There Are Too Many Bipolar Disorder Diagnoses
A supervising psychiatrist examines a problematic trend
Casual references to bipolar disorder are tossed around these days with alarming frequency.
We’ve all heard someone say “that’s my OCD” when double checking plans or details, or perhaps “he’s schizophrenic about that” to describe an ambivalent person. And of course “they’re so ADD” as a disdainful commentary of anyone showing lack of attention. Now we’ve added “she’s so bipolar” to the list of casual accusations, meaning someone’s moods change rapidly — without apparent reason.
As a psychiatrist, I am sensitive to each of these incorrect usages and consider them offensive — as they grossly minimize the struggles of actual people while mischaracterizing what is truly going on. Sadly, misapplying a bipolar diagnosis is a real problem. It is now commonly misapplied not just in casual conversation, but by mental health professionals as well. Countless patients I see are led to believe that a bipolar diagnosis explains their troubles when the truth may be more complex or, ironically, much simpler.
I supervise a small number of clinicians and review clinical charts. I see the diagnosis of bipolar disorder appearing in charts with an implausible frequency, as high as one in three patients. As a rule, I believe none of these bipolar diagnoses without proof. Unfortunately, my skepticism is usually born out.
This growing pattern among mental health professionals of diagnosing bipolar disorder, in lieu of clinical depression, is repeated across clinics and practitioners. My colleagues see the same pattern, which research has now confirmed. Sadly, with each mistaken diagnosis comes the risk of inappropriate treatment, overmedication, and years of unnecessary suffering.
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From the 1950s to the 1980s, American psychiatrists tended to under-diagnose bipolar disorder compared to their European colleagues. If someone was very sick and had a chronic course, mental health professionals…