From the Department of Psychiatry and Human Behavior of Brown Medical School, and Rhode Island Hospital, Providence, RI, USA.
, researchers, under the auspices of lead author of a clinical study conducted to determine if bipolar disorder is overdiagnosed, Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital
, concluded that bipolar disorder is, in fact, overdiagnosed.
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Zimmerman states, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder
. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."
The study was part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS)
Bipolar Disorder Underdiagnosed?
Big pharm supports and finances support for the medical model of mental health.
Frequently, the objection has been raised that bipolar disorder
is underdiagnosed. For example, quoted on WebMed, NIMH senior investigator Kathleen R. Merikangas, PhD, states that a large percentage of people diagnosed with major depression may actually have this form of bipolar disorder, that is sub-threshold bipolar disorder. Based on this idea, then, millions who are not diagnosed with bipolar disorder
, and who rate at a sub-threshold level, that is, they don't quite measure up to a bipolar diagnosis, actually have bipolar disorder. This implies that those in the sub-threshold category should also be treated with drugs for bipolar disorder.
Additionally, this NIMH study concludes that 4% of the U.S. adult population is affected by bipolar disorder. This is an astounding percentage of people, on the level of an epidemic, if those figures are accurate.
This stretching the boundaries of psychiatric disorders, so that those who do not actually fit the criteria of the disorder, find themselves in them within the "spectrum" of a serious disorder such as bipolar disorder, is a way of expanding upon the limits imposed by modern psychiatry, which already is under fire from many sources for overmedicating the population.
With, not only the facts of such a study, but the sweeping conclusions and interpretations of the conclusions by the media,a serious disorder such as bipolar disorder becomes, what Sharna Olfman, PhD refers to as the "disorder de jour," something very popular to diagnosis in patients, something they already know a little bit about, and that fits into their framework of understanding of mental illness, and a disorder that is treated with very strong psychiatric drugs.
According to Zimmerman's study, the underdiagnosis of bipolar disorder is not the case. Rather, only 43 percent of those surveyed who were diagnosed with bipolar disorder actually match the criteria for the disorder.
Only 43 percent of those who had been labeled with bipolar disorder could be appropriately considered of meeting the criteria for a bipolar disorder diagnosis.
The method used to conduct the study involved 700 psychiatric outpatients who were interviewed using the Structured Clinical Interview for DSM-IV (SCID)
. The interviewees also completed a self-administered questionnaire, which asked the patients whether they had been previously diagnosed with bipolar or manic-depressive disorder
by a health care professional. Family history information was also used to from first-degree relatives in determining validity of previous diagnoses and history. The diagnoses were blind to the results of the self-administered scale.
Only 43 percent of those who had been labeled with bipolar disorder actually could be appropriately considered to meet the criteria for a bipolar disorder according to this method of cross-checking diagnoses based on a scientifically-oriented procedure.
Zimmerman and his colleagues concluded that a large percentage of those diagnosed with bipolar disorder actually were more appropriately considered to be suffering with borderline personality disorder
or impulse disorders. Other disorders diagnosed using the SCID interview were major depressive disorder
, antisocial personality disorder, post-traumatic stress disorder and eating impulse disorders
Why Bipolar Disorder is Overdiagnosed
Zimmerman concludes that one of the reasons that bipolar disorder is overdiagnosed is, as he states, "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."
Doctors are often more comfortable prescribing medications than referring a patient for therapy intensive treatment such as that for Borderline Personality Disorder
, where there are not yet medications approved for, or in general use for treatment. This is very serious, according to the authors of the study, because bipolar disorder is treated with strong psychiatric drugs
, mood stabilizers
, that can have potentially hazardous physical effects in the long-term and short term, for some, in addition to causing distressing side effects for many, whereas medication is not prescribed or recommended for Borderline Personality Disorder
Serious physical side effects that can result from medication prescribed for bipolar disorder included impact to renal (kidneys), endocrine (glands and hormones), hepatic (liver), immunologic and metabolic functions.
Other reasons for the overdiagnosis of bipolar disorder
are noted by psychotherpaist Michael J. Formica, M.S., M.A., Ed.M., who refers to Boston bipolar disorder expert Gary Sachs, of Harvard points out that according to Dr. Formica, "one of the major influences on the change in diagnostic trends may be the educational sessions that doctors are attending, which are sponsored by drug manufacturers."
Additionally, Dr. Formica notes, again, based on Sachs summations, diagnoses concluded in "an academic setting are far more involved than those undertaken in general clinical practice."
Academic reviews tend to be detailed and more thorough than those in the medical field in general, where diagnoses are more likely "to take on the form of generalized conversation and a more superficial history, which can lead to"
largely subjective, or what Dr. Formica refers to as "snap" judgements.
Dr. Zimmerman concludes his study stating, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."
Colleagues of Zimmerman in this study were, Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital
and Brown University
References for Bipolar Disorder is Overdiagnosed - How and Why?
1. Boyles,S. (2007, May 7). Bipolar Illness Widely Underdiagnosed
Study Shows More Than 4% of U.S. Adults Affected. http://www.webmd.com/bipolar-disorder/news/20070507/bipolar-disorder-widely-underdiagnosed
2. Formica, Michael J. (2008, May 7). The Overdiagnosis of Bi-Polar Disorder
. Enlightened Living. Psychology Today. http://www.psychologytoday.com/blog/enlightened-living/200805/the-overdiagnosis-bi-polar-disorder
3. If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?
(2009, July 29). Science Daily. http://www.sciencedaily.com/releases/2009/07/090729100936.htm
4. Zimmerman M, Ruggero CJ, Chelminski I, Young D. Is bipolar disorder overdiagnosed? Journal of Clinical Psychiatry. 2008 Jun;69(6):935-40.
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Other Related References to Bipolar Disorder Overdiagnosed
1.Brody, Howard. (2007). Ethics, the Medical Profession and the Pharmaceutical Industry. Bowman & Littlefield. Detailed discussion of ties between pharmaceutical companies and medical profession.
The close relationship between physicians and the pharmaceutical industry represents one of the greatest challenges to medical professionalism. Funding of medical education programs, sophisticated marketing techniques, and direct-to-consumer advertising are just a few, but important, modalities through which drug companies exert significant influence and pressure on physicians' prescribing habits. In his book Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, the author describes the present relationship between the medical profession and the pharmaceutical industry, assesses that relationship from the standpoint of ethics and policy, and suggests positive changes. JAMA
2. Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry
. (December 10, 2008). Wollschlaeger, Bernd, MD, Reviewer. JAMA. 2008;300(22):2675-2676. doi:10.1001/jama.2008.781.
3. Wooton, Tom. (2012). Why I Am Against Bipolar Meds
The extremes both for and against meds give new meaning to the word Bipolar.
Being bipolar without disorder. Bipolar Advantage. Psychology Today.