The Challenge of Accurately Diagnosing Bipolar Disorder
(ISTOCKPHOTO/HEALTH)Youve read up on bipolar disorder and think it may be causing your intense mood swings and problems with relationships at school or work.
But you arent sure. Your symptoms—or those of the spouse, child, or friend youre worried about—also resemble those of other mental disorders, such as depression, borderline personality disorder, anxiety disorder, schizophrenia, or attention deficit hyperactivity disorder (ADHD).
Your confusion is understandable. Bipolar disorder can be difficult even for mental health professionals to diagnose, because many of the symptoms overlap with those of other mental illnesses, says S. Nassir Ghaemi, MD, the director of the Mood Disorders Program at Tufts Medical Center in Boston.
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Roughly half of people with bipolar disorder see at least three mental health professionals before getting a correct diagnosis, according to a 1994 survey by the Depression and Bipolar Support Alliance (then known as the National Depressive and Manic-Depressive Association). According to the same survey, about one-third of those with bipolar disorder received their diagnosis more than a decade after they sought treatment.
Here are some of the symptoms and treatments for other disorders that are sometimes mistaken for—or occur alongside—bipolar.
Bipolar disorder is marked by extreme shifts in mood that can vary between deep depression and mania, an abnormally elevated mood.
About 40% of patients with bipolar disorder are initially diagnosed with major (or unipolar) depression, which does not involve mood swings or mania, Dr. Ghaemi says.
There are several reasons for the confusion. Most people with bipolar disorder experience an episode of depression before an episode of mania. Often its the depression that drives people to seek medical treatment. And sometimes the person has never actually experienced a manic episode when he or she seeks treatment for depression.
In addition, studies show that about half of those experiencing mania dont realize theyre manic. “The patients often dont have insight into their manic symptoms. They either dont remember it, or they deny it,” Dr. Ghaemi says. To diagnose bipolar disorder, psychiatrists may enlist the assistance of family members who will share details about suspected mania or hypomania, a milder form of mania thats much less noticeable.
Symptoms of depression include a loss of interest in normal daily activities, feeling sad or down for an extended period, feeling hopeless or worthless, crying spells for no reason, sleep problems, trouble focusing or concentrating, unexplained weight gain or weight loss, irritability, and fatigue.
People who go on to receive a diagnosis of bipolar disorder are more likely to have postpartum depression, psychosis during their depression, and recurrent episodes of depression, Dr. Ghaemi says.
In addition, about 60% of those who go on to receive a diagnosis of bipolar also have some symptoms that mimic mania during their depressive episodes. This is called a “mixed” episode.
Symptoms of a “mixed” episode may include agitation, irritability, racing thoughts, hyperactivity, and anxiety. Only about 20% of those with major depression have such “mixed” episodes.
Complicating diagnosis even further, more than 40% of those with bipolar disorder experience whats known as a mixed episode, in which the symptoms of mania and depression occur simultaneously. And studies have shown that about a quarter of those with major depression experience a form of agitation that can resemble a mixed episode.
Depression is treated with prescription talk therapy, antidepressant drugs, or both. Antidepressants may bring on a manic episode, which is why its critical to tell your doctor about any unusual “up” periods that might suggest a manic or hypomanic episode.
Next Page: Borderline personality disorder [ pagebreak ]Borderline personality disorder
Like bipolar disorder, borderline personality disorder is marked by a lack of emotional regulation. People with the disorder have unpredictable mood swings and self-image problems that lead to relationship difficulties.
Unlike bipolar disorder, in which episodes of mania or depression typically last for several months, borderline personality disorder is characterized by intense bouts of anger or anxiety that may last a few hours.
Symptoms of borderline personality disorder include rapid mood changes, anger, aggression, depression, anxiety, unstable relationships, distortions in self-image, aggression, impulsivity, and harming ones self.
Since there are so many overlapping symptoms with bipolar disorder, some mental health professionals have argued that borderline personality disorder is actually a form of bipolar in which moods change unusually rapidly. Bipolar and borderline personality disorder can also coexist.
Treatment for borderline personality disorder may include psychotherapy, psychosocial treatments (such as dialectical behavior therapy), antidepressants, mood stabilizers, and antipsychotic medications.
Unlike fleeting moments of stress, anxiety disorders are chronic fears or worries that significantly impact your ability to function.
Bipolar disorder is sometimes mistaken for an anxiety disorder because anxiety, agitation, and irritability can be symptoms of both conditions. You can also have bipolar disorder and an anxiety disorder at the same time.
Anxiety disorders can take many forms, including:
- Panic disorder, or repeated episodes of sudden fear and dread
- Obsessive-compulsive disorder, or frequent, repeated thoughts leading to repetitive behavior (such as excessive hand-washing)
- Generalized anxiety disorder, or an excessive worry that lasts for months and often has physical symptoms such as headache or fatigue
Antidepressants, antianxiety drugs, cognitive behavioral therapy, and psychotherapy may be used to treat anxiety disorders.
Next Page: Schizophrenia [ pagebreak ]Schizophrenia
Schizophrenia is a severe brain disorder that can cause psychotic reactions, including hallucinations (seeing things or hearing voices that arent there), delusions (thoughts not based in reality), paranoia (the belief that something or someone is out to “get” you), disorganized speech and thoughts, a lack of motivation, social withdrawal, and flat or blunted emotions that can mimic depression.
Since people with bipolar disorder can also experience psychosis during the early stages of the illness, it may be very difficult to tell the two diseases apart, Carlson says Gabrielle Carlson, MD, a professor of psychiatry and pediatrics at Stony Brook University Medical Center in New York.
Over time, symptoms of the two conditions tend to diverge. While bipolar psychosis is typically episodic, schizophrenic delusions become chronic.
Schizophrenia is often treated with antipsychotic medications and psychosocial treatments.
Attention deficit hyperactivity disorder (ADHD)
ADHD can affect both children and adults. Its marked by impulsivity, inattention, and hyperactivity. However, distinguishing between ADHD and bipolar disorder is more difficult in young patients.
Symptoms of ADHD include difficulty paying attention, careless mistakes at school, becoming easily distracted, the inability to sustain attention on tasks that others easily complete, restlessness, and fidgeting. Some people, but not all, also have hyperactivity.
Because ADHD is more common in children than bipolar disorder, a childs violent outbursts, discipline problems, and aggression are often assumed to be ADHD, Dr. Carlson says. These problems are more likely to be chronic, rather than episodic, in children with ADHD, she adds.
One key difference between the two conditions is that bipolar children tend to have explosive anger and “hair-trigger” tempers. (Children with bipolar disorder may also experience psychosis, which is not a part of ADHD.) There is little research comparing ADHD and bipolar in adults; Dr. Ghaemi says he doesnt believe many adults have ADHD.
Prescription stimulants such as methylphenidate (Ritalin) are often prescribed for ADHD; however, they can worsen mania, so its important to get a correct diagnosis.
Drug and alcohol abuse
Some drugs, such as cocaine and amphetamines , can mimic mania, while alcohol abuse can mimic (and even cause) depression.
About 60% of people who have bipolar disorder also have a substance abuse problem.
To differentiate, consider behavior during any periods of sobriety. If the person seemed manic, then the cause of their difficulties is probably bipolar disorder and not the drugs. If the mania is only present when a person is abusing a drug, then its likely the drug, not the bipolar disorder, that is to blame.