Diagnosing in the Dark: The Challenges of Identifying Bipolar Disorder

by R. O.
(Houston, TX USA)

"Isn't it a bit unnerving that doctors call what they do 'practice'?" This witty one-liner is actually quite accurate when diagnosing bipolar disorder (BPD) is the context. Because there is no definitive test for it, the process is so subjective that it is a big stretch to call it scientific; it is much more like shooting arrows in the dark.

One problem is that there are a lot of conditions (like lupus, HIV, and syphilis) and medications (like steroid-based drugs) that can mimic the symptoms of BPD. Additionally, since it is common for bipolar patients to also have one or more other psychiatric conditions in tandem (usually anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and post traumatic stress disorder), it can be challenging to pull the right needle out of this particular haystack.

Even if a provider is looking for BPD specifically, patients' personal accounts can be misleading. For one thing, most bipolar patients seek help for the depression but not the mania, leaving many of them mislabeled, sometimes for years, as suffering from unipolar depression. Worse, patients will sometimes inaccurately self-diagnose BPD due to the limited information widely supplied by the aggressive marketing campaigns of pharmaceutical companies. Because this can send doctors off in the wrong direction, the fact that the term "bipolar" has become increasingly prevalent in the vocabulary of the general public is sadly more of a hindrance than a help.

So what do providers look at to determine whether or not a patient is bipolar? The depression component includes feelings of fatigue, sadness, guilt, and low self-esteem. Sufferers also experience loss of interest in activities, difficulty sleeping, decreased appetite, and trouble making decisions. Mania, the symptom that separates bipolar disorder from normal depression, is characterized by elation, over-confidence, and/or irritability. These feelings are often accompanied by racing thoughts and a decreased perception of risk.

There is a great deal of disagreement within the psychiatric community as to whether the symptoms are the same in children. In fact, many believe that BPD does not apply to children at all. Some cry out against over-diagnosing juveniles with the condition while others bemoan under-diagnosing the same group. This is, perhaps, the arena in which the lack of conclusive scientific indicators is felt most acutely.

Still, there is hope. Researchers at the Mayo Clinic in Rochester, Minnesota, may have found an answer. Magnetic Resonance spectroscopy seems to show clear visual differences between the brains of those who are bipolar and of those who are not. Perhaps with some refinement, this breakthrough will reduce the years of suffering many bipolar patients experience due to misdiagnosis, as well as prevent needlessly medicating those who are not afflicted with the disorder.