Bipolar Disorder: Over- and Under-diagnosed

It seems odd that bipolar disorder can be diagnosed both too often and not enough. Many people who actually have bipolar disorder are never diagnosed with a mental disorder or are incorrectly labeled with another disease, such as schizophrenia.
On the other hand, the diagnosis of bipolar disorder tends to be used too liberally, often for people with no real mental disorder. The National Institute of Mental Health estimates that about one percent of the adult U.S. population, or more than two million individuals, actually have bipolar disorder.
Bipolar disorder involves a disturbance of mood. People with bipolar disorder may have episodes of depression, but to be diagnosed with bipolar disorder they must also have at least one episode of mania or its less intense form, hypomania.
If mania is thought of as the opposite of severe depression, then it might seem appealing. In reality, however, mania is a severe condition that can have a devastating impact on one's life.
Episodes of mania may include feelings of elation, increased energy or restlessness, irritability, distractibility, poor judgment, excessive spending, increased sexual drive, and a sense of needing little or no sleep. During a manic episode, a person may have unrealistic beliefs, delusions, racing thoughts, disorganized thinking, and a sense of having special powers.
Much of the confusion about and misdiagnosis of bipolar disorder is due to its hallmark sign of mood swings. It is true that bipolar disorder patients may switch back and forth between episodes of depression and mania, but the episodes usually are sustained — lasting one week or longer.
Many people who do not have bipolar disorder feel as though their moods swing up and down repeatedly throughout the day, or some react to situations with intense emotions. For this reason, they or others may assume they have bipolar disorder when they do not.
Diagnosis is further complicated when people with or without bipolar disorder have other mental disorders. For example, the effects of drug abuse can resemble aspects of bipolar disorder. In such cases, the diagnosis of bipolar disorder may be used inappropriately.
On the other hand, people who do have bipolar disorder may never be evaluated for a mental disorder, so will never be diagnosed. They resist seeking help or assume their symptoms are due to their life circumstances or personality. Their mood extremes and unusual thoughts and behaviors are never explained.
And some patients with true bipolar disorder are incorrectly given other diagnoses. During manic episodes, some people express bizarre delusional beliefs and act in a completely disorganized manner, similar to schizophrenia. Still others with bipolar disorder have complex histories that are not typical of the classic depression-mania alternations.
Bipolar disorder is a treatable condition. It is important to identify who has it and who doesn't. If you think you're one, check with a psychiatrist. Effective treatment can help prevent serious consequences.