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Elisa Goldstein, Ph.D.Elisha Goldstein, Ph.D.
A blog about mindfulness, stress-reduction, psychotherapy and mental health.

Misdiagnosing Bipolar Disorder: What's at Stake

Elisha Goldstein, Ph.D. Updated: Dec 1st 2009

sad girlIt wasn't too long ago that Bipolar Disorder was the flavor of the day among physicians, therapists, and educators. However, the danger of this is that it can be overdiagnosed. It seems to me that often times there is a rubber band effect with diagnoses, meaning that they are often over-diagnosed and then eventually swing back to the center. You might be diagnosed with bipolar disorder if you came in presenting with difficulty sleeping, irritability, anxiety, restlessness, and maybe some depression. Misdiagnosis could have detrimental effects.

In an interview with WebMD, Mark Zimmerman MD, associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University in Providence and practicing psychiatrist at Rhode Island Hospital in Providence, says "These could be symptoms of bipolar disorder. But they really have to be accompanied by other criteria, such as hyperactivity, feeling energetic despite just a few hours of sleep, or inflated self-esteem."

So what's at stake with misdiagnosis of bipolar disorder?

  • Insurance - On the one hand, a misdiagnosis will likely go on your health record which healthcare companies take very seriously and may not re-insure the person if they were to try and get healthcare somewhere else.

  • Self Esteem - Also, the label of bipolar disorder has this incorrect, yet subtle, effect on many people that they are somehow defective in some way, which leads to feelings of shame and low self-esteem. If you do actually have bipolar disorder, these feelings are best worked out with a skilled therapist and can be overcome.

  • Physical Side Effects - The diagnosis of bipolar disorder almost certainly comes with medication. I am an advocate of medication when it's needed, but bipolar medications can often come with some fairly uncomfortable side effects and you want to be sure that this is what you need prior to taking the medication.

If all else fails you can always consult with another doctor to get a second opinion.

What's been your experience with yourself or friends and family who have been diagnosed with bipolar disorder? Was it the correct diagnosis? What have you found that helps?

As always, please share your thoughts, stories, and questions below. Your interaction provides a living wisdom for us all to benefit from.

Elisha Goldstein, Ph.D.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations.

Check out Dr. Goldstein's acclaimed CD's on Mindful Solutions for Stress, Anxiety, and Depression, Mindful Solutions for Addiction and RelapsePrevention, and Mindful Solutions for Success and Stress Reduction at Work. -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist.

If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

Reader Comments
Discuss this issue below or in our forums.

wrong diagnosis and being on the wrong meds scars you - raichelle - May 2nd 2013

i was wrongly diagnosed with bipolar and given lithium seroquel epival clonazapam prozak and many others i took them from the time i was 19 till age 37 when they realized i didn't have bipolar just depression i was taken off all my meds over a 5 month period it was hell i have been on meds so long i no longer know what is normal also i went through so much trauma in my past that everything feels overwelming i am starting to get to know myself but it is a very long journey if you feel the same please let me know i would really like to know i don't feel alone thanks

 

I believe its natural responses,not the diagnosis's - - Jul 31st 2011

I was diagnosed with bipolar as a child.Unfortunately, I had a problems at home with my caregiver who was always intoxicated,I was also sexually abused.The meds always made me feel worse.So I went off of them.For 10years life went along smoothly,although I was homeless as a teenager,I still managed to obtain my highschool dipolma & get training for a job I desired.I obtained a job related job injury(lower back) inwhich I did not get any compensation for.After my 2nd childs birth my back had gotten much worse,I was also astmatic & on albuterol which supposingly can make u get lack of sleep etc.I had problems with my kids father,which as my friends would say"he was being selfish",he cheated etc.1 day I was admited for hallucinations etc,something I had never had b4.I believe it had to do with insomnia,which unfortuntely being in chronic pain,makes it difficult for me 2 go and stay asleep.For a few weeks with all the pain&induced stress coming from my kids father,I was only sleeping for 2-3hrs a night,when I was hospitalized,I was unasleep for over 48hrs or more.When I came out of the hospital my insurance wouldnt cover my meds,so I wasnt on them,which didnt bother me at all,I still had trouble going to sleep,I was gr8 for a whole yr,up until a few months ago when I found out my kids father was 1nce again cheating on me with a employee,which at the time with pain&finding out my mom had cancer,of course everything hit all at once,so I seeked guidance thru therapy&physciatry.But I truely dont believe I have what their saying.b4 my injury I felt great&it was much easier to cope.My ortho Dr says she see's alot of my symptoms in pain patients,which only occured after my 2nd child&after my back pain worsened.I do not have extreme highs or lows,but of course like any1 in the world I can get mad or sad,if provoked,but theres always a reason;I believe I cope&handle it pretty well.I do not sleep around&have a moderate sex drive,I have been only with my kids father 6 1/2 yrs, I do not do alhcohol or recreational drugs,but I am on prescription painkillers for my agonising pain syphtoms.I also have xrays 2 prove that I have pain due to a injury¬ for a mental illness.I dont take many risks&I try to always make the right decisions.I am very responsible&I dont go on spending sprees etc,I perfer to save,not be careless with what I have.My diet is bad,Im probaly lacking certain vitamins etc.I try to exercise,but that creates pain.I took some assessment tools online,to see what the diagnoses would come out to. I dnt really believe in unnatural rememdies,even with my 1st child I had natural birth,no epidural,my 2nd was a emergancy csection. Id like to be refered or find some1 who may be more accurate on my situations&medical issues,rather than just throwing me on meds.Im in NJ NY area.I enclosed my email if any1 can be of help.TY

Still don't know after 23 years - Mark - Feb 18th 2011

I was diagnosed 23 years ago with BPD, by the Director of Forensic Medicine at our local physchiatric hospital. The first 6 years I was prescribed choropromozine (and thats all). I ask why not a proven mood stabilizer. Finally, after 6 years, following a stressful set of events I self overdosed with the same med thinking I could regain a grasp on things. After readmission and at the pleading of my family I was prescribed Lithium carbonate.  I had been discouraged therapy (an understood prerequisite in the treatment of BPD many times).

It has been suggested that no one doctor is such a small town dare question Dr. Neil McFeely's original diagnosis. What to do ?

Going off Meds - Bean - Nov 21st 2010

I had a cousin diagnosed with Bipolar Disorder who did not like the way he felt on the prescribed medications. My cousin thought he had been misdiagnosed and that the medications did nothing but make him feel poorly... so he decided to stop taking his medications.  Unfortunately my cousin took his own life shortly after he went off his medications.  This is a sad reality faced by most families of loved ones with Bipolar Disorder.  It is important to consult your Doc if you or a loved one think that you/they have been misdiagnosed and want to go off you meds... the Doc can safely monitor you as you are weaned off the meds or could suggest other medications that have fewer side effects.  Please be safe and God bless.  

drugs I was taking - - Nov 9th 2010

I was diagnosed as bipolar when I was 15, I was prescribed depokote.  I was taking my medications until I went to a scientology rehab called Narconon at the age of 20.  They don't believe in prescription meds at all.  On top of all the prescription drugs that I was taking (depakote, abilify, straterra)  I was also abusing illegal drugs.  I felt like a robot the whole time I was taking these meds.  Now that I am off of all of the drugs, I feel so much better. Overprescribing medication is a problem!  I do feel that sometimes it is necessary for medication, but now I realize that just because you have mood swings it doesn't mean that you're bipolar.  If I could I would never have went to a psychiatrist at all.  I felt like I couldn't even function properly on all of the drugs I was taking.  Just thought I would share that.

Child - - Aug 2nd 2010

My child has been diagnosed with bipolar and she is not the same person. What is the first steps to helping her?

Don't give up - - May 4th 2010

Yes, overdiagnosis can be a problem just as underdiagnosis...

However, one has to remember that there is no test for bipolar unlike quick testing for diseases like diabetes or hypertension. Mental health professionals can only base their diagnosis on emotions/symptoms of past and present and personal/family history.

Many times, people seek help for depression and forget about manic episodes that have occurred in the past. This may lead a psychiatrist to prescribe an antidepressant. When an antidepressant is prescribed to a bipolar, it's like a ticking time bomb. It can kick them into mania at any point.

Also, there are many medication combinations. Unfortunately, there is not a test to see which would work best. Simply put, it is trial and error. Again, there are lots of medications out there that can help.

If the medications are not helping or you are having side effects, talk to your healthcare provider. They can adjust your medication regimen and also help you get to a counselor.

Confused with diagnosis and the medication - - Apr 7th 2010

I was diagnosed with bipolar about 5 years ago when I plowed my excursion (which I bought on a whim after moving to California on a whim) into a bridge.  When I was committed to a hospital it was then after a diagnosis of ADHD that I was diagnosed with bipolar.  I took my meds off and on because the feeling of being on meds was sickening then I lost my personality and all the things that made me me.  I ended up spending this last year at home, scared to go outside, unsure and just unmotivated...in December I was finally given anti depressants AFTER 5 years of only taking lithium and lo and behold I wasn't depressed anymore but paranoid and hallucinating and unable to sleep and function in crowds.  After trying to kill myself twice in what they now say was a result to adverse reactions to my anti depressant I have now decided to forego the damn meds and deal with my "bi polar" alone because I dont see how it can be worse.

4 Years Askew - ROCKWOOD - Jan 24th 2010

4 years ago I was in a lousy job, eventually got really depressed and was having panic attacks every day.  Went to county mental health and was put on effexor, xanax, trazadone, then straterra.  Worked ok for a year, then I started becoming disassociated with myself.  I no longer had a connection to the little parts that make me an individual.  This is hard to express.  Began drinking sporadically for no reason.  Had been sober for many many years.  Effexor was replaced with lamictal.  Problems got worse, I slept as many hours as I could, up to 16 a day.  Could barely function.  Sporadic drinking became a problem.  Got into trouble with the drinking.  Although I’d asked several times to get off the meds, I was very firm and went through three months of weaning (pure hell).  I’ve now been off the meds for almost 4 months.  I feel much better, but having problems with memory from when I was taking meds.  Still have the anxiety/panic issues and still take xanax.  As my mind clears up, I realize I am not bi-polar, I am no longer stuck in depression.  Am a bit angry about living 4 years in a zombie like state.  One day at a time. 

 

I feel fine - Maximo - Jan 6th 2010

Last year I was diagnosed with bipolar disorder with psychotic syndromes by Stuart Marchman ACT corp. They prescribed me tegretol and all it did for me was cause an intense migraine. I've been off the med for more than eight months and feel great. I've been Reading about the effects of bipolar disorder and hardly any relate to me. It makes me wonder..

thoughts on diagnosis - Stephintoornto - Jan 4th 2010

i have struggled with depression for 15 years and in the last 10 months it has gotten increasingly bad. The worst is the mania and the anxiety.  I have now asked for a second psychiatric assessment to see what a second opinion says.  All i know is that i feel like i am going crazy, and life has to be better than this.  This article has helped to continue to add clarity to this. thank you.

I agree too :) - Karen - Dec 18th 2009

...only it was the other way around for me. I was only diagnosed with Bipolar(BP) 1 last year, after 27 years of "Major Depression, recurrent". Since I got onto a bipolar drug regimen, I cannot begin to describe how dramatically my life has stabilised and how I have literally been given my life back. I'm 48.

I was also diagnosed with Borderline Personality Disorder along the way and repeatedly told that medications would not help me. I spent the better part of 10 years after that dx in DEEP despair (and depression) over how doomed I was, because I could never seem to get on top of the emotional instability.

The correct (Bipolar) dx was a shock, but I am VERY grateful for it and to the pdoc who diagnosed me. Correct treatment is life-changing and I'm now high-functioning without crazy out-of-control mania, brilliant as it seemed at the time.

Thanks for writing this.

undiagnosed for too long - V.J. - Dec 18th 2009

There are dangers with both overdiagnosing and underdiagnosing. I wasn't diagnosed as bipolar until I was 38 (I'm now 49) when I switched into mania from a major depression after 2 days on Prozac.

I had been to numerous therapists over the years and none had ever looked beyond the immediate "crisis" that brought me there. I think looking at a patient's mental health history would help clarify whether a diagnosis of BP is in order.

In my case, I had recurring depressions since I was 10 and episodes of what I subsequently learned was hypomania (euphoria, grandiosity, high energy) since age 12.

misdiagnosed - really - Dec 13th 2009

I'm beginning to believe that for 25 yrs I have been misdiagnosed. The meds that I was always on for BiPolar disorder kept me from depression but I had no zest or zeal for life. I was a zombie. Several yrs ago I started taking anti anxiety meds oh my how my life has changed! What a vast and marked improvement. My Celexa and Topamax has helped tremendously with my PTSD Agorophobia Anxiety and Depression - Praise The Lord!

Misdiagnosis - Joe Barry - Dec 7th 2009

Yes, this statement - Misdiagnosis could have detrimental effects.- is true. It is a sad but common occurence.

Your article was very informative.

Thank you.

Joe Barry

www.panicaway.com

 

I agree! - Buck Black - Dec 5th 2009

I'm a therapist who works with people via skype, phone, and in the office.  I often see people needlessly diagnosed with bipolar disorder and its scary.  I am much slower to diagnose someone with bipolar disorder than the average therapist because I want to really make sure that is what it is!

Great article and thanks for going against the grain here. 

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