How Often is Bipolar Disorder Misdiagnosed?

Up to 40% of people with bipolar disorder are misdiagnosed, according to a 2018 study. As a mental health condition that entails severe shifts in energy levels and dramatic mood changes, mood episodes can involve low depression and hypomania, with mixed states throughout. Some features of bipolar disorder can be commonly mistaken for other mental health disorders with similar symptoms, depression, anxiety disorders, and ADHD.

Mental health diagnosis and treatment can involve a lot of trial and error. Find out below why bipolar diagnosis is missed and what you can do to get the right diagnosis if you think you, or someone you love, may have this disorder.

What is Bipolar Disorder?

Bipolar disorder is a mood disorder characterized by extreme highs and lows. Patients often have debilitating, depressive lows followed by extremely elevated moods, also called mania. About 4% of people in the United States experience bipolar disorder at some point in their lives, according to the National Institute of Mental Health. There are 4 main types of bipolar disorder:

• Bipolar 1 Disorder: an illness where people have experienced one or more mania episodes. Most people diagnosed will have episodes of mania and depression, but an episode of depression isn’t necessary for a diagnosis. Manic episodes must last for 7 days minimum or be severe enough it requires hospitalization.
• Bipolar II Disorder: a subset of bipolar disorder where people experience depressive episodes shifting back and forth with hypomanic episodes. There is never a “full” manic episode recorded.
• Cyclothymic Disorder: chronically unstable mood state where people experience mild depression and hypomania for two years minimum. Brief periods of normal mood states occur, but they last less than eight weeks.

Bipolar Unspecified: when a person doesn’t meet the criteria for the above disorders, but still have periods of clinically significant abnormal mood elevation.

Why is Bipolar Disorder Misdiagnosed?

Bipolar is a particularly difficult disorder to diagnose. Many won’t receive a proper diagnosis until years after their first mood episode, which often happens in adolescence. In the US, bipolar is diagnosed using the DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders.

According to the DSM-5, to be diagnosed with bipolar disorder a person must have experienced at least one episode of mania or hypomania. Mania must last for at least one week and be present most of the day, nearly every day. To be considered hypomania, the most must last for at least four consecutive days and be present most of the day, almost every day.

Symptoms that must be present and represent a significant change from usual behavior are:

• Decreased need for sleep
• Racing thoughts 
• Increased talkativeness
• Inflated self-esteem (grandiosity)
• Distracted easily
• Engaging in activities that have potential, painful consequences (buying sprees, hyper-sexuality, etc.)
• Increase in goal-directed activity or psychomotor agitation

On the opposite side of the spectrum, the depressive side of bipolar disorder is a major depressive episode. The DSM-5 states a person must experience five or more of the following symptoms in a two week time period:

• Depressed mood most of the day, nearly every day
• Diminished ability to think or concentrate
• Indecisiveness
• Feelings of worthlessness or guilt
• Engaging in purposeless movements (pacing the room, etc.)
• Significant weight loss or decrease/increase in appetite
• Loss of interest or pleasure in all activities
• Fatigue
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

Symptoms of bipolar disorder overlap frequently with other mental health conditions, which can lead to misdiagnosis. Depression, major depressive disorder, attention deficit hyperactivity disorder, schizophrenia, borderline personality disorder and substance use disorder all have overlapping symptoms with bipolar disorder. 

The first symptoms of bipolar disorder are unusually varied. Over time, a pattern emerges. This timeline leaves those with bipolar disorder waiting months, even years, for an accurate diagnosis. 

Sometimes a doctor doesn’t thoroughly review a person’s medical history. Sometimes a professional can be overly restrictive with the DSM-5 diagnostic criteria. Ethnicity and discrimination in the healthcare industry can also lead to misdiagnosis. Research shows that Black patients are more misdiagnosed with conditions other than a correct bipolar disorder compared to non-Black people.

The problem with a late or incorrect diagnosis? People miss out on getting the effective treatment they need.

How to Get The Right Mental Health Disorder Diagnosis

Everybody has good days and everybody has bad days. Some days are wonderful, other days we go through a bad break-up, lose out on a job we really wanted or have a falling out with a friend. Questions to ask yourself if you think your mood swings could be bipolar disorder:

• Have you ever gone to bed feeling euphoric and woken up the next morning feeling absolutely hopeless?
• Have you noticed your high-energy levels causing problems in your daily life?
• Have you noticed your racing thoughts turning into feelings of worthlessness suddenly?
• Are your mood swings caused by a situation, person, or event? Or do they appear without cause?

People with bipolar disorder frequently become manic or depressed for no apparent reason, while for most people without bipolar disorder, moodiness is found to be died to a situational event. If you’re unsure whether your mood swings are normal or a bipolar disorder symptom, try keeping a mood diary. Track and monitor your mood fluctuations. If you notice your moods changing for no apparent reason, you may have bipolar disorder.

Treatment for bipolar disorder is lifelong and can include a combination of psychotherapy and medications. If you think you have bipolar disorder, or you want to learn more, try a virtual diagnosis assessment, tele-therapy and medication management with The Couch. Getting the psychiatric care you need should be easy, accessible, stress-free, and uncomplicated. The Couch was created to ensure that happens. 

If you find yourself looking for a bipolar diagnosis, therapy to manage your symptoms or help with medication management, The Couch can help match you with a psychiatrist tailored to meet your needs.

We offer easy scheduling and work with your insurance and pharmacy of your choice, all electronically with our advanced telemedicine system. Don’t hesitate to reach out to a medical professional if you believe you have bipolar disorder.