[Gabyunbound]

Hi all! I think maybe it is.

I've read articles that say that the diagnosis of Bipolar Disorder (once underdiagnosed) has skyrocketed in recent years (actually over the last decade or so), and this might be because, in some cases, it is wrongly diagnosed.

Now I know that BP and BPD can and do co-exist in some people. But some of the symptoms overlap so much that I think, in the case of some pdocs, they diagnose BP when, in fact, the diagnosis should exclusively be BPD.

Mark Zimmerman has written extensively about BPD and is a proponent that Bipolar Disorder is misdiagnosed in the BPD population: Borderline Personality Disorder and the Misdiagnosis of Bipolar Disorder

I actually think that the two disorders are vastly different (i.e. the core feature of fear of abandonment in the case of BPD, but not BP) Traits such as these make them radically different. But, as the article points out, things like irritability and anger in the BPD population can be mistaken for that in manic and mixed episodes of Bipolar Disorder.

In my opinion, as I've said in other posts, I think the onus is on pdocs to 'watch and wait' before giving a Bipolar diagnosis; starting with BP NOS, for example, until they're sure. My assumption is that if you watch and wait long enough, BPD traits will show themselves, and/or Bipolar episodes will eventually develop. In my opinion, too many pdocs just don't want to wait and see, and sometimes, as well, they're under pressure from patients themselves, eager to get some answers as to why they feel and behave as they do: in other words, to get a diagnosis.

So what do you guys think? Do you think Bipolar Disorder is over-diagnosed
these days? Do you think it is confused with BPD? Do you think pdocs are to blame for this?

[USMCBIPOLAR7]

I was first misdiagnosed as schizo-effective after my first manic episode which occurred in the Marines. I then journaled my moods / thinking as it impacted my ability to do college course work and work full time. After about 2 years I realized my depression in the fall happened over the same months and was severe and I dropped classes wear my spring moths were over achieving. Ie. Making all A”s and not having to take the final because I already had an A average in tests without it. I was diagnosed Bipolar after bringing up all I found and then had another Mania in May. Over the last 30 years now I have had many spring manias and only 2 in August that were brought on by antidepressants. I have depression anxiety etc every fall/ early winter. My diagnosis now and for many years is Bipolar 1 with a seasonal pattern. So maybe initial diagnosis’s can be inaccurate in the long run but may help to identify a group of symptoms and treat them til further evidence surfaces. I have been seen by the number 2 leading bipolar Dr in the nation and by Harvard Drs and have 30 years of medical records to show my diagnosis now is accurate as well as the lithium etc I take improved my condition significantly. So I believe maybe the diagnosis could be over diagnosed but it could help treat current symptoms til other evidence surfaced imo

[Nammu]

People often reject the BPD dig but will latch on to BP and make it their excuse for not learning coping skills. Many people will Doctor shop until they get the dig they want and because of stigma it's not BPD even if that's the one that is amendable to treatment and doesn't require dangerous meds. It's a lot of hard work and a lot of people would rather pop dangerous meds and say poor me than work hard at changing ingrained personally traits.

I'm not certain if bipolar disorder is over diagnosed, but my sense is that in people diagnosed it may be. I put it that way, because I think there are still many people out there with bipolar disorder (of some type) that have yet to even get/go to a psychiatrist.

I think your points about some people getting BP dxs instead of BPD are valid, and I agree that Borderline Personality Disorder does have significant features that shouldn't make it that difficult to differentiate from bipolar disorder. Your point about a psychiatrist really taking their time to differentiate between the two (and asking the right questions) is indeed crucial. I sometimes feel that a small number of patients themselves "feed" the information they want to their psychiatrists. That means maybe leaving out details, overemphasizing symptoms they read in the symptom list for the mental illness they self diagnose themselves with, and similar tactics. Of course perhaps the psychiatrist improperly leads them into that, too.

The whole issue of emotional mood lability and ultra or ultra rapid cycling likely causes misdiagnosis, too. It could go either way depending on the psychiatrist's view on ultra or ultra rapid cycling.

I know that people with bipolar disorder do have mood lability, but more "mood" lability than "emotional". I also think that medications could play some part. It always surprises me how often antidepressants are used for people with bipolar disorder. Not that they can't be helpful in conjunction with a moodstabilizer and/or antipsychotic, but really, wouldn't an antidepressant alone NOT exacerbate the issues of Borderline PD alone? Maybe it wouldn't help much (they say DBT is more effective), but shouldn't hurt as much as antidepressant monotherapy for bipolar disorder.

Another issue about "over diagnosed" bipolar disorder separate from Borderline Personality Disorder is possible bipolar diagnosis in people who actually have unipolar depression. I believe the opposite was mostly true in the past, but nowadays I have heard of some psychiatrists being too "bipolar happy", especially now when there is a bipolar spectrum concept. Are some people given Cyclothymia or even bipolar type 2 diagnoses incorrectly? Have some of these folks ever really experienced hypomania? People without a mental illness can have periods of feeling damned good or extremely angry. Or even acting a little wild. I think a good psychiatrist has to be very careful to decide what falls into the hypomania range and what was/is in some other range. That is likely hard sometimes and may take time. Full mania observed is far easier to accurately label.

[sarahsweets]

Originally Posted by Nammu

People often reject the BPD dig but will latch on to BP and make it their excuse for not learning coping skills. Many people will Doctor shop until they get the dig they want and because of stigma it's not BPD even if that's the one that is amendable to treatment and doesn't require dangerous meds. It's a lot of hard work and a lot of people would rather pop dangerous meds and say poor me than work hard at changing ingrained personally traits.

Why do you have to call them dangerous meds? Some of us have to take them as a matter of life and death. I read the study shared here and it is important to get the diagnosis right because evidence suggests that medications may not be effective in treating BPD but I do not think they need to be called 'dangerous"

[sarahsweets]

I think the two disorders are very different as well so until I read this study I had no idea that bipolar was the label being slapped on people who were really BPD. I think Bipolar disorder is the soup du jour now. Its seems everytime there is some celeb having a meltdown all the gossip mags theorize that is must be bipolar. And there are a ton of jerks who think moodiness must mean they are bipolar and offensively say "I am so up and down today. I'm like bipolar or something". I do think in more cases though there are a lot of misdiagnosis. I think that some doctors care more about rubber stamping their "expertise" and "solving" a patient's mystery and do not dig far enough to be thorough with their diagnostic process. I think the misdiagnosis is in a way more damaging than general overdiagnosis because then you go treating a different disorder using bipolar treatment options so a patient stalls in their recovery.

[Nammu]

Originally Posted by sarahsweets

Why do you have to call them dangerous meds? Some of us have to take them as a matter of life and death. I read the study shared here and it is important to get the diagnosis right because evidence suggests that medications may not be effective in treating BPD but I do not think they need to be called 'dangerous"

Because they are dangerous thanks to my AP I have metabolic syndrome. Don't get me wrong I need my meds to be stable but they have very serious side effects

[Blueberrybook]

Well, it is underdiagnosed as major depression A LOT, so yeah, maybe in people with BPD it is overdiagnosed (I don't know enough about it BPD), but true bipolar misdiagnosed as depression (especially in women) is very common. I was misdiagnosed with major depression for 10 years. I have no proof, but I do feel being put on an endless stream of SSRIs messed up my brain/thinking permanently, but IDK, maybe it's just paranoia.

The pdoc at the IOP I was recently in I think overdiagnosed BP. There were some people that came in and didn't share anything in group that sounded like a history of hypomania/mania and they got a BP diagnosis and were put on meds (not that I'm a psychiatrist).
Although I am going to say that reading this thread does kinda make me doubt my diagnosis and want to stop my current treatment even though I know without it I would probably have been dead by now because it has helped.
My philosophy is that the diagnosis doesn't matter to anyone but the docs as long as the treatment helps more than harms

[Gabyunbound]

Originally Posted by spikes

The pdoc at the IOP I was recently in I think overdiagnosed BP. There were some people that came in and didn't share anything in group that sounded like a history of hypomania/mania and they got a BP diagnosis and were put on meds (not that I'm a psychiatrist).
Although I am going to say that reading this thread does kinda make me doubt my diagnosis and want to stop my current treatment even though I know without it I would probably have been dead by now because it has helped.
My philosophy is that the diagnosis doesn't matter to anyone but the docs as long as the treatment helps more than harms

Why would this thread make you doubt your diagnosis, especially since, as you say, you would be dead without the treatment you have received? My intention was not to lead anyone to doubt their diagnosis, only to take a second look at BP and BPD and how these are diagnosed these days. Please take good care...

Originally Posted by Gabyunbound

Hi all! I think maybe it is.

I've read articles that say that the diagnosis of Bipolar Disorder (once underdiagnosed) has skyrocketed in recent years (actually over the last decade or so), and this might be because, in some cases, it is wrongly diagnosed.

Now I know that BP and BPD can and do co-exist in some people. But some of the symptoms overlap so much that I think, in the case of some pdocs, they diagnose BP when, in fact, the diagnosis should exclusively be BPD.

Mark Zimmerman has written extensively about BPD and is a proponent that Bipolar Disorder is misdiagnosed in the BPD population: Borderline Personality Disorder and the Misdiagnosis of Bipolar Disorder

I actually think that the two disorders are vastly different (i.e. the core feature of fear of abandonment in the case of BPD, but not BP) Traits such as these make them radically different. But, as the article points out, things like irritability and anger in the BPD population can be mistaken for that in manic and mixed episodes of Bipolar Disorder.

In my opinion, as I've said in other posts, I think the onus is on pdocs to 'watch and wait' before giving a Bipolar diagnosis; starting with BP NOS, for example, until they're sure. My assumption is that if you watch and wait long enough, BPD traits will show themselves, and/or Bipolar episodes will eventually develop. In my opinion, too many pdocs just don't want to wait and see, and sometimes, as well, they're under pressure from patients themselves, eager to get some answers as to why they feel and behave as they do: in other words, to get a diagnosis.

So what do you guys think? Do you think Bipolar Disorder is over-diagnosed
these days? Do you think it is confused with BPD? Do you think pdocs are to blame for this?

I couldn't agree more. It's a pet peeve for me actually. Why? Because it gives people the idea that behaviors that are not part of BP are. I DON'T have those traits, and don't want people to assume that I do. Yet, if BP is dx'd to people who have BPD, that's exactly what happens.

This is not meant as a putdown of anyone with BPD, I just value accuracy a lot, and it bothers me that it is misused like that.

I also agree that they are quite different to one another.

[Gabyunbound]

Originally Posted by Innerzone

I couldn't agree more. It's a pet peeve for me actually. Why? Because it gives people the idea that behaviors that are not part of BP are. I DON'T have those traits, and don't want people to assume that I do. Yet, if BP is dx'd to people who have BPD, that's exactly what happens.

This is not meant as a putdown of anyone with BPD, I just value accuracy a lot, and it bothers me that it is misused like that.

I also agree that they are quite different to one another.

That's a very good point: if all the general public knows of Bipolar Disorder is moods and behaviors turning on a dime due to relationship issues (which is actually a trait of BPD) then the stigma of true Bipolar Disorder only increases exponentially.

[yellow_fleurs]

I have been wondering that myself, if I really have it or if I was misdiagnosed/it is just overdiagnosed. Coincidentally just posted about questioning my diagnosis. I do not have the answer, but I would not be surprised if it were overdiagnosed. I also sometimes question if BPD is overdiagnosed in women, though.

[cashart10]

Originally Posted by Innerzone

I couldn't agree more. It's a pet peeve for me actually. Why? Because it gives people the idea that behaviors that are not part of BP are. I DON'T have those traits, and don't want people to assume that I do. Yet, if BP is dx'd to people who have BPD, that's exactly what happens.

This is not meant as a putdown of anyone with BPD, I just value accuracy a lot, and it bothers me that it is misused like that.

I also agree that they are quite different to one another.

This. Very much this!

[BipolaRNurse]

I don't know, I just tend to think that doctors are getting better at diagnosing bipolar, especially in people with BP 2. Even I was misdiagnosed for years with depression, and when I got my BP NOS diagnosis I was both shocked and relieved. Now I knew what monster I was dealing with. I have since gone on to be diagnosed with BP 1 several times because my symptoms changed and became more severe, but I'm glad it's settled. I was in limbo for far too long.

[Pookyl]

Yes in children and adolescents.
According to an Australian Government website ‘Australian Institute of Family Studies’, diagnosis of Paediatric Bipolar Disorder has increased by 4000% globally in the past 20yrs which I think is awful.
Diagnosis of autism and ADHD has also increased.

From lots of memes about bipolar disorder and things I've heard on TV, much of the general public probably does think of bipolar disorder as changing moods ultra rapidly at the drop of a dime. The fact is, that's not the most common way it works with bipolar disorder. Not at all.

Originally Posted by Gabyunbound

Why would this thread make you doubt your diagnosis, especially since, as you say, you would be dead without the treatment you have received? My intention was not to lead anyone to doubt their diagnosis, only to take a second look at BP and BPD and how these are diagnosed these days. Please take good care...

It's more so because I don't trust the pdoc in the IOP and because I have been diagnosed a ways back with BPD traits and can relate to a few, sometimes wondering (like when I posted that) if I have BPD instead of BP even though I've definitely experienced mania.

[Unrigged64072835]

I have both BP 1 and BPD. And there is definitely a difference.

It may be clients lying because they’ve seen the stigma that goes with a BPD diagnosis. It could be MH professionals not discerning whether their client actually has it or not. It could be societal notions of what BP is.

All I know is the mood stabilizer worked where dozens of meds didn’t.

[Wander]

Personally I think Bipolar is overdiagnosed, but not for those on this forum from what I’ve read. If only 5% of people worldwide have some form of Bipolar (and 1% the severe forms), based on scientific studies, it would seem by interaction that more than those stats say they have it. Not saying they are lying, just misdiagnosed. Psychiatrists seem to rush to diagnose people with something rather than watch and wait it seems. To me this does a disservice to those who genuinely have Bipolar.

[sophiebunny]

I agree. The problem is that Borderline Personality Disorder is not a desirable diagnosis. There is a great deal of stigma attached to it and many clinicians won't treat it because patients with BPD can wreak havoc in their practices. It is possible that people with BPD seek out a bipolar diagnosis because it seems more "legitimate" to them and they think they'll be treated better by clinicians. The problem is taking meds you don't need for a disorder you don't have is a serious health problem. The responsibility falls on psychiatrists to take good histories and be clued in to patients' inconsistent symptom reporting.

[pirilin]

Bipolar is the scapegoat for when a shrink doesn't know what you have.
Like a "virus" or an "allergy" in regular practice.

Don't get me wrong, it exists.
And very abundant IMO.
I think there are at least,
three times more undiagnosed
than the diagnosed cases.