Why does it take so long to diagnose bipolar disorder? Stigma may be a cause (2023)

FAQs

Why does it take so long to diagnose bipolar disorder? ›

Bipolar disorder can be an elusive disorder for doctors to identify because the symptoms can vary widely and is often masked or exacerbated by other factors such as concurrent drug use or remission of symptoms. Stigma makes it even more difficult for people to get help.

Although there is often a stigma associated with all mental illnesses, bipolar disorder can be especially stigmatizing. 2 Individuals with bipolar are often portrayed as "crazy" in books and movies and quite often, these individuals commit crimes or aren't able to live independently.

Because of this, it might take a long time to get a correct diagnosis – sometimes it can take years. The trouble with bipolar is that sometimes it can go undiagnosed. You don't go to the doctor to tell them you are feeling extremely happy. That you've got so much energy and can conquer the world (quite literally).

A major reason for the difficult diagnosis is the challenge of differentiating bipolar disorder type I or II from unipolar depression—an illness characterised by recurrent depressive episodes— especially in patients who present during a depressive episode and in those with no clear history of mania or hypomania.

Bipolar disorder, especially subtypes I and II, are difficult to diagnose. In fact, during the first year of seeking treatment, only 20% of patients are correctly diagnosed. The usual time span between a misdiagnosis and an accurate diagnosis of bipolar disorder is 5-10 years.

Bipolar affects everyone differently and can be difficult to diagnose, but there are some common signs that can help you identify the illness.

To diagnose bipolar disorder, a doctor performs a physical exam, asks about your symptoms, and recommends blood testing to determine if another condition, such as hypothyroidism, is causing your symptoms. If the doctor does not find an underlying cause of your symptoms, he or she performs a psychological evaluation.

Whether it's intense moods, agitation, or impulsivity, some features of bipolar disorder are commonly mistaken for other disorders with similar symptoms — and vice versa. In fact, a 2018 review reports that up to 40% of people with bipolar disorder are misdiagnosed, most commonly with major depressive disorder.

How long does it take for a psychiatrist to diagnose you? ›

Typically, a psychiatric evaluation lasts for 30 to 90 minutes. At J. Flowers Health Institute, evaluations take approximately 2 hours to ensure a comprehensive and accurate evaluation.

The single most significant reason why individuals with schizophrenia and bipolar disorder fail to take their medication is because of their lack of awareness of their illness (anosognosia). Other important reasons are concurrent alcohol or drug abuse; costs; and a poor relationship between psychiatrist and patient.

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. To be considered mania, the elevated, expansive, or irritable mood must last for at least one week and be present most of the day, nearly every day.

Bipolar disorder affects men and women equally, as well as all races, ethnic groups, and socioeconomic classes. Although men and women appear to be equally affected by bipolar disorder, rapid cycling is seen more often in women. Women also tend to experience more depressive and mixed state episodes than do men.

Many studies indicate that bipolar disorders are underdiagnosed.

There is a high rate of comorbid psychiatric disorders in pediatric bipolar disorder (especially attention deficit hyperactivity disorder [ADHD] in prepubertal children), and significant symptom overlap in common comorbid conditions makes the task of reaching accurate diagnosis even more difficult.

Mental disorders which may be commonly confused with bipolar disorder include Borderline Personality Disorder , Schizoaffective Disorder, Unipolar Depression, and Premenstrual Dysphoric Disorder.

The diagnosis for bipolar disorder requires at least one depressive and one manic or hypomanic episode.

Diagnosing Bipolar Disorder

With the greater understanding of mental disorders today, doctors can identify the signs and symptoms of bipolar depression, hypomania, and mania, and in most cases, treat the disorder effectively and safely with bipolar medications.

Correcting negative language that can cause stigma by sharing accurate information about how the virus spreads. Speaking out against negative behaviors and statements, including those on social media. Making sure that images used in communications show diverse communities and do not reinforce stereotypes.

How to overcome the stigma of mental illness? ›

Breaking stigma is important because it is a form of suicide prevention. Mental illness is treatable and recovery is possible. Often, people will speak with a friend, family member or faith leader before they will talk to a mental health professional.

Of the major mental illnesses, individuals like you with borderline personality disorder (BPD) are perhaps among the most stigmatized. 3 Even among healthcare professionals, BPD is frequently misunderstood.

This can lead them to not seek treatment, to withdraw from society, to alcohol and drug abuse or even to suicide. Stigma can lead people with mental illness to be discriminated against and miss out on work or housing, be bullied, excluded from social groups, or become a victim of violence.

No one knows exactly what causes bipolar disorder. Research suggests that a combination of factors could increase your chance of developing it. This includes physical, environmental and social conditions.

Moreover, impulsivity, a hallmark of BPD, is also increased among bipolar patients, even during periods of euthymia [17, 18]. In a recent study, nearly 40% of BPD patients were found to have a mistaken diagnosis of BD [8], whereas other studies reported an even higher rate (56%) of over diagnosis of BD [12].

Childhood traumatic events are risk factors for developing bipolar disorders, in addition to a more severe clinical presentation over time (primarily an earlier age at onset and an increased risk of suicide attempt and substance misuse).

Cyclothymia, or cyclothymic disorder, causes mood changes – from feeling low to emotional highs. Cyclothymia has many similarities to bipolar disorder.

What should I do if I can't get a diagnosis? If you think you have an underlying disease that hasn't been diagnosed, you can ask your primary care provider for a referral to a specialist. And if you or your doctor suspect the disease could be genetic, you can always make an appointment at a medical genetics clinic.

You have specific rights when disclosing your diagnosis as a client receiving therapy. For example, it's your right to ask your therapist to tell you if they believe you have a mental health condition. If you want a diagnosis, you can ask your therapist upfront.

Are psychiatrists supposed to diagnose you? ›

A psychiatrist is a medical doctor who can diagnose and treat mental, emotional and behavioral conditions. They can prescribe medications and other medical treatments.

People with bipolar disorder may not take their medication because of side effects, fear of addiction and a preference for alternative treatment – according to research from Norfolk and Suffolk NHS Foundation Trust (NSFT) and the University of East Anglia (UEA).

Anxiety disorders, SUDs, and behavioural disorders are the most common comorbid psychiatric disorders associated with BD.

Stigma, patient satisfaction and system-related factors

For many people with BD the stigma of having a chronic mental illness and needing to take long-term treatment for it may deter adherence.

Lithium is considered the gold standard treatment for bipolar disorder (BD). Current clinical guidelines and scientific evidence support its use as a first-line treatment in BD.

On average, it took 3.5 (±5.8) years to confirm a diagnosis of bipolar I disorder following the first major mood episode. Approximately one-fourth of the total sample waited 5 or more years before receiving the diagnosis of bipolar I disorder, and 12.4% waited 10 or more years from the first major mood episode.

Misdiagnosis results in ineffective treatment, which further worsens the outcome. Major contributors toward misdiagnosis include lapses in history-taking, presence of psychiatric and medical comorbidities, and limitations in diagnostic criteria.

Genetics. Bipolar disorder tends to run in families. Children with a parent or sibling with the disorder have a higher chance of developing it than those without affected family members. Identical twins don't have the same risk of developing the illness.

To diagnose bipolar disorder, a doctor performs a physical exam, asks about your symptoms, and recommends blood testing to determine if another condition, such as hypothyroidism, is causing your symptoms. If the doctor does not find an underlying cause of your symptoms, he or she performs a psychological evaluation.

Mental disorders which may be commonly confused with bipolar disorder include Borderline Personality Disorder , Schizoaffective Disorder, Unipolar Depression, and Premenstrual Dysphoric Disorder.

What mental illnesses are similar to bipolar? ›

Cyclothymia, or cyclothymic disorder, causes mood changes – from feeling low to emotional highs. Cyclothymia has many similarities to bipolar disorder.

The main sign of bipolar disorder is extreme mood swings that go from emotional highs to emotional lows. Manic episodes cause people to seem very energetic, euphoric, or irritable. During depressive episodes, your loved one may seem sad, upset, or tired all the time.

During manic episodes, people with bipolar disorder may experience a heightened sense of sexuality. It's only when this is paired with other symptoms of bipolar mania—including risk-taking, impulsivity, and poor judgment—that it can shift into problematic hypersexuality.

Bipolar disorder and post-traumatic stress disorder (PTSD) represent two different mental health diagnoses. But they share enough symptoms that they can sometimes resemble each other, even to experienced mental health professionals. This symptom overlap can create complications when it comes to diagnosis and treatment.

Mania. The hallmark of bipolar disorder is a manic episode that lasts at least one week. Mania is an excessively elevated mood state that includes feelings of euphoria. It might also cause a person to be unusually irritable and quick to get into conflicts.