Bipolar Disorder: A Condition That Gets Misdiagnosed So Often

Posted October 11, 2023 by in Health + Fitness

Family and friends might worry about a person who suffers from excessive mood swings. They don’t know how to help this person. These mood episodes can last for several weeks or months if untreated. When a person has these mood swings, it is time to see a doctor.

However, a person should not expect to receive this diagnosis during the first visit. Doctors find it hard to Identify bipolar disorder, as it mimics many other mental health disorders. Why should a person know when they see the doctor?

The Personalized Nature of the Disorder

Bipolar disorder is characterized by extreme shifts in mood and energy levels. The main symptoms are periods of mania and depression. Mania involves elevated mood, increased energy, reduced need for sleep, racing thoughts, and sometimes impulsive behavior. Depression involves low mood, low energy, loss of interest in activities, and sometimes suicidal thoughts.

While the basic symptoms are consistent, how they appear differs greatly between individuals. Some experience more depression, others more mania. The length and frequency of episodes also vary widely. Overall, bipolar disorder has a consistent framework of symptoms, but the exact presentation differs from person to person.

Overlap with Other Disorders

Bipolar disorder often co-occurs with anxiety disorders, ADHD, or substance abuse problems. The overlapping symptoms can muddy the diagnostic picture. For example, the concentration and sleep issues seen in ADHD may also occur during mood episodes in bipolar, making it tricky to tease the two apart. Substance abuse may also show up as mood instability. Identifying which symptoms are part of which disorder is challenging.

Cyclical Mood Patterns

Unlike depression, which tends to be more constant, the cycles between mania and depression in bipolar can make it harder to recognize. Depressive or manic episodes may only last days or weeks, with long stable periods in between. Patients may downplay the severity of cycles, making them hard for doctors to detect. Tracking mood changes over time is key to establishing a pattern consistent with bipolar disorder.

Lack of Patient Insight

Many people with bipolar disorder lack insight that their behaviors are abnormal during mood episodes. The euphoria of mania may feel productive to them rather than concerning. Depressive symptoms may be attributed to regular sadness. Poor patient insight makes it difficult for doctors to evaluate the presence and severity of symptoms. Patients may omit key details that would aid diagnosis.

Late Onset of Symptoms

Although bipolar disorder often emerges between ages 15-25, symptoms appear later in life in some individuals. Middle-aged adults may suddenly develop manic or depressive symptoms without a prior history. Doctors may not consider bipolar as a possibility if onset occurs outside the typical age range. A thorough medical history is required to rule out late-onset bipolar disorder.  

Misdiagnosis

Bipolar is frequently misdiagnosed at first, most often as depression, anxiety, or ADHD due to overlapping symptoms. Patients may be treated with inappropriate medications or therapies for years before their condition is properly identified as bipolar. They may be reluctant to seek second opinions to get the right diagnosis. Proper screening tools and a thorough evaluation are needed to avoid misdiagnosis.

Lack of Objective Tests

There are currently no medical tests such as brain scans or blood work that can definitively diagnose bipolar disorder. Doctors must rely on subjective information from the patient, family members, and their own observations. This makes it hard to diagnose, especially among patients who lack insight or have subtle symptoms. More research is needed to find biological markers that identify bipolar disorder.

Stigma

The stigma surrounding mental illness may prevent patients from honestly disclosing feelings or behaviors to doctors that would support a bipolar diagnosis. Manic symptoms like reckless behavior may be embarrassing. Mood swings might be chalked up to character flaws rather than bipolar. Patients may intentionally omit details or downplay symptoms. Doctors need to establish trust and non-judgment to ease stigma.

Many things contribute to making it a challenge to recognize and accurately diagnose bipolar disorder. Improved screening tools, research into biological markers, and awareness of these diagnostic difficulties by both doctors and patients will help lead to earlier, more accurate identification of this complex condition.