Misdiagnosing Mental Health

By sharing our stories about what it means to experience bipolar disorder, we give permission to people to question their own experiences.

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I was diagnosed with depression in January 2017. In the decade leading up to my diagnosis, there was no place in my mind that held hope of ever being able to have a stable work life or meaningful long-term relationships. I lost interest in life and experienced bursts of extreme irritability. I often slipped into long periods of slowed thinking and crippled self-worth. A clinical psychologist helped guide me toward some useful tools to manage my symptoms.

Although I gradually improved, I sometimes had a lot of trouble with reckless impulsivity and a complete lack of focus on any given thing. It wasn’t until two years later that I decided to return to the doctor after I recognized some of these symptoms during a presentation about mental health. In January 2019, I was diagnosed with bipolar disorder and prescribed the appropriate medication. With my tools and medication in hand, my life finally began to feel like it belonged to me.

Three in 20 people diagnosed with depression are actually experiencing bipolar disorder. For some, it can take over 10 years to receive an accurate diagnosis. The more time between first episode and accurate diagnosis, the more difficult it becomes to successfully manage symptoms. Misdiagnosis can be a matter of life and death. People taking anti-depressants for bipolar disorder without also taking bipolar-specific medications are more likely to take their own life.

Clinicians usually diagnose bipolar disorder after asking the patient questions about personal experiences and then reviewing their notes about symptom severity, length, and frequency. Misdiagnosis can result from physician assumptions about which symptoms they think should be present. Sometimes they rule out the possibility of bipolar disorder by comparing their own conclusions to symptoms identified by questionnaires filled out by patients. However, not all self-tests are accurate.

Thomas Meyer and his team wanted to determine the accuracy of questionnaires intended to identify bipolar disorder. They conducted a systematic review of 55 studies looking at various self-tests. Systematic reviews rely on a structured and comprehensive approach to comparing studies and their results. Conclusions that can be drawn from systematic reviews strengthen our confidence in how much evidence exists to support a particular topic.

With my tools and medication in hand, my life finally began to feel like it belonged to me.

Out of 16 different questionnaires identified in the systematic review, Meyer’s team found only three that accurately and frequently identified people experiencing bipolar disorder. They highlighted evidence that some of the 13 inaccurate questionnaires could have been unreliable because they didn’t include questions about symptoms common among the majority of patients with bipolar disorder.

Overlapping symptoms between major depressive disorder and bipolar disorder could be another explanation for misdiagnosis. Like depression, a bipolar episode is usually accompanied by extreme low moods, leading to a lack of interest in life, difficulty concentrating, and feelings of worthlessness and sadness. But bipolar disorder also includes experiencing periods of what many describe as “high energy.”

A final important cause of misdiagnosis is how people feel when mania sets in. People often seek out treatment only when they are experiencing depression. When these symptoms go away and the high-energy associated with mania takes over, many consciously decide to avoid treatment because they no longer feel like they have a problem.

All of the potential causes of misdiagnosis — misplaced clinician assumptions, inaccurate questionnaires, overlapping depressive symptoms, and self-perceived lack of need for treatment — could be addressed if more people speak up about their bipolar experiences. Storytelling helps more than just the individual. It contributes to a culture of compassion by destigmatizing mental health related problems. By sharing our stories about what it means to experience bipolar disorder, we give permission to people to question their own experiences. Such questions are essential to driving the patient-physician conversation, ruling out other mental health problems, and increasing treatment seeking during manic episodes.

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