If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?

[Skyler]

If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?

 

ScienceDaily (July 29, 2009) — A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool --the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients.

 

Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

 

Click If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses? to read the article, and here to read the paper from which the article was drawn.

[Altostrata]

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."

 

The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

 

Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."

The way I would interpret is that doctors are throwing prescriptions at mood conditions they can't identify.

[Barbarannamated]

Let's look at MEDICAL CONDITIONS that mimic Bipolar Disorder:

http://www.bigsiteofamazingfacts.com/what-medical-conditions-can-mimic-bipolar-disorder

Hyperthyroidism and hypothyroidism (too much or too little thyroid hormone) • Hypoglycemia, hyperglycemia, diabetes (abnormalities in blood sugar) • Cushing’s syndrome (a hormonal disorder involving excessive cortisol) • Anemia and other blood disorders, including porphyria • Traumatic brain injuries, both open and closed head injuries • Brain tumors, aneurysms, or cranial bleeds • Strokes • Dementia (Alzheimer’s disease and other variants) • Epilepsy (especially the confusional, post-ictal, state following a seizure) • Parkinson’s disease • Huntington’s disease (a hereditary neurological disease) • Multiple sclerosis (an autoimmune disease that affects the nervous system Wilson’s disease (a disease in which the body accumulates copper) • Syphilis • Systemic lupus erythematosus (SLE) (an autoimmune disease) • Meningitis (inflammation, often caused by infection, of the tissues that cover and protect the brain and spinal column) • HIV/AIDS infection, including opportunistic infections of the brain, and HIV-associated dementias • Pancreatic and bladder cancers • Withdrawal from alcohol • Withdrawal from benzodiazepines • Delirium (This broad term refers to a confusional state that can be caused by many things from high fevers and infections to drug reactions to organ failure to tumors.) • Severe nutritional deficiencies (vitamin B12, thiamine) • Electrolyte imbalances (sodium, calcium) • Sleep disorders such as sleep apnea, narcolepsy, and severe sleep deprivation

• WITHDRAWAL FROM ANTIDEPRESSANTS - SS/NRIs, TCAs, etc. (My addendum)

• PERSONALITY! (also my addendum)

[Rhiannon]

Not to mention the hundreds of thousands of people who are diagnosed bipolar because of mania caused by antidepressants. And the severe mood swings and depression caused by trying to get off ADs and other psych drugs--okay, Barbara did mention the AD withdrawal. I think it's a big one. It happens with other commonly prescribed drugs too. I was "diagnosed" bipolar due to drug reactions and withdrawal reactions. I'm about as bipolar as I'm a fish.

[Skyler]

Not to mention the hundreds of thousands of people who are diagnosed bipolar because of mania caused by antidepressants. And the severe mood swings and depression caused by trying to get off ADs and other psych drugs--okay, Barbara did mention the AD withdrawal. I think it's a big one. It happens with other commonly prescribed drugs too. I was "diagnosed" bipolar due to drug reactions and withdrawal reactions. I'm about as bipolar as I'm a fish.

 

Yup.. I think it's Whitaker who says a lot about how rare true bipolar was before antidepressants were prescribed? That almost all Dx of BiPolar I are related to adverse manic responses to ADs. Very very disturbing. The article supports limiting the Dx, and I think the Dx should be largely eliminated except for cases that are classic. If there is no acute mania, then no bipolar Dx. No fabricated sub thresholds. A true episode of mania is very delineated, and pretty much unmistakable. Soft bipolar symptoms should not be counted. We have a medication epidemic, and the iatrogenic effects resulting from unnecessarily medicating trumped up mood disorders are disastrous.

[meistersinger]

Not to mention the hundreds of thousands of people who are diagnosed bipolar because of mania caused by antidepressants. And the severe mood swings and depression caused by trying to get off ADs and other psych drugs--okay, Barbara did mention the AD withdrawal. I think it's a big one. It happens with other commonly prescribed drugs too. I was "diagnosed" bipolar due to drug reactions and withdrawal reactions. I'm about as bipolar as I'm a fish.

 

My problems with bipolar I think raised it's head in college. I have always been a loner, and not many people took me seriously. The only comfort I could ever find was in junk food. When I got in the professional world, and after dad died, I really went overboard. I would bounce checks just to get some form of communication. In some ways, I was always my own worst enemy. I would work 3 jobs just to pay the bills. I now know where it landed me, and it's all my fault. Problem is, when I asked for help, I was told go to hell. I told that to my sister-in-law, and she didn't get it either. It's any wonder I now stay isolated, because no one in the family understands, nor do they care. I've always been a bit too trusting, and have been taken advantage of too many times. It is why I stay shut in my room, as not many or willing to help.

[Skyler]

My problems with bipolar I think raised it's head in college. I have always been a loner, and not many people took me seriously. The only comfort I could ever find was in junk food. When I got in the professional world, and after dad died, I really went overboard. I would bounce checks just to get some form of communication. In some ways, I was always my own worst enemy. I would work 3 jobs just to pay the bills. I now know where it landed me, and it's all my fault. Problem is, when I asked for help, I was told go to hell. I told that to my sister-in-law, and she didn't get it either. It's any wonder I now stay isolated, because no one in the family understands, nor do they care. I've always been a bit too trusting, and have been taken advantage of too many times. It is why I stay shut in my room, as not many or willing to help.

 

You have problems with the routine skills you need to meet basic needs. But these can be identified in ways other than sticking you with a bipolar diagnosis. The bottom line is you want off meds, and the way your issues have been assessed fast tracked you onto psychotropics. Why should you need a label to get help and why should the primary 'help' be drugs? (this last sentence is rhetorical).

[meistersinger]

 

My problems with bipolar I think raised it's head in college. I have always been a loner, and not many people took me seriously. The only comfort I could ever find was in junk food. When I got in the professional world, and after dad died, I really went overboard. I would bounce checks just to get some form of communication. In some ways, I was always my own worst enemy. I would work 3 jobs just to pay the bills. I now know where it landed me, and it's all my fault. Problem is, when I asked for help, I was told go to hell. I told that to my sister-in-law, and she didn't get it either. It's any wonder I now stay isolated, because no one in the family understands, nor do they care. I've always been a bit too trusting, and have been taken advantage of too many times. It is why I stay shut in my room, as not many or willing to help.

 

You have problems with the routine skills you need to meet basic needs. But these can be identified in ways other than sticking you with a bipolar diagnosis. The bottom line is you want off meds, and the way your issues have been assessed fast tracked you onto psychotropics. Why should you need a label to get help and why should the primary 'help' be drugs? (this last sentence is rhetorical).

 

Mostly because the prevailing attitude is "I've got mine and screw every one else.".

 

I don't dare get angry, since I'll end up alienating myself more than I already have.

[Barbarannamated]

QUOTE:

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."

 

Along with Zimmerman, other researchers involved in the study include Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital and Brown University. (END QUOTE)

 

While I appreciate the effort of these authors to move away from a medication-focused diagnosis (Bipolar) toward a psychotherapy-based diagnosis (Borderline PD), I've seen Borderline treated with SSRIs among other psychotropics. I also have little belief in Axis II disorders, especially Borderline.

It seems to be a bit of a turf war by PhDs to steer toward borderline which, theoretically, is not responsive to drugs. Anyone else seeing this?

[Skyler]

It seems to be a bit of a turf war by PhDs to steer toward borderline which, theoretically, is not responsive to drugs. Anyone else seeing this?

 

I see a turf war, but more than borderline personality disorder is involved. I chose this article because it pretty much dismisses 50% of bipolar diagnosis out of hand (to illustrate how flawed the diagnosis is).. not because of the validity of borderline Dx, and not because the other 50% diagnoses are necessarily valid. And for a reason inscrutable to me, borderline is now being conflated with antisocial. Go figure.. IMHO, when the DSM is used as more than a short hand way to describe symptom constellations, it's useless.

[Barbarannamated]

I like when you all make me look up vocabulary words ;-)

 

Conflated...meaning Borderline PD is being blurred with Antisocial PD? Antisocial PD is plenty misunderstood on its own, IMHO. Let's throw in "psychopath", "sociopath", narcissistic... just to confuse matters (or ME, at least!).

[Skyler]

I like when you all make me look up vocabulary words ;-)

I love scrabble!

 

Conflated...meaning Borderline PD is being blurred with Antisocial PD? Antisocial PD is plenty misunderstood on its own, IMHO. Let's throw in "psychopath", "sociopath", narcissistic... just to confuse matters (or ME, at least!).

 

Ayup.. pitiful ain't it? This would have me doing same, but there is gravitas as people with Borderline PD will end up being even more stigmatized than they already are.. and some of the nicest people I've met have BPD (my father for one). NOT the same as sociopathic. ARGHARGHARGH

[Barbarannamated]

Just for the sake of discussion... what is the purpose of diagnosing Borderline PD? This gets back to my issue with labeling or determining what is/is not 'normal'. I've seen people who embrace their diagnoses as an identity and it's only served to reinforce their feelings of being abnormal or disabled. I have a few friends whose teenage daughters are diagnosed BPD.

I dont mean to be challenging, but trying to understand. Would it not be better to work on whatever issues are present without labeling the individual?

[Skyler]

Just for the sake of discussion... what is the purpose of diagnosing Borderline PD? This gets back to my issue with labeling or determining what is/is not 'normal'. I've seen people who embrace their diagnoses as an identity and it's only served to reinforce their feelings of being abnormal or disabled. I have a few friends whose teenage daughters are diagnosed BPD.

I dont mean to be challenging, but trying to understand. Would it not be better to work on whatever issues are present without labeling the individual?

 

IMHO, when the DSM is used as more than a short hand way to describe symptom constellations, it's useless.

We need a way to be on the same page when talking about people, but this should be used as a point of departure.

 

It's very hard for me to discuss anything without ending up justifying the means. I use psychodynamic, and need to address the concerns of the CBT folk, or the Mindfulness contingent, and if I use technical mumbo jumbo, more justification is needed. There really does have to be some point of commonality, so at least we know when we disagree!

[Jemima]

 

I dont mean to be challenging, but trying to understand. Would it not be better to work on whatever issues are present without labeling the individual?

 

My goodness, Barbara, there's no money in that so what good would it be to psychiatry or Big Pharma? You are far too sensible.

[Jemima]

 

The way I would interpret is that doctors are throwing prescriptions at mood conditions they can't identify.

 

I agree, and I'd like to add that this dysfunctional behavior - on the part of "physicians" - dates back to the dawn of modern medicine when invasive procedures such as blood-letting and "snake oil" medications that incorporated opium were used with the same impunity and arrogance with which extremely harmful surgery and drugs are used today.

[Skyler]

 

 

The way I would interpret is that doctors are throwing prescriptions at mood conditions they can't identify.

 

I agree, and I'd like to add that this dysfunctional behavior - on the part of "physicians" - dates back to the dawn of modern medicine when invasive procedures such as blood-letting and "snake oil" medications that incorporated opium were used with the same impunity and arrogance with which extremely harmful surgery and drugs are used today.

 

Hi Jemima.. I often compare blood letting and lobotomies to today's use of psychotropics. All are equally heinous. ~S

[Barbarannamated]

I'm seeing something different in this article. Perhaps I should read again...