Diagnosing Bipolar Disorder

by T.K.
(Law student, FL)

In recent years the number of people diagnosed with bipolar disorder has increased dramatically.
Why is this? Only a few years ago, the estimates were that about 2 million Americans had bipolar disorder. Now experts such as NIMH are estimating this could be as high as 9-10 million. Could it be that the way we diagnose bipolar disorder is unreliable?

The problem is that there is no definitive test for bipolar disorder, based on physical symptoms such as the way diabetics can be tested for glucose and insulin.

Instead, we use "talk tests" - a person visits a doctor or psychiatrist and describes thoughts and feelings and behaviors that may indicate the presence of one of the forms of bipolar disorder.

The majority of people with bipolar disorder spend most of their time feeling depressed, with the other face of their bipolar disorder - elevated moods known as mania - being much more rare. So it is common for bipolar to be misdiagnosed as depression.

People who are manic may also be misdiagnosed. Often their bipolar disorder is misdiagnosed as ADHD or even schizophrenia.

However, these sorts of misdiagnosis mistakes would result in fewer numbers on people being deemed "bipolar" - not more.

Some recent research sheds light of on the so-called symptoms of bipolar disorder that work the other way around - "tricking" medical experts into thinking they are dealing with bipolar instead of something else.

In a 2009 study, published in the Journal of Clinical Psychiatry, researchers used very detailed interviews and discovered that 57% of people previously diagnosed as bipolar realy had something else.

Nearly half of the subjects actually had major depression, while borderline personality disorder, post-traumatic stress disorder (PTSD), generalized anxiety and social phobia were each diagnosed in roughly one-quarter to one-third.

Why would doctors and mental health professionals over-diagnose bipolar disorder so heavily?

Actually there are a couple of possible reasons:
1. Borderline Personality Disorder has a lot of negative connotations - even more than bipolar disorder, and basically just sounds like teh client is a jerk.

2. Doctors prefer to diagnose something they can treat. Today there are many drugs available for trating bipolar, and teh drug companies have done a great job of pushing studies that suggest bipolar is actually under-diagnosed, with the paradoxical effect that doctors are over-vigilant about it, and now find bipolar "under every rock".

Maybe one day soon diagnosis of bipolar disorder will be more reliable. For example, in Australian, researchers at Monash University have developed a new invention called “electrovestibulography''.

An electrode in the ear detects changes in the electrical patterns in the patient’s balance system, which is linked to primitive parts of the brain relating to emotions and behaviour. This is the menatl health version of an ECG, analyzing the brain's electrical signals in the same way an ECG can detect heart problems.

So far the Monash University researchers have found the device to be giving reliable results but as they have only tested hundreds, not thousands, of people, it is way too soon to say.

Whether this or some other breakthrough improves bipolar diagnosis, it will be a great relief to millions of people all over the world to have a reliable form of testing for bipolar disorder.

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