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Bipolar Disorder Is Overdiagnosed

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The young man jumped up and yelled, “You’re not bipolar! Look at you, you’re fine! My sister is bipolar and right now she’s in the hospital recovering from a suicide attempt!”

If I told him that I spent a day in the ICU after my own suicide attempt and had been hospitalized six times,

5 thoughts on “Bipolar Disorder Is Overdiagnosed

  • August 31, 2019 at 3:07 pm

    The purpose of diagnosis is to get the right treatment to the patient, not to earn respect or compassion for our suffering or even research dollars for our illness.

    Why were the criteria for hypomania loosened? Because people who did not meet the previous criteria were diagnosed with Major Depression and treated with one antidepressant after another which flipped them (us) into mixed episodes, putting us at risk for suicide, and worsening the course of our illness. Eventually, after an average of ten years of suffering, we did fit the older criteria and were harder to treat because of the delay. We are not “the worried well.” We’re right next to Mr. Hofmann in the psych ward and on the disability roles. And once diagnosed correctly and treated appropriately, we are right next to him back in the world and functioning well.

    The public perception of bipolar is shifting because treatment works. As it does, people such as Mr. Hofmann himself are often able to function well and risk coming out about our condition, which increases the chance that others who are suffering in silence will pursue treatment. This is not a bad thing.

    Indeed, as Mr. Hofmann points out, health care in the US is a mess, including the allocation of resources. But this call to restrict diagnosis to the most severely ill is bound to backfire. The pharmaceutical companies do follow their financial interest. A smaller population buys fewer meds and receives fewer, not more research dollars. More money spent on the less impaired may benefit the more impaired, as well, with meds that work for both. This is a condition that gets worse without treatment, so the sooner people get help, the fewer end up in dire conditions. We are not the enemy.

    Meanwhile I am not willing to earn Mr. Hofmann’s concern by going back to the days when I was being urged to take my eighth antidepressant, which surely would have been my last.

    • October 1, 2019 at 5:45 am

      Very well put and I agree completely, Willa.
      I wonder if the guidelines on bipolar disorder have changed some because they understand the illness better now. Also, I have read some psychiatrists feel that is a more accurate description of bipolar disorder. I have been diagnosed almost twenty five years and I feel like for me that is more accurate. I have the highs and the lows as well but not all the time since I have the right meds, thankfully.
      Most people in my experience, myself and my husband included, are very reluctant to acknowledge that they have a mental illness due to the terrible judgment and social stigma surrounding mental illness. People are even less likely to take medication and continue on their meds. Many people are unaware they are even sick which is especially tragic. It is hard for me to understand when I read articles like this one why anyone wants to make it any harder on anyone who has been diagnosed with a mental illness. It is so freaking hard enough. I see that with my husband. He has schizoaffective disorder. I have to be stronger for both of us and it is very draining. I don’t see any winners in mental illness- no matter what category you put us in.

  • September 6, 2019 at 2:42 pm

    I agree with you entirely about many people who are very severely affected by Bipolar disorder not receiving the proper care and that we must do something to change that.
    However, there are two objections I have to this piece.
    Firstly, if we do not continue to treat those who seem well, we risk having them backslide to where they are really too ill to be able to function. Unfortunately it is hard to discern whether someone is well (or have not been so extremely affected in the past) because they are perhaps “not nearly as sick” or whether they seem less sick because they are receiving the care they need.
    I have been severely affected by my bipolar. But had I not been diagnosed and treated I would have had much worse stories to tell.The thing is, I’ve spent and continue to spend a ridiculously large amount of my money on treating my bipolar.
    Having done this, I have regained the ability to function “normally” for the most part. I can hold a steady full-time job (given a bit of understanding from my employers and colleagues) which allows me to afford my treatment. I can live independently. I can get through most work days.
    But when I get home and am alone, I might end up in a puddle on the floor. I have had to adapted my life to my constraints. I cannot have both a career and a family and cannot handle the pressure of going back to study more. I cannot have a high-pressure job like being a doctor as I was on track to be once upon a time.
    But from a stranger’s perspective I do not seem ill at all. Just average.
    My father refuses to support me because I can function now. I “should not need it” unless I’ve messed up, which simply is not acceptable.
    Secondly, how do we measure the extent of the illness? Do we consider that some are simply more willing to put in the effort or have more grit to keep themselves healthy and alive? Do we keep in mind that some are unemployed because they consider jobs they can manage with their illness beneath him or will not ask for help because of their egos? Or do we just conclude that they are “too disabled”? How do we compare personality, aptitude and inner strength?
    I am reminded of what I was taught in first-aid courses. A first-aider cannot help anybody if he is not alive. In the end, all I can really know for sure is that by doing the best I can for myself, I can also assist others. Sometimes financially because I have a salary and can afford it. Sometimes by being a shoulder to cry on. And sometimes simply by not being a burden and allowing them to believe that I am “worried well”.
    Maybe we should stop competing and start helping each other by helping ourselves.

  • September 21, 2019 at 11:24 pm

    I actually really enjoyed this piece. I was diagnosed back in 2005 and I went through many medications then, first being put on an antidepressant which spun me into a full blown manic episode that lasted nearly a year before a family member was able to catch me at just the right moment and I was hospitalized. I remember starting all of my medications and I remember there weren’t many generic forms back then. Between monthly medications and therapy I was in the hole about $700 a month. Now 14 years later, more of a career and stable medications and therapy, I am way more self aware and have a bit more knowledge of when to seek emergency help. With that said, the last two times I went manic and wasn’t able to see my doctor right away I went to the hospital where they did an intake evaluation. I was told both times that because I wasn’t suicidal at that moment or a physical harm to others and because I was articulate and self aware that I would not be admitted. I had to ‘deal with it’ until my doctor could see me. Which resulted with losing two jobs, and having to have someone with me around the clock, unfortunately no one took any of my income that I had access to away. I can see the viewpoints in this article from many sides. But still here I am, 14 years into my treatment and diagnosis knowing that if myself or someone close notices me start going down the rabbit hole that I am too self aware for emergency care. While I am able to manage it and have successful treatment there are still moments every so often that it reads it’s ugly head. Where does that leave me? Where do I go because I know I am sick and need help? Do I lie and have my family lie to be admitted and safe and get help BEFORE it’s too late? I cannot morally do that or allow my family to. If I am seeking help I won’t lie because then I don’t get the treatment I need. I really do welcome suggestions if anyone has gone through something like this.

  • September 28, 2019 at 7:55 am

    interesting replies. they add yet another wrinkle, another complexity between the obviously suffering andthe not obviously. the strict and the expansive criteria. this is the class ill describe this way: “oops, scratch that, i see it clearly now. you dont have A; you have B! ”

    this isnt a rare situation. it might be the most common. The DSM is a billing code guide as much as a presriptional guide. payments matter in this world. time matters. I’ve read of front line being prevented from testing before assuming a diagnostic stance. time, money. DIFFERENTIAL DIAGNOSIS does not do well under such conditions. Time is not so of the essence. but using inappropriate medications can be medically problematic and blow off trust. it sometimes takes a little longer than allowed. day to day can vary month to month. this is a big frustration to family with 72 hour evaluation decisions., well. love the post. its getting early, gotta go.


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