11 Difficulties of diagnosing bipolar disorder

Photo credit: Abode of Chaos

It is not uncommon for us,  bipolars,  to receive our correct diagnosis about 10 years after we first go to a doctor.  There are a myriad of reasons why this happens.  Below I have compiled a list of the main difficulties of diagnosing Bipolar Disorder (BD).

  1. BD is a complex illness with a wide range of symptoms that play out differently for each person.
  2. Besides,  BD is in reality a spectrum of different types which are easily misdiagnosed as Anxiety Disorder,  Schizo-Affective Disorder or a Personality Disorder.
  3. In addition,  mixed episodes are really difficult to detect since symptoms of both (hypo)mania and depression coexist.
  4. BD usually starts with one or more (up to 5) episodes of depression before (hypo)mania hits.  Hence,  patients are often misdiagnosed with Major Depressive Disorder.
  5. As the medical journey many times starts with the GP it is vitally important that he is able to be aware of the differences in unipolar and bipolar depression.  Sadly this is not the case for the majority of GP’s.
  6. It is an art to be able to ask the right questions in order to find out if someone is also suffering from (hypo)mania.
  7. If the right questions are being asked,  the patient still has to recognize the symptoms in his own life.  This is made even harder since the patient might not be aware of the symptoms,  as it seems to him his normal life.
  8. Also,  because of the stigma of a mental illness (where depression is a far more acceptable diagnosis) it is easy to downplay any possible symptoms that point to BD.
  9. Especially when the patient is (ultra) rapid cycling he doesn’t meet the criteria for BD plus he is even more likely to encounter difficulties in recognising symptoms in his own life.
  10. Family history plays an important part in susceptibility for BD.  However,  the likelihood of (grand)parents being undiagnosed is huge.  Furthermore the family medical history might not be known.
  11. Other complicating factors are certain diseases which mimic some symptoms of BD,  like lupus,  Lyme disease,  thyroid disorder and epilepsy,  amongst others.
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11 responses to “11 Difficulties of diagnosing bipolar disorder

  1. Wow! That is so interesting Fenny, I never knew that! And I have a good high school and an aunt by marriage who are both bipolar. My friend was diagnosed at about 21 years of age when she had a massive manic episode after troubled teenage years. My aunt was also diagnosed in her twenties for the same reason actually! I’m very interested in psychology–I almost always learn something new here. 🙂

  2. Hi Larchik! Nice to see you back 🙂
    We shar the love of psychology, it’s sooooo interesting, is it not?
    Yes, usually the proper diagnosis follows after a manic episode. Since I have hypomanic episodes mainly it took a long time for me to get the proper diagnosis. I was 15 when the first major depression hit. But being hypomanic was my ‘normal’ if you like, way before that. I was diagnosed at 38(!) after a manic episode induced by being on too high a dose of anti-depressants.
    It’s sad that we have to struggle so long before the right diagnosis is made, but that is part of the illness 😦

  3. So interesting! Bipolar is something I don’t know a lot about – would make sense that it would be hard to diagnose. Thanks for sharing that.

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  6. fenny the exact thing happened to me…..they upped my zoloft and it sent me into mania….how long did your last and are u back to feeling your mormal self agian???

    • Hi Crystal,
      When it happened to me it was December 2006 and I was actually in a mixed state for months on end and for the first time, hence I didn;t have a clue of what was going on. To me it seemed the anti-depressants really didn;t do anythign. I already took Efexor and another one was added (can’t remember the name now, shucks!). I immediately went into overdrive and begged the hospital to take me. They didn’t since “I was not suicidal enough”. Right, did they want my family to sue them after the fact or what??? Anyways, I had enough, so I took myself in rapid succession off of the second anti-depressant. Life slowed down again in a week or so, phew! It convinced me I needed to see a pdoc, which my PG had wanted me to do many months before. Stigma hold me back though….
      So in Jan 07 I got my Dx.and started mood stabilisors (Depakote). I was kept on the anti-depressants cuz my depressions were so darn bad.
      How are you doing now? It just sucks so bad when meds are working against you instead of help you… Good luck and Take care!

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