Overdiagnosis of Bipolar Disorder & Depression

Overdiagnosis of Bipolar Disorder & Depression

Vasavi Ganesan Shanthi

Department of Psychology, Eastern Michigan University

PSY 743: PsychopathologyDr. Alexandros Maragakis

October 7, 2021


Mental illness is classified into many categories in psychiatry.The definitions establish the boundary between normal and abnormal as far as what counts as a disorder and 

how someone qualifies to be disordered. The boundary has radically changed in the past 

century. As new disorders are added and old ones are revised in succeeding classifications. With increasingly complex forms of suffering identified, diagnoses have increased rapidly. More people qualify for diagnosis and more treatments are deemed necessary when psychiatric classifications cast a wider net. Bipolar Disorder and Depression have been overdiagnosed the past two decades and this paper will cover literature based on overdiagnosis, limitations of DSM 5 leading to overdiagnosis, reasons for overdiagnosis in clinical setting, case examples from peer reviewed literature and ways to improve as patients and clincians to get an accurate diagnosis.

According to the study conducted by Bolton,” states that there have been criticisms of psychiatry for over diagnosing, for pathologizing normality since at least the antipsychiatry critiques of the 1960s. Psychiatrists 

were making the ICD and DSM classifications at approximately the same time, a process that has resulted in the progressive revision of both classifications.Revising diagnostic manuals of diseases and disorders, such as the International Classification of Diseases and the Diagnostic and Statistical. Manual(DSM), inevitably leads to further criticism, and the revision of the DSM V has been the focus of debate for quite some time about overdiagnosis. There is almost no consensus on the question of whether a particular illness or illness in general depends on a decisive marker, but rather the relative medical, psychosocial, and financial harms and benefits the illness may cause. (Merten et.al) States that children and 

adolescents are diagnosed with mental disorders in increasing numbers every five years. Study findings of time trends of prevalence of mental disorders are mixed. We can now address previously neglected mental health issues by broadening the definitions of mental illness. By becoming more commonplace, mental illness is likely to be less stigmatized.

(Ghouse et.al) The first description of bipolar disorder was by Jules Falret in 1854, as Case Circulaire (circular insanity). It was later renamed as manic-depressive psychosis. Bd is said to be one of the most disabling mental conditions and the reason is it’s high rates of morbidity, disability and premature death from suicide.

 Until recently, bipolar disorder was thought to be an uncommon condition, however the concept of soft bipolar spectrum disorder gained traction in the mid-1990s and early 2000s, leading to the current focus on subthreshold bipolar disorders. In response, the pharmaceutical industry is increasingly interested in treatment for BD. Diagnostic criteria for BD II have widened dramatically, with increasing rates of diagnosis. Mitchell in his article suggests that there are many valid reasons to be concerned about overdiagnosis.

In recent years, the mainstream media and lay public have become more aware of the condition of BD. “We are being presented with mood disorders that are based on “refined mood swings” that are produced by Google.” Says clinician Reddy from India in his article “Are we overdiagnosing bipolar disorder” .

According to Ghouse et al. in her article reveals that the potential downsides of over diagnosing BD are several. They include the negative effects of unnecessary labeling, the risk of harm related to unnecessary treatments, and the misuse of health care resources, with important human and financial implications. The phenomenological distinction between BD and some personality disorders may be challenging, not only because of the overlap between some personality disorder features and the diagnostic criteria for mood episodes but also because of the lack of reliability of the time criteria for BD says the Ghouse study on “overdiagnosis of bipolar disorder”. It may be the issue of differential diagnosis versus comorbidity which is most critical to think about when discussing BD and personality disorders. Ghouse et al “This is confirming especially when it involves patients with borderline personality disorder. Bipolar disorder and borderline personality disorder are quite common co-occurring disorders, but the similarities between the two may cause diagnostic confusion”.

“The rates of comorbidity between substance use disorders and BD are extremely high “ (Kenneson et al.). The behavioral consequences of various psychoactive substances, on the other hand, can easily imitate the mood symptoms seen in bipolar disorder patients. Patients frequently experience typical manic or hypomanic symptoms associated with cocaine and stimulants, and alcohol has well-documented mood-depressing effects. Although the DSM-IV suggests diagnosing mood disorder due to substances in patients whose mood symptoms appear to be limited to periods of substance use, clinical practice can make this distinction challenging.

According to Zimmerman, the study indicated that while some people who fulfilled the criteria for bipolar disease were never diagnosed with it, considerably more people were incorrectly classified as bipolar. Part of the explanation, he says, is aggressive marketing to doctors by corporations that make bipolar illness medicines. Zimmerman (2017) According to the 2016 review, the limited amount of time that some clinicians spend with patients could also contribute to incorrect diagnoses. People with bipolar disorder frequently have another mental health issue or condition, such as anxiety disorder, an eating disorder, or a substance abuse problem, which can also contribute to difficulty getting the right diagnosis, according to the NIMH. “The finding about overdiagnosis aren’t surprising”, says Schwartz a psychotherapist in Brooklyn, New York. Bipolar disorder can be hard to diagnose, he says, because people often seek professional help only during their down periods and neglect to mention their up, or manic, periods. Furthermore, some younger patients with bipolar disorder may have had depression but not yet had a manic episode, resulting in a misdiagnosis of depression. The mania may not always be visible, which adds to the patient’s and provider’s confusion.

Researchers from Rhode Island Hospital and Brown University found a year ago that after employing a complete, psychiatric diagnostic interview instrument, fewer than half of individuals previously diagnosed with bipolar disorder acquired a genuine diagnosis of bipolar disorder. Their study included 82 psychiatric outpatients who said they had previously been diagnosed with bipolar illness but that their diagnosis had not been validated using the SCID. These patients’ diagnosis were compared to 528 persons who had never been diagnosed with bipolar illness. The research took place between May 2001 and March 2005.

The difficulty of the DSM-based diagnosis of BD to detect bipolar patients without a typical history of classic manic or hypomanic symptoms, that is, a patient whose index episode is depressive, is the most significant limitation (Ghouse et al.). The description of traits that, if present in a patient with depression, are highly suggestive of bipolar illness, has been attempted to mitigate this restriction.

Being properly diagnosed is crucial to receiving the appropriate therapy for your bipolar disorder, allowing you to control your symptoms and enjoy a healthy, active, and full life. According to Schwartz, talking with your doctor about all of your symptoms and emotions, both positive and unpleasant, is one of the most critical things you can do to improve your odds of receiving an accurate diagnosis.


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