Why is BP so overdiagnosed in the US?

2 month wait for pdocs is usual here too. I've waited 6 months for a public T before, but if I was to go the private route it would be much shorter.

The more I read on this forum to more I wonder how many of the diagnosis's fall under one single diagnosis rather than the 5 or 6 that many seem to have. Do pdocs just like to put labels on every single symptom there? Is this beneficial or detrimental?

One thing that many people forget is that bipolar disorder is also underdiagnosed - the average bipolar person goes 10 years without receiving a correct diagnosis.

Just browsing around and I thought this was a good thread. It can't hurt to get it flowing again so new people can read it.

I remember how shocked I was back when I started this thread. Kinda scary that I am no longer shocked by what I read here haha. All I can say is thank **** Im not being treated in the US!

I wasn't diagnosed "officially" until I was 40, but I had been hospitalized and in and out of therapy since I was 14. In my experience, doctors seem hesitant to diagnose this, especially since so many of us have had other diagnoses in the past. Stigma? Insurance? I'm not sure. But I don't think it's over diagnosed here at all. I feel like some of us have had to fight for it!

I was once diagnosed with BP II. I did not believe it, because my mood fluctuations, which lasted usually about a week, only occurred when I was on an SSRI. Out of the 5 different SSRIs I have tried, two caused bipolar symptoms. One of the drugs made me acutely psychotic and agitated. I wondered around my city incoherent and confused for about a week. Another one made my moods swing. Some people believe this indicates bipolar disorder. It cannot be in my case since none of this has happened ever since I have taken those two drugs. My experience makes me wonder if medication contributes to the over diagnosis of BP.

I live in Canada where psychiatrists appear to be more cautious.

I'm in Canada, so I'm not sure if it's different than in the US, but i know it took a long time for me to get the bipolar diagnosis, and some misdiagnosis on the way. But i work in mental health, and i have seem people given bipolar as a misdiagnosis too.

The DSM criteria are open to interpretation. There is no such thing as a definitive diagnosis in psychiatry... The diagnoses are just descriptions of symptom, which can't always be applied to real people. I have seen patients given a bipolar diagnosis because they need an official "serious and persistent" mental disorder to access care in community psych clinics and money for disability. The real problem might be BPD or ADHD, but those diagnoses don't qualify, so patients get diagnosed bipolar It's a slippery slope - is it wrong to give a misdiagnosis if it gets your patient care and money? The diagnosis becomes permanent and takes on a life of it's own. I don't really know the answer, it's a bit of an ethical dilemma.

With my patients, i will stretch a soft diagnosis as much as i can if it's going to get them money, housing, or treatment. But i tell them that i'm filling out the form about them on their very worst day so tgat it will be approved, so don't get offended. So far the patients seem to like that, and i've never had one of my disability applications rejected. (I'm an NP, and i work with low income, inner city patients, so i think they should all qualify for as much money etc as possible). But i don't write down inaccurate diagnoses.


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It took a great deal of time and observation before my pdoc felt right giving a definitive diagnosis. I certainly didn't experience it as a quick diagnosis and don't seem to run into many other people with the diagnosis. I suppose like all things, it gets misdiagnosed. Just haven't experienced it as the go-to diagnosis personally.

I do think it is unethical to put patients on disability when they could work out their issues with hard work and therapy - such as those with BPD. It gives them an excuse not to try, they dont need to, they are set sitting on disability with a diagnosis that excuses their behaviour. Short term government support I can understand, but long term for people with minor mental health issues is not helpful to them in the long run.

When I started this thread all that time ago, what really concerned me was the amount of people that said things along the lines of "I have this behaviour, but I have bipolar so it is excusable, the only option is stronger meds/med change" when the issue is so clearly able to be worked on in a therapeutic environment and perhaps not a bipolar issue at all.

Many patients do not realise that their codes on their insurance slips are just so the pdocs can get coverage, they take that as gospel and then blame every problem on the fact they have such a "severe" mental illness. I feel sorry for these patients as they do not realise the life they are missing out on by immersing themselves in a mentally ill lifestyle.

Some of us on disability are on it to rebuild our lives so we can one day work. Others go on it for a period of time and recover enough to work. Most people don't want to remain on provincial run disability programs for the rest of their lives. The low pay is usually thousands of dollars below the poverty line. E.g., $ 6 000 less for a single person living in Ontario

BPD is debilitating disorder that should get the same respect as bipolar disorder and all the other "axis 1 disorders" even though the treatment is different. Often these people have comorbid disorders that need to addressed alongside the personality issues.

Are you implying people with BPD are not mentally ill?

You seem to be implying BPD here.

This type of thinking isn't specific to one diagnosis. It is seen in all mental illnesses. It won't change until the person with the illness decides to.

How have I implied that? Please I'd like to know as I dont see that anywhere in my response.
Again cant see how I am implying that, this also rings true for anxiety, ocd, depression, sleep issues, diet and lifestyle

I do believe those with BPD should be treated correctly, with therapy and short term medication if required, but it is an illness that will not get better if the patient believes they have no control because they are Bipolar.

I think perhaps part of the BPD/ bi-polar crossover may be that BPD is considered a difficult diagnosis and so it's easier to simply tell the patient they have bi-polar, medicate them and send them on their way so they don't need to be dealt with.

Right here:

Even though the bolded words are in different sentences, they can be interpreted as connected or a continuation of the idea.

And here:

What can those other illnesses be? They have to be similar to BP. BPD definitely is. ADHD, epilepsy, substance abuse, PTSD and ASD are a few others I can think of. Since the misdiagnosis of BPD and BP is very well known, people may automatically conclude you were referring to BPD without considering other conditions.

This is very good point. Explicitly stating this would have prevented BPD from being implied. You can also add autism spectrum disorder, endocrine and neurological disorders along with substance abuse to the list.

I think this is true for simple BPD. Unfortunately, most people with BPD have comorbid disorders such as OCD, and depression that can benefit from medications. Some even have BP 1 and schizophrenia. Therapy alone won't cure those illnesses, but it will definitely help.

We are all unique. There are so many factors to consider when treating mental illness. No one treatment works for all people with a particular illness.

Brave and adventurous people came from Europe to the U.S. Ones willing to risk death on a boat, infection. Brave=bipolar.

In America 26.2% of adults have a mental illness, 6% are considered serious, 9.5% fall under mood disorder, and 2.6% of all adults in America are bipolar.
Comparatively that is one of the lest common disorders to have (almost a tied with BPD). OCD and Schizophrenia have a small percentage.

If more than one fourth of the country are effed up, than it kinda sounds like a effed up country..... and it should be in hands of sociologists and educators, not shrinks and their pharma profits.

Seriously, this statistic scares me and annoys me at the same time. I kinda don't believe it... couple with "it's biological" it would imply human breed is one very defiecient species.



The most debate about BP is with children because for the first time the idea that children can have this disorder is arising. Early detection early prevention.
Anyone else have other opinions?

Prevention of what? Having a life untarred with "my brain is broken"? Prevention of their brain developing right without having all kinds of drugs thrown at it? Prevention of the chance they may grow out of it with loving and empathetic guidance?

There is no cure of MI. Drugs only treat symptoms. They don't prevent anything. Labelling a child is only gonna create more problems with issues of self-perception and self-worth.

I think some people claim it because the diagnosis is thrown around a lot in some cases.

Plus there is so many "bipolar" celebrities that I am really suspicious about it in some case (I think some of them just can't handle the fame and were cracking under presure. And substance abuse might have played a role in there). Of course, even Chris Brown is bipolar, apparently (and many people feel sorry for him, because, you guess it, bipolar made him beat up Rihanna, let's feel sorry for poo wittle Chris.... I wonder if bipolar made him write garbage music too).







and I think another huge problem is that once you are diagnosed, it's hard to get undiagnosed. Any questions from patiences = delusion = proof they are ill. How many times we seen here the "your illness is lying to you" line?

My patients are legitimately disabled and unable to work, but the forms have to be filled out a certain way or they get rejected. If the diagnosis is too soft it gets rejected, even if the person is very impaired. I only do it for people who are legitimately unwell, otherwise i say no. It's a stupid system really, and even disability is not enough to live on, but at least it gives them a chance to try to improve their situation in some way. Plus it gives them access to things like dental care etc, which are necessary but not otherwise covered. My job is to advocate for my patient's health, and i will do that however i can. I don't think what i do is unethical, i think the system itself is unethical.


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Yes.

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The_little_didgee, the way you have interpreted my response is not the same as how it was intended. The bolded words WERE in different sentances... Just because YOU want them to match up is the only reason you have taken offence. Read it how it is written, instead of how you want to see it. Makes me wonder what issues you have to argue something that is not even there if you read the responses as they are written.

I have seen people who do have OCD, ADHD, GAD, MDD, PTSD ALL dismiss therapy because "Bipolar is a chemical disorder". I used "such as BPD" as an example as it is the easiest to compare, but it is certainly not the only mental issue that is blamed on bipolar.

I agree, the system is the unethical bit. I totally agree with government support for those that are legitimately unwell. Its the ones that rort the system that make it harder for the legitimately ill to get the help they need.

All of the disability systems work differently but here the only way to get disability is for it to be a permanent life long issue. Mental illness does not have to mean long term instability with the right treatment and work. What I see happening are people who do get onto disability and then life stops, they dont endevour to do anything more with their life for fear of instability, but they wont work at it either. This leads to life long depression problems, as we know humans need to be social and have purpose in order to feel forfilled and happy.

Thats a whole new discussion which I would love to have if anyone wants to start a thread!

I wasn't offended by anything you have written here until now. You have obviously taken offense to my challenge, which was never my intent. I just made an observation and wanted to point it out. Your post appeared to be a generalization so I wanted to discuss it.

If you are going to discuss a controversial topic like this at least be open minded to different opinions. It is very possible for people to have different opinions and be respectful.

I like to think and get others thinking too. It may not be popular but that isn't going to deter me. My posts were never about me being right or you being wrong. My intention all along was only to discuss the matter. You seemed reasonable and somewhat open to discussion even though it appeared you were looking for people to agree with your opinions. I was just trying to add another dimension to the conversation.

Language can be interpreted in a multitude of ways. If you want to lessen ambiguity be explicit.

I agree people do better with work or something meaningful in their lives. And mental illness doesn't necessarily mean life long inability to work - i have a bipolar diagnosis, and i was approved for long term disability, but i choose to work instead. That's just me, everyone is different, and not everyone can handle work. Where i live you can work and make up to $800 per month when you are on disability, so people can work part time. If you choose to work more you lose the financial support, but keep your extended health benefits. So there are options. This could totally be another discussion - didn't mean to hijack this thread, sorry!

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Actually, from every study I've read, about 4-7% of the US population has been diag. with bipolar disorder (manic-depression). It may seem like a lot because we have such a huge population. And American doctors are more & more aware of this illness. In the past, people with this were only diag. with depression because people who had it were more worried about themselves when they were unable to get up out of bed & etc. The euphoric highs are more "fun" (even tho' we can get in trouble overspending & etc. in a high). But now that more MDs & pdocs are aware of symptoms, there are more diagnoses.
You can't be diag. with bipolar without having gone through many tests (Minnesota Multiphasic & so forth). It's nothing to do with insurance. Most insurance only pays for 50% of any mental health treatment.

The opposite for me. I saw 12 pdocs & NONE caught the bipolar thing
They kept saying "you are highly intelligent & creative. People like you are just different." But I was suffering horribly. Finally, in my late 40s, after weeks of testing & the pdoc interviewing me, my MD and my husband (plus reading my past therapists' comments), I got diag. with bipolar disorder, mostly manias, OCD also. I know others who went to pdocs insisting they had "something wrong" but were dismissed & told to "exercise & eat a balanced diet."
So there are many people who would have benefitted Much from an earlier diag.

I don't think of any serious mental illness being over diagnosed. Episodes of depression and anxiety in otherwise healthy people are medicated too frequently by doctors in the US, but when it comes to anything that requires long term care answers and help are hard to come by.

Seeing ads for Latuda and Abilify in women's magazines does bother me. How many people actually need an AP medication considering the long term side effects? It's kind of scary that doctors are writing scripts for these meds without proper training. It's bad enough that they send people out with antidepressants all the time.

In my experience, help and a diagnosis is hard to find until you are in the system and on a public health plan. I ended up in the ER before I got any help, despite trying on and off for years. If my illness had been caught when I was young it would have saved me a lot of suffering. With my out of control, reckless behavior and dark depressions I am very lucky that I didn't die before finding real treatment.

My opinion is that the problem with mental health care in America is that we rely on family doctors to diagnose and prescribe. You either have to be rich or flat on your butt broke to find care.

It's actually a very easy diagnosis to get. I wasn't tested at all; in fact just a few 10 minute talks with a psychiatrist landed me with bipolar nos. Doing the same thing also got a bipolar 1 diagnosis with a different psychiatrist just weeks later.

It was only after a a real sit down and more in depth discussion with yet another psychiatrist was the diagnosis dropped.

I have a history of horrible miscommunication and misdiagnosis before all of this, too, and I was in inpatient when these diagnoses were made, so it was even easier for them to pull the trigger prematurely and make assumptions about why I was there.