If bipolar disorder is over-diagnosed, what are the actual diagnoses?

Jul 29, 2009

A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool --the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients. Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "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 results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with , antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that "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."

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."

Source: Lifespan (news : web)

Explore further: How to predict who will suffer the most from stress

add to favorites email to friend print save as pdf

Related Stories

Is bipolar disorder overdiagnosed?

May 06, 2008

A new study by Rhode Island Hospital and Brown University researchers reports that fewer than half the patients previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on a comprehensive, ...

Bipolar disorder impacts workforce

Sep 01, 2006

Bipolar disorder causes twice as much lost time on the job as does the far more prevalent depressive disorder, a study found.

Recommended for you

How to predict who will suffer the most from stress

8 minutes ago

More than 23 per cent of Canadians report being stressed or very stressed on most days. While chronic stress increases the risk of poor mental and physical health, not everyone is affected the same way. Some cope well, but ...

Self-compassion key to positive body image and coping

20 hours ago

Women who accept and tolerate their imperfections appear to have a more positive body image despite their body mass index (BMI) and are better able to handle personal disappointments and setbacks in their daily lives.

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

Nemo
not rated yet Jul 30, 2009
A better use of time would be to figure out what is actually wrong with the patient. In my case 23 years of being labeled bipolar did nothing to aid the finding that I was just sensitive to caffeine. No caffeine = very few symptoms.