Why is BP so overdiagnosed in the US?

Is it just because of insurance reasons? I find this so bizarre, wouldnt it be detrimental to patients to tell them they are bi polar when they are not or when they are not sure? I have seen many threads of people diagnosed within the first few sessions

I dont know many people diagnosed with bipolar where I live, it seems to be not nearly as common a diagnosis as it is in the US. It took 3 months in a psyc ward before they would even consider giving me the diagnosis and trying me on specific BP meds.

Wouldnt it be more harmful for the patients to be told they have this disorder when it could be something that could be treated with therapy if instead of messing around with dangerous medications? I'd assume there would be some patients that really struggle being given this diagnosis, especially if it is not correct.

from what i have seen a fair few people with bpd get diagnosed with bipolar. I know sometimes thats to avoid the stigma but sometimes its also because they overlap so much.

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.

There is a lot of miss DX's that happen. I had to go through many hospitalizations before I got the diagnosis, but I was almost diagnosed with ADHD, ADD, Schizophrenia, OCD, and other things before they came to BP as a Dx.

It just is case to case...
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?

Is there a large amount of overlap? My experience with BP is very different to my friends with BPD and those on this forum.

I suspect it is for insurance reasons. I don't believe insurance companies cover the personality disorders as much as mood disorders. In other words, it's for the patients benefit so their insurance will cover more visits and therapy.

I agree that they diagnose it too quickly. It took 5 months of therapy and a 2 week manic episode with psychotic features before I was "officially" diagnosed. They still kept track of my moods and how I crashed at the end of the highs and that I didn't have constant mood swings to rule out bpd. I must admit they were very thorough and took their time which I appreciate because I feel like my diagnosis validates what I had been experiencing, not just a label to slap on quickly.

I also believe it has to do with the overlap with borderline even though the two are very different. If someone comes in saying they have mood swings they think they're bipolar, what kind of mood swings? one's that last weeks to months or ones that happen instantly due to an outside trigger?

Doctors are to quick to diagnose it, I'm sure quite a few are due to insurance reasons and personality disorders not being covered. If I were someone with borderline I'd want to know my diagnosis, how will they get better until they know the tools necessary to help them cope, dbt. It's really unfair to them in the end. Diagnosing takes time.

I was dxed bp after 72 hours stay inpatient, have questioned dx ever since but my pdoc is 100 percent convinced. and yes I am on heavy meds.

I was in t and seeing a pdoc for 4yrs before I was officially diagnosed bp. I suffered pp-psychosis, so the 2 were masking each other. Pdoc and t both suspected bp for quite awhile before the official dx. Was not a dx that was jumped to right away. What I hate are people who self diagnose mood disorders and think it's such a commonplace disorder.

How do you come to the conclusion that Bipolar is over diagnosed in the US? I have never seen any facts to back up this argument. Less than 3% of ppl in the US are diagnosed with Bipolar. You consider that being over diagnosed? What country are you from?

I got diagnosed as bipolar 5 years ago after hospitalization. I have borderline features with anxiety/depression and have some mood instability off medication. I don't remember what its like to be unmedicated. I was probably misdiagnosed though.

Is Bipolar Disorder Overdiagnosed? A Conversation with Mark Zimmerman | Psych Central Professional

I think the above article (actually from here at PC) sums it up very well. A study, the reasons for overdiagnosis and the implications of the same. I've seen lots of other articles expressing similar concerns.

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

Above, interview of same researcher re Bipolar vs BPD diagnoses.

Someone who lives in Europe (?) here mentioned once that in her/his country depression with hypomania (I guess assuming it's a mild form) are generally diagnosed with depression rather than Bipolar II, unlike here. This makes sense only insofar as in many cases of Bipolar II, depression is most frequent and what is truly debilitating (greatly affecting functioning, etc.) and by this logic, it is the depression that needs to be addressed. Assuming the hypomania (or hypomania-type moods) do not affect one's functioning to the point of necessitating treatment with medication (instead of for example treatment in the form of therapy for mood regulation), then the focus (medically) is depression, and thus the diagnosis of depression. But I guess, it seems, that the threshold in the U.S. for what necessitates medication (and in a sense diagnosis) is far lower. You could argue the extent to which depression (of a milder sort) is medicated, is likely far higher in the US as well; in any case, I've read this to be the case.

I'd venture to guess that only 'major' depression is medicated in many other countries, just as only 'major' mania (for lack of a better term -i.e. mania as opposed to hypomania) is medicated. And diagnoses tend to correspond with what is considered needing to be medicated.

This leaves the problem of those who may initially present with hypomania who eventually go on to experience mania. I don't know what they do with that; perhaps close monitoring and crossing that bridge if they ever come to it.

But those who live in other countries would be in a better position to explain the differences. I'd be curious as to what the pdocs abroad have to say.

If you google, for example, bipolar disorder and overdiagnosis (or something similar) you'll find tons of articles, on both adult and childhood bipolar overdiagnosis.

that I didn't have constant mood swings to rule out bpd.

I've often contended on here that frequent 'mood swings' (as opposed to mood episodes) is used to *rule out* bipolar (as you're saying in a different way). However, I have found that there is a lot of disagreement on this issue.

My psychiatrist of some years ago said once that, "psychiatrists are seeing bipolar under every rock," for what it's worth.

Many articles in journals, etc contend that the pendulum has swung to other extreme: there used to be a great deal of concern over the underdiagnosis of bipolar (people being erroneously/dangerously diagnosed with depression) and because of this pdocs are erring on the side of bipolar, even when there's a good deal of doubt. Though I think the 'erring on the side of bipolar' is due to various reasons, as cited in the articles I posted.

It seems like at least some doctors think bipolar as soon as a patient has mood swings. Either mood swings up and down, or having depression with aggression and/or anxiety. Other doctors seem to think you can actually have some type of hyper mood without being bipolar, as part of another disorder. Some doctors see a hyper episode as the litmus test for bipolar indeed and once you had one you are bipolar forever.

I have met several people first diagnosed with BP and then it was scratched for PTSD. Also I've seen inheriting a bipolar diagnosis, the mother had mania, and one child had depression and addiction, the other one had severe ADHD, both children got diagnosed with BP, because it runs in families, they had issues so it must be bipolar. All these were in USA but that really tells you little since many of my friends are from there.

But still, here BP is often the end diagnosis and not one that can get changed for another. In USA it seems possible to be believed to have BP and then they find out you have something else. Here they rather misdiagnose you a few times before you get the final diagnosis of BP. It is common they think you have BPD or depression before.

I do not know a single person IRL here that has a diagnosis of bipolar. Maybe just by chance but it strikes me as a little odd.

I really can't find any statistics how many people are diagnosed bipolar in different countries. That would have helped. Here it is "assumed" about 2 % have bipolar but I can't even find if those are diagnosed cases or how many they believe have it in all.

Interesting though, I first went to a counselor in 92 for depressive type issues but not treated, just counseled. Went to pdoc for adhd symptoms in 01, depression in 04, again in summer 06 and at my breakdown in Sept 06 (second depression) thats when it was realized I was having manic behavior in the middle of the depressions and dxed bp. It took a long time to get my diagnosis even though I was seeing the same pdoc for 5 months in 06.

It's very hard to diagnose BP. I read a statistic that said a correct BP diagnosis (on average) takes about 8 years (which sounds about right to me). (Took me around 17 yrs for BP diagnosis.)

I saw a documentary about early Psychiatry which was interesting. In early 1900's in England lots of manic-depression diagnoses were given while in US lots of schizophrenia diagnoses were given. As British/US psychiatric organizations, Universities, etc. started sharing more information BP and schizophrenia diagnoses started to even out in both Countries. (BP and Schizophrenia can share a number of symptoms.)

I also saw the 60 Minutes segment on the Pediatric Doctor who wrote a book on Childhood BP over a dozen years ago. Since then BP diagnoses among children has increased like 1300%.

It really can be very confusing even for professionals. I have known a number of people, men and women who had bipolar, it was called manic depression back then. Some of them were easy to diagnose or tell, some however get very aggressive, anger and have fits of rage, which could also make you wonder if they are schizophrenic. Now I've actually seen personally a friend of mine, a girl, who was off her meds for 6 months. She is most definitely a bipolar. However, she also was a heavy drinker and substance abuser too. In her Manic periods, she could have mood swings minute to minute! One minute a sweet little angel, the next yelling profanity that would embarrass a truck driver! Her manic episodes were all over the map! She could easily be confused as one having BPD. I would imagine that the opposite might also be possible too. Just saying, it really is not so easy some times, and unless your hospitalized for a few months, it's mostly guess work even to the most trained eye. Even folks with bipolar have mood swings minute to minute in a manic state, not all but a significant number of them can be all over the map in a manic state, not just in a up state.

husband
4 years labeled as aggressive depressive. He got a job while hypo-manic 2 months later requiring a psy eval to let him back into work. psych eval and 'are you safe, is he safe' convo with me he had a BPII dx and a not release to work for at least a year note.

Me

Okay, my Dx. has changed over and over again. It took years for both my husband and me to get dx'd with bipolar. My first time being Dx. BP 2 came from my first appointment with my new GP because he didn't know whether to let me leave the office. I geuss you shouldn't scream at a dr. when he asks why I'm not taking my anti depressant (from previous dr) " Do I look like I NEED an anti-depressant. My husband calmed me down and I was allowed to leave with a pdoc appointment.

Under new Pdoc my Dx. went to IED, to BP1, to Personality-nos & RAD, to mood disorder nos. Often she had no idea whether to let me go home and tried to insist on me seeing a T 2x a week to keep a close eye on me. I Refused.

I moved to this area: After my husband was getting treatment I decided I should try therapy because I thought I was going into a depression. 4 hrs intake by a Pychologist, consult from x-pdoc, transfer of pdoc's file, conversation with my husband about the crisis unit. I had BP I with psychosis dx. w/ History of ED. Laughing and joking about the prettiness of harming your husband is again not a good idea. I was set up with both T and pdoc even though I was adamant that I did not wan't/need medication.

My son
Suicide attainment at 8 lead to ADHD, attachment disorder dx. We changed him to our center after talking to my therapist about his dx. He originally, keep his Dx. after trying all adhd med combo, 2nd attempt lead to mood disorder-nos and the addition of a mood stabilizer. It was originally thought he had Autism not adhd so we played the waiting game for an assessment. That came the PDD-nos. His pdoc believes he has Bipolar but because his symptoms are being treated by lamictal which has a PDD off label use she will not change his dx unless hospitalization is required. his pdoc is hoping that because he's already on BP meds he will not be dx'd with BP. She's pessimistic that he'll last with an un-officially dx until mid teenage years. As she feels his psychotic episodes will get more intense when he hits puberty.

I don't think any of us were rushed into our dx. Most of my family is dx'd with bipolar or schizophrenia after a min. stay at a facility of 3 weeks or more.

Thanks for the discussion, this is what I was after when I posted the thread.

I still believe that telling a patient they have BP when they dont or are not sure is completely unethical. It is a serious disorder and for people to be labeled with, and it seems (from reading this forum) that many use it as an excuse for their behaviour - even when the behaviour is not a BP trait.

Another thing I read here "Bi Polar is a rubbish diagnosis" it certainly isnt viewed that way in my country. But it is also not given out so readily. They do not diagnose BP just because someone has hypomania, especially if that hypomania has been brought on by triggers or medications. Therapy is usually recommended in conjunction with medication, it is rare that someone is given BP meds without having regular contact with either a pdoc or T to start off with. It honestly shocked me when I came to this forum and read how BP is handled in the US.

It is treated like a serious mental illness likened to schizophrenia. I think just like where you live (ICD-10 I assume) BP is here on page 89 depending on who is reading the same manuals It could be looser or stricter definition.

I know here we avoid hospitalization almost at all costs. So if it's send them home drugged out of their mind until they see s specialist (takes 2-6 months here) or put them in crisis care or the hospital. You'll be sent home drugged. Usually most are treated by GP's for depression and deal with the consequences of mania through legal trouble. So by the time we get into the mental health system your whole lives are almost irreparable. Therapy has always been looked down upon in general population. I have never or will I ever hear a GP recommended therapy. They probably would loose far to many clients. Even getting into the hospital is horrible and if you don't have insurance forget even trying.

In the general population yes it's treated like a joke. Even on this board we're confused when exactly hypo mania trips into mania or when we're down vs. life threateningly depressed and we live with this disorder. A lot of people that use GP's have former dx's and are refered back to their GP for maintenance for the next 6 mths- a year.

I think everyone here takes their illness seriously, or they wouldn't be on a forum talking about it. There has been the BP I vs. II argument here several times. I do not think that BPII would be labeled as depressed if it was in an ICD-10 country. We seem to be very skeptical about the health industry and treat mental illness like they should be institutionalized. This is only because most that have committed crimes or drug offences here do have some form of mental illness.

Even folks with bipolar have mood swings minute to minute in a manic state

It's also possible that this is a misdiagnosis, which is common. Or, when intoxicated with whatever she's on at the time, her mood is affected.

MM, GP's don't recomend therapy?!?!

I think one of the biggest problems is that the US has private for profit health care. It is a mess from what I can see. When money is involved so directly how do you trust any of these people to be providing good proper care? Too many conflicts of interest, which also involves big pharma which is a problem here as well. Why did I keep getting offered seroquel no matter how much it did not work for me..

One thing I found disturbing was seeing dx's handed out by therapists. Is that official .. unofficial? Either way I don't think it's a good idea.

The other big problem I see is long term therapy being overused and inappropriatly used. It has it place, and it also has many problems. But I don't see it talked about much.

Things like situational depression.. greiving etc. even physical problems that fail to be dx'd quickly and the new version of the diagnostic manual...will be no shocker to see over dx on the rise.

Along with that you have overprescibed and inappropriatly prescribed medications. And it's just a speading trend in many countries.

And all these problems seem to come right back to the money.

I have no idea how anyone can dx a mood disorder or any mental illness in an active substance abuser. I thought there was some rules about doing that? Yes I am sure there used to be... must be getting old.

I disagree with some of the statements you have made here.

It is treated like a serious mental illness likened to schizophrenia.

I think you're referring to a genetic study published not long ago which found some genetic markers in common (along with another disorder, I think). But the study also concludes that the link is not conclusive and more research is needed. Additionally, such a study has nothing to do with how the two illnesses are viewed or treated within the psychiatric community: which is very different. Also, often first generation relatives of those diagnosed with bipolar have mood disorders (MDD, bipolar), but not schizophrenia.

But I think what Supanova was getting at as far as it not being taking seriously in the US, is that it is often too quickly diagnosed: after 1 or 2 short sessions with a psychiatrist, and even more concerning, diagnosed when it is only a *possibility* but not at all sure, to 'err on the side of bipolar' for all kinds of reasons (don't want or can't take the time to be thorough, it can be medicated, avoiding stigma, insurance compensation, etc.) that pop up in article after article. I think especially with bipolar II (full-blown mania is usually pretty obvious). Slapping this label on someone so relatively easily I don't think is taking it seriously.

Additionally, I do not think these kinds of diagnosis problems occur with Schizophrenia (who's ever heard or read about this being overdiagnosed??) precisely because this illness is taken so very seriously.

until they see s specialist (takes 2-6 months here)

This has not been my experience as someone who has worked in healthcare (including in mental health care) for over 10 years. It may well be more common in finding a pediatric pdoc. No doubt this happens occasionally, people fall through the cracks, things happen, but I don't think it's the norm.

Therapy has always been looked down upon in general population. I have never or will I ever hear a GP recommended therapy.

In the course of my work, I've seen many GP's recommend therapy to their patients, and refer them. Also, I see mental health professionals falling all over themselves to recommend CBT; it's huge these days, these people love it: 'evidence-based' and short duration.

Even getting into the hospital is horrible and if you don't have insurance forget even trying.

A lot of my patients don't have insurance -I've never seen any of them refused a bed. The worst I've seen is having to spend the night in the ED waiting for a bed at a hospital that takes patients without insurance; that sucks, but they're not refused a bed.

My understanding is that diagnoses made by therapists are not 'official' -it has to be done by a pdoc. If they do suggest something to their patient (that is, something that would require medication) I think it would be irresponsible not to refer them to a psychiatrist for an official diagnosis (that is, not to a GP).

Though I also think it's a good idea for the pdoc to consult with the therapist, as he/she will likely know the patient better, so taking their experience of the patient into account could be very useful. For example, someone in the eval tells their pdoc that their mood switches have no triggers (not lying, just not aware), but the therapist has noticed they do. The therapist knows how their patients relate to them and others, emotionally, behaviorally, cognitively. I know my pdoc and therapist have consulted with each other, but I don't know how common this is.