Bipolar disorder is a severe psychiatric disorder. It is a chronic and disabling condition and was ranked as the sixth-leading cause of disability by the World Health Organization in 1990. The illness involves significant economic cost, and comes with a greatly increased risk of mortality—people with bipolar disorder are 20 times more likely to commit suicide than members of the general population.
Unfortunately, the many challenges involved in treating and living with bipolar disorder are often further complicated by misdiagnosis. A survey by the National Depressive and Manic-Depressive Association (DMDA) in 1994 found that 69 percent of bipolar patients were initially misdiagnosed, and that nearly one-third of them did not receive the correct diagnosis until 10 or more years had passed. A second survey in 2000 found that the rate of misdiagnosis had not changed. In addition, two studies from Europe found the average time span from misdiagnosis to correct diagnosis to be 5.7 years and 7.5 years respectively.
The Challenges of Correct Diagnosis
One of the biggest challenges in correctly diagnosing the disorder is that many bipolar patients initially seek treatment only for depressive symptoms. Many patients do not recognize their manic episodes as symptoms of an illness, especially if they have experienced relatively mild manic episodes known as hypomania. Major depressive disorder is the diagnosis in approximately 40 percent of bipolar misdiagnoses.
Many people suffering from bipolar disorder are also dealing with substance abuse, which can make it more difficult to diagnose the illness. A study of bipolar patients published in JAMA Psychiatry found that 46 percent of people with bipolar disorder also deal with alcohol abuse, while 42 percent of bipolar patients abuse drugs. However, other studies have estimated that the percentage of bipolar patients who abuse alcohol or abuse drugs may be as high as 70 percent and 60 percent.
There are also many other psychiatric illnesses that frequently appear with bipolar disorder and confuse the process of diagnosis. Obsessive-compulsive disorder, panic disorders, eating disorders, attention-deficit hyperactivity disorder (ADHD), social phobias and axis II personality disorders are all frequently present in adults with bipolar disorder. In people under the age of 20, oppositional defiant disorder, conduct disorder and ADHD are frequent comorbid illnesses with bipolar disorder.
The official guidelines for a diagnosis of bipolar can also contribute to misdiagnosis. The Diagnostic and Statistical Manual of Mental Disorders requires at least one hypomanic episode lasting four days before a diagnosis of bipolar II is advised (bipolar II is characterized by depression and hypomania, while bipolar I is characterized by depression and severe manic states.) However, many experts believe that hypomanic episodes last between one and three days on average.
The Cost of Misdiagnosis
Misdiagnosis of bipolar disorder can negatively affect a person’s mental, social, educational and economic well-being.
Without the correct mood stabilizing medication, bipolar disorder can be extremely disruptive to a person’s ability to lead a productive life. Performing well at work or in school becomes more difficult, as does maintaining stable relationships. When the right treatment is delayed, manic or depressive episodes are more likely to recur or become more frequent.
Misdiagnosis of bipolar disorder leads to higher medical costs for a variety of reasons that include an increased number of hospital visits and higher rates of attempted suicide. Patients with bipolar disorder are already at very high risk for attempted suicide: between 25 percent and 50 percent of people who suffer from bipolar disorder will attempt suicide at least once. Bipolar disorder also has an economic impact that is more difficult to quantify because it disrupts education and job skill development as well as job attendance and performance.
An absence of the correct treatment is not the only risk associated with bipolar misdiagnosis. These patients can also experience negative effects from receiving treatment designed for another illness. Many patients who are misdiagnosed with major depressive disorder are put on antidepressants. Fifty-five percent of bipolar patients who are put on antidepressants develop mania, while 23 percent develop a condition known as rapid cycling. Rapid cycling involves four depressive or manic episodes in a single year. One study found that 73 percent of all bipolar patients who experience rapid cycling were taking antidepressants at the time their cycling began.