disorder symptoms often present in many different forms.1 Each individual is unique. For example, while symptoms such as elevated energy, decreased need for sleep, and accelerated thinking are common in most bipolar mania states, the symptoms can be evident through euphoria and grandiosity or irritability and anger outbursts.1 Also, as bipolar disorder often coexists with other psychiatric diagnoses, the mental health clinician is faced with sorting out which symptoms belong to which disorders.1 It’s not easy, and some patients wait an average of ten to twelve years for an accurate diagnosis.1
In fact, bipolar disorder is often misdiagnosed as other mental health disorders, such as unipolar depression, attention deficit/hyperactivity disorder (ADHD), and the group of personality disorders.1 Regarding personality disorders, patients are often diagnosed with borderline or narcissistic personality characteristics.1 Therefore, what are some guidelines that can help distinguish between unipolar depression, ADHD, personality disorders, and bipolar disorder?
Commonly, bipolar disorder begins with episodes of unipolar depression.1 In fact, adolescents may go through years of intermittent depressive episodes before they begin to manifest mood elevation which tips the diagnosis towards bipolar.1 Also, the symptoms of unipolar depression may overlap with those of bipolar disorder; however, some symptoms can actually tip off the clinician that bipolar disorder is underlying.1 For example, patients who feel energized and irritable, as well as angry and pessimistic about life have not had their depression steal away their energy.1 In fact, as their negative feelings are accompanied by a degree of agitation, bipolar disorder could be an underlying factor.1 With unipolar depression, people are often extremely tired, with their thought processes exhausting them.1 However, those with bipolar disorder may be unable to get a good night’s sleep due to their agitation.1
With ADHD, clinicians often see symptoms such as poor attention to detail, frequent inattention or losing focus, difficulty following through with instructions, difficulty organizing tasks and activities, and forgetfulness.1 In bipolar hyperactivity, symptoms include difficulties sitting still, difficulties engaging in quiet leisure activities, and excessive talking.1 Therefore, what is the distinction? Feelings of grandiosity, intense elation or intense anger, racing cognition, and lessened need for sleep is more common in bipolar disorder than in ADHD.1 This does not mean that some with ADHD will not appear to have these symptoms, but those with bipolar disorder will sometimes have them more severely.1 Also, these symptoms will appear absent in patients with bipolar disorder as they go through mid-range moods.1 Patients with ADHD are not without those symptoms at all times, as it is their behavior at baseline.1
The same concept is true with personality disorders.1 When an individual struggles with personality disorder symptoms, their struggles are ongoing.1 However, patients with bipolar disorder who have these symptoms may look like they have a personality disorder; however, their mid-range moods will be absent of those same symptoms.1
A diagnosis of bipolar disorder should be ascertained over a more extended period of time, in order to view all mood ranges and be sure that all other disorders are properly ruled out.1