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Bipolar Basics (And the Challenges in Diagnosis)
A complex mood disorder, bipolar poses several challenges to those who experience it. These pains include maintaining relationships, holding down sustainable employment, and often financial struggles. Less than 20% of those having bipolar disorder receive an accurate diagnosis within the first year of treatment. In fact, five or even ten years is not unheard of. So what is so difficult about diagnosing bipolar disorder?
What is Bipolar?
Bipolar disorder is a mental illness causing fluctuating moods and energy levels. It often affects emotions, sleep, appetite, focus, and many other aspects of the person’s life. Diagnostic criteria include experiencing depressive and manic episodes.
What Might a Depressive Episode Look Like?
During a depressive episode, some or all of the following signs and symptoms are present:
● Feeling sad and/or a sense of emptiness
● Loss of interest in activities
● Reduced energy and/or decreased activity levels
● Difficulty concentrating and/or forgetfulness
● Changes in appetite
● Sleep disruptions
What Might Mania Look Like?
A manic or hypomanic episode may present some or all of the following signs and symptoms:
● Increased activity levels and/or taking on many tasks
● A sense of euphoria
● Racing thoughts
● Irritability
● Feeling jittery or similar agitation
● Engaging in risky behavior
● An abundance of energy and/or insomnia
Types of Bipolar
We can divide bipolar disorder into four categories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar-Related Disorders. Each type of bipolar causes mood cycling. None of these has a singular cause although risk factors include trauma, brain function anomalies, and genetics. Symptoms typically begin during the teenage years.
This is what most people think of when considering bipolar. It is characterized by a depressive episode and a manic episode. Episodes may last a significant amount of time or rapid cycle. Mania symptoms last seven days or more, or are severe enough to require intervention.
Frequently misdiagnosed as major depressive disorder, bipolar II is characterized by a depressive episode and a hypomanic episode. As hypomania is less extreme than mania, they may pass it off as the person simply feeling better for a while.
Less extreme than the above, a person with cyclothymia vacillates between milder depression and hypomania. Continuous cycling for two years is considered cyclothymia.
Bipolar-Related Disorders
While not specifically a sub-type, this category encompasses mood disorders that resemble bipolar disorder but do not meet the criteria for a diagnosis.
The Wrong Diagnosis
People are more likely to seek treatment during a depressive episode and may not recall experiencing a manic or hypomanic episode, particularly in cases of bipolar II. This often leads to a diagnosis of major depressive disorder.
Substance abuse may also lead to a misdiagnosis as the use of alcohol or drugs can often affect episode cycles. This can lead the healthcare professional to believe that substance use is directly responsible for mood swings.
Someone with bipolar may also receive the incorrect diagnosis of schizophrenia as symptoms are similar for both diagnoses.
Medication and Misdiagnosis
Misdiagnosing bipolar disorder can lead to the healthcare professional prescribing medication that can worsen symptoms. For example, a provider may prescribe SSRIs for depression, which can trigger a manic episode.
Medications prescribed for different conditions may trigger mood and energy cycles. For example, a prescription for corticosteroids may induce mania.
Receiving the Right Diagnosis
Healthcare providers are not intentionally misdiagnosing people who seek care. As we understand more about the wide sphere of mental illness, the need for deeper psychological evaluation and a detailed patient history becomes more apparent.
If you are seeking treatment for your mental health, it’s important to share a lot of information, even if you find it embarrassing or shameful. The better your provider can understand your experience, the better they can treat you, and the sooner you can feel better.
