Is Bipolar Disorder Sometimes Overdiagnosed?

In my opinion, Bipolar Disorder is sometimes over diagnosed or too quickly diagnosed.  Although there are diagnostic criteria, testing, surveys and questionnaires as well as clinical history from patients and clients, I feel that in the current process of public Psychiatry and individual practice this disorder is all too quick to be given medications and to a person is sometimes too quickly labeled "bipolar".

There is no question that the classical syndrome of bipolar disorder is complex and often requires clinical time, expertise and even trial and error to deal with all that is involved including medication management, therapy and all of the responsible interventions we do in this field.

I am speaking though of various situations and inner symptoms, experiences and  issues which make the diagnosis more difficult and challenging to sometimes define and treat.  There are many personality disorders that can resemble bipolar disorder and also substance drug and alcohol use that can mimic its issues--- particularly if there are periods of withdrawal, sobriety and/or any cycle in between.  Anxiety and ADDHD can also resemble bipolar traits and issues in adulthood and even childhood, along with other diagnoses and so these matters need to carefully be sorted out over some period of time.

Some clients have many stressful and intense adjustment issues in their lives to work, money and relationships.  They can have unresolved past grief, trauma, anger and unresolved feelings to past abuse, misuse, stemming from anything and everything.  There is unresolved issues of parental divorce, discord with relatives and friends and many unresolved therapy issues that can be at hand. Self esteem from any and all levels can be undermined and if there has not been healing in this area it can also manifest as bipolar traits in many ways.  And, many who do come to treatment sometimes want a quick and fast medication relief regimen to issues that require a lifetime of healing through therapy, Self-help, supportive groups, their own research and reading, and Spiritual interventions.  Many issues have not occurred overnight and will not and cannot be healed overnight as well.  And I feel we have stepped away from non-pharmacological interventions or we do not have enough time to understand where someone is in their healing process aside from medications.

In addition, nutritional and lifestyle factors do play a role.  In my opinion, Psychiatry should be at the forefront of these matters in bridging these medical/psychiatric factors with other medical fields, but I feel and find that this is lacking---often for many reasons-including--over-focus on medications, lack of interest and time, need for more education on the part of the clinicians and better reimbursement models and support to execute and practice what the recommendations are for lifestyle change.

So when a patient comes in and says they are irritable, edgy, frustrated; that they have mood swings, ups and downs; that they are labile, quick to react and have anger outbursts and of lack of sleep--when they complain of having pressured and racing thoughts and thus all the "buzz words and check list items" for bipolar---it is all too easy to give this label too quickly.

In this day and age of short medication evaluation and management visits and often stops and starts and various other resistances to individual and group therapy---medications sometimes I feel are given too fast, too many, and too much.  Sometimes a messy soup is created where one does not know fully what one medicine does or not--and often there is higher risk for drug interactions when this is the case.

Mood stabilizing medications in various classes are powerful chemicals that do have long and short term side effects and need to be carefully given/prescribed.  All too often, I see children and adults given anti-psychotic/mood stabilizing medications right away without turning to more traditional medications.  While all medications have their risks and benefits, in my opinion the anti psychotic/mood stabilizing medications have very important and serious issues to contend with and should be used slowly, carefully and with a lot of thought---not just a knee jerk reaction because of what physicians in this are conditioned to think sometimes about starting these medications through various channels.

Yet, in our current rushed, and yes, sometimes haphazard, limited,
and plastic model with little diagnostic and supportive time with people (usually about 20 -30 minutes initially and 15 minutes or less for followups---unless there are other arrangements made)---We have to be careful and considerate in separating out what is actually Bipolar Disorder and what are other factors contributing to the complex areas of mood, anxiety, psychosis and other symptom categories.

DR. R