By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Diagnosing Bipolar Disorder.
Why is it so hard for people with Bipolar Disorder to get diagnosed and treated? For mental and emotional problems, the sooner the diagnosis, the sooner the treatment begins, the less the suffering. The more entrenched the illness the longer and more difficult the recovery. We continue to have difficulty with Bipolar Disorder. Why?
Almost 70% of people with a Bipolar Diagnosis had another diagnosis first. On average they get four other diagnoses before the Bipolar one. Usually, somewhere along the line, they are diagnosed with Major Depressive Disorder, given an anti-depressant. At this point, on an antidepressant, 40% of clients with Bipolar experience an episode of mania or hypomania. Antidepressants given to people with Bipolar disorder also increase the likelihood they will become rapid cyclers.
Our understanding of this condition has changed over the years. To be honest the mental health profession’s understanding of most illnesses has changed a lot over the years. We used to call Bipolar Disorder by another name – Manic Depressive disorder. Clients continue to come into facilities and tell us that they have Manic Depressive Disorder and Bipolar, not understanding that both are the same thing, just a new name.
Currently, there are two principle camps in this debate – those who think too many people are being diagnosed with Bipolar Disorder and those who think that professionals are missing a lot of Bipolar Disorder. The controversy goes back to the first efforts at classifying anything, the lumpers, and the splitters. Some people would like a different name for every possible type of dog; other people are content to consider them all dogs, the same with mental illnesses. So what difference does it make? It could make a lot of difference.
Ira Glick, up at Stanford wrote an article a while back called Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. This is not a really new article but it is important as we think about how the diagnosis is likely to change in the next few years when the DSM-5 comes out. Glick suggests that the true rate of Bipolar may be as much more than what is being diagnosed. We used to expect Bipolar Disorder to run 1% to 2 % of the population; recently it has been diagnosed closer to 7%.
We are starting to think of this condition as a spectrum disorder. So there is a range of symptoms and the ones with less noticeable symptoms are not getting diagnosed.
Does it matter if some mild cases are getting missed and not treated? Yes, it matters and the clients with the less prominent symptoms are not necessarily milder cases. Currently, we separate cases into Bipolar I and Bipolar II. People who have Bipolar II don’t have pronounced episodes of mania. They do have other significant differences.
People with Bipolar II have way more unemployment. They get divorced more often; have more thoughts of suicide and more suicide attempts. This one disorder, according to Glick, accounts for more suicide attempts than any other mental illness, excluding personality disorders. This is a big problem since Bipolar II looks like Major Depression until the mania or hypomania kicks in.
Many people who eventually get the Bipolar Diagnosis are first seen by their primary care physician. Primary care doctors treat more than half of all the depression and anxiety. There are a lot of medical problems that are especially problematic for people with Bipolar Disorder. People with bipolar disorder are more likely to have migraines, diabetes, or obesity.
Medications for people with Bipolar are especially problematic. People with Bipolar II get antidepressants till they have a manic episode then they may get all sorts of meds. People with Bipolar I have the more pronounced psychosis and may get all kinds of heavy-duty antipsychotics. Sometimes people with depression have distorted thinking and we see psychosis. Sometimes the psychosis in Bipolar II looks a lot like Schizophrenia, Schizoaffective disorder, and a lot of other things.
We are also not sure how much of all this is a result of genetics and how much is learning. Some authors have talked about how personality traits, those supposed unchanging characteristic ways of behaving may be related to Bipolar Disorder.
In fact, there is some question as to which mental health issues are district illnesses and which are symptoms. A cough is easy to notice but what causes the cough can vary a lot from person to person.
Despite all the issues with diagnosis, Bipolar disorder in all its forms causes a significant amount of suffering. It is also a difficult disorder to manage for the client and for the professional. If there is a chance you or someone you know has this disorder get a professional evaluation. If you have Bipolar disorder become a knowledgeable client, and don’t give up hope, the treatment options continue to improve.
Staying connected with David Joel Miller
Seven David Joel Miller Books are available now!
My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.
Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.
Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.
As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.
Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.
Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.
Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.
Planned Accidents The second Arthur Mitchell and Plutus mystery.
Letters from the Dead: The third in the Arthur Mitchell mystery series.
What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?
Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.
For these and my upcoming books; please visit my Author Page – David Joel Miller
Want the latest blog posts as they publish? Subscribe to this blog.
For videos, see: Counselorssoapbox YouTube Video Channel