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

Mariah Carey’s revelation of bipolar disorder — a condition that was first diagnosed in 2001 — may help others with the condition to share their experience as well, experts say.

Many patients keep their diagnosis a secret, fearing personal and career fallout because of the stigma attached to mental illness. That was certainly true of Carey who says she had been struggling in silence for over a decade.

"Until recently I lived in denial and isolation and in constant fear someone would expose me,” she told People Magazine. “I was so terrified of losing everything. I convinced myself the only way to deal with this was to not deal with this.”

Carey was diagnosed with bipolar II, a less severe of the disorder which is characterized by dramatic mood swings from highs — called hypomania — to lows, or depression.

It’s estimated that 4.4 percent of adults in America will experience bipolar disorder, formerly known as manic depression, at some point in their lives, according to the National Institute of Mental Health.

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.

“The average length of time between a person’s first episode and getting the correct diagnosis is eight years,” said Kay Redfield Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine and author of “Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.”

“That’s a very large chunk of life given that bipolar disorder most often hits in late adolescence or in the early 20s,” Jamison said.

Why does it take so long to diagnose bipolar disorder? Stigma may be a cause (2)
(Video) Bipolar disorder: how we can work together to fight the stigma

While depression is recognizable to many, mania may be not be as familiar. Oftentimes bipolar disorder can wreak havoc with an individual's life, but it may not be obvious to others that something is wrong.

“It’s a great misconception that you are a basket case if you have bipolar disorder,” Jamison said who has been public about her struggle with bipolar disorder. “I am someone who has specialized in this all my professional life and I’ve been around specialists who treat mood disorders. When I went public, most of my colleagues were shocked. It can be deceptive in that respect.”

(Video) Living with Bipolar Disorder: Stigma

“It’s a great misconception that you are a basket case if you have bipolar disorder. When I went public, most of my colleagues were shocked. It can be deceptive in that respect.”

The condition does have some clear symptoms, said Dr. Andrew Nierenberg, a professor of psychiatry at Harvard Medical School and director of the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital.

A manic episode must include at least three of the following symptoms for more than 1 week:

  • increased talkativeness
  • increased self-esteem or grandiosity
  • decreased need for sleep
  • increased energy level or irritability
  • racing thoughts
  • poor attention, and
  • increased risk-taking behavior

Mania is much more extreme than a sudden burst in energy or motivation or a happy mood. "They're not only talking fast, but other people can't get a word in edgewise," said Nierenberg. Someone with bipolar "might be walking by a Tesla in the mall and decide to buy even if you don't have the money."

It often results in problems in work, school, and relationships, and in some cases it may require hospitalization.

Related

(Video) Discrimination and Stigma Against Patients with Depression and Bipolar Disorder

Sometimes the symptoms of bipolar disorder may contribute to the length of time it takes to get diagnosed. When depressed, people may not have the energy or will to seek treatment.

“When you’re depressed, a cardinal sign is hopelessness,” Jamison said. “When people start to get manic they very often feel better than they ever have in their lives. So they don’t feel that anything is wrong.”

Still, Jamison said, when bipolar disorder is untreated, “there’s tremendous disability and pain and suffering.”

Carey may be an example of an association Jamison pointed out years ago: the strong prevalence of bipolar disorder among creative folk, such as writers, painters and composers. Actress Carrie Fisher was praised for her candidness about her struggles with bipolar before her death in 2016.

While some patients may worry that treating the disorder might crimp their creativity, “most people, in the few studies that have been done, are as productive if not more productive once they’ve gotten treatment,” Jamison said.

(Video) Stigma, Mental Illness, and Families with Special Reference to Bipolar Disorder

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.

What is the stigma of being diagnosed with bipolar disorder? ›

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.

How long does it take to get a diagnosis of bipolar? ›

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).

What factors may make it difficult to diagnose a person with bipolar disorder as opposed to another disorder? ›

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.

Do you think that bipolar disorder is difficult to diagnose why or why not? ›

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.

Is it easy to get diagnosed with bipolar? ›

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

How can you reduce the stigma of bipolar disorder? ›

Seven Things You Can Do to Reduce Stigma
  1. Know the facts. Educate yourself about mental illness including substance use disorders.
  2. Be aware of your attitudes and behaviour. ...
  3. Choose your words carefully. ...
  4. Educate others. ...
  5. Focus on the positive. ...
  6. Support people. ...
  7. Include everyone.

How do you overcome a bipolar stigma? ›

Steps to cope with stigma
  1. Get treatment. You may be reluctant to admit you need treatment. ...
  2. Don't let stigma create self-doubt and shame. Stigma doesn't just come from others. ...
  3. Don't isolate yourself. ...
  4. Don't equate yourself with your illness. ...
  5. Join a support group. ...
  6. Get help at school. ...
  7. Speak out against stigma.

How is bipolar disorder diagnosed? ›

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.

How accurate is bipolar diagnosis? ›

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.

What is the most common reason for medication non adherence in a patient diagnosed with bipolar disorder? ›

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.

What is the only criteria that needs to be met to be diagnosed with bipolar I? ›

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.

Who is more likely to be diagnosed with bipolar disorder? ›

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.

Is bipolar overdiagnosed or underdiagnosed? ›

Many studies indicate that bipolar disorders are underdiagnosed.

Why is it hard to diagnose bipolar in children? ›

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.

What Can bipolar disorder be confused with? ›

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

How many symptoms do you need to be diagnosed with bipolar? ›

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

Do they still diagnose people with bipolar? ›

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.

What is the most effective way to reduce stigma? ›

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? ›

9 Ways to Fight Mental Health Stigma
  1. Talk Openly About Mental Health. ...
  2. Educate Yourself and Others. ...
  3. Be Conscious of Language. ...
  4. Encourage Equality Between Physical and Mental Illness. ...
  5. Show Compassion for Those with Mental Illness. ...
  6. Choose Empowerment Over Shame. ...
  7. Be Honest About Treatment.
Oct 11, 2017

Why is it important to break 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.

What are the most stigmatized mental illnesses? ›

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.

What impact does stigma have on mental health? ›

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.

What is the main cause of bipolar disorder? ›

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.

How often is bipolar overdiagnosed? ›

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].

Can a traumatic event cause bipolar? ›

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).

What mental illness is similar to bipolar? ›

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

What to do when doctors can't diagnose you? ›

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.

Does your psychiatrist have to tell you your diagnosis? ›

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.

Why do you think some people with bipolar disorder don t want to take their psychiatric medications? ›

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).

What is the most common comorbid disorder for those with bipolar disorders? ›

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

What is a reason that people with bipolar disorder have difficulty with treatment adherence to the most commonly used medications for bipolar disorder? ›

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.

What is the gold standard for bipolar disorder? ›

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.

How long does it take to diagnose bipolar disorder? ›

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.

Why bipolar disorder is often wrongly diagnosed? ›

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.

What is the strongest risk factor for bipolar disorder? ›

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.

How is bipolar disorder confirmed? ›

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.

What medical conditions mimic bipolar disorder? ›

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.

What does undiagnosed bipolar look like? ›

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.

What triggers bipolar hypersexuality? ›

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.

Can trauma mimic bipolar disorder? ›

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.

What is the most noticeable manifestations of bipolar disorder? ›

Symptoms - Bipolar disorder
  • feeling sad, hopeless or irritable most of the time.
  • lacking energy.
  • difficulty concentrating and remembering things.
  • loss of interest in everyday activities.
  • feelings of emptiness or worthlessness.
  • feelings of guilt and despair.
  • feeling pessimistic about everything.
  • self-doubt.

Which symptom is the hallmark of bipolar disorder? ›

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.

Videos

1. Confronting Stigma in Bipolar Disorder
(International Bipolar Foundation)
2. 6 Common Myths about Bipolar Disorder | HealthyPlace
(HealthyPlace Mental Health)
3. How to Accept Your Bipolar Diagnosis
(HealthyPlace Mental Health)
4. Living with bipolar disorder: Maarten opens up | DW Documentary
(DW Documentary)
5. Mental Illness Stigma: Why I Talk About My BPD Diagnosis
(HealthyPlace Mental Health)
6. intro to bipolar disorder / stigma and the spectrum
(psychdarling (연이))
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