Why Is It So Difficult to Diagnose Bipolar Disorder?
why is it so difficult to diagnose bipolar disorder

Why Is It So Difficult to Diagnose Bipolar Disorder?

On the surface, bipolar disorder may sound fairly straightforward. It’s a mental illness characterized by abrupt and seemingly unprovoked changes in mood, from extreme highs to extreme lows. Therefore, a person might assume that bipolar disorder is as easy to diagnose through behavioral observation as it is to define conceptually, but that’s not always the case.

In reality, bipolar disorder has proven to be an extremely difficult condition to diagnose. Many bipolar individuals are diagnosed with one or more other psychological disorders before the affliction is finally identified as being bipolar disorder. According to researchers, nearly 70 percent of all people who suffer from bipolar disorder are misdiagnosed initially and more than one in three remain misdiagnosed for ten or more years.1 This high rate of misdiagnosis is disturbing, especially considering some of the implications. In particular, this means that individuals with bipolar disorder are likely to go an extended period of time with only part of their symptoms being addressed. But what is it about the symptoms of bipolar disorder that makes a timely diagnosis so unlikely? What makes bipolar disorder so difficult to diagnose?

Only the Lows Feel Abnormal

As stated above, bipolar disorder is a psychological condition in which a person cycles between extreme highs and lows, seemingly without provocation. The lows are the depressive periods and will usually last two weeks or more at a time. The high periods, on the other hand, are referred to as episodes of mania, which typically last about a week at a time.2 Prior to being known as bipolar disorder, it was called manic-depressive disorder, reflecting the alternating, cyclic nature of the condition.

It can take years before the psychiatrist or counselor becomes aware that the depressed individuals is actually suffering from bipolar disorder.

One of the main issues with getting an accurate bipolar disorder diagnosis is due to the tendency for bipolar patients to suffer from depressive episodes far more prominently than manic episodes. Furthermore, most people find the experience of intense depression to be more debilitating than mania. While in a manic episode, people tend to have feel energetic and inexplicably upbeat, and they are often able to be very productive. By comparison, a person is either unable or nearly unable to function normally while experiencing depression. Therefore, it’s typically the depressive symptoms that prompt individuals suffering from bipolar disorder to seek help.3 Meanwhile, they disregard — either intentionally or unknowingly — their experiences of mania. In such cases, it can take years before the psychiatrist or counselor becomes aware that the depressed individuals is actually suffering from bipolar disorder.

Shared Symptomology With Other Conditions

As is the case with many emotional disorders, some of the symptoms of bipolar disorder happen to also be symptoms of other psychological conditions. To understand this problem, one must consider the behaviors a person with bipolar disorder is likely to exhibit. Someone suffering from bipolar disorder will experience prolonged periods of profound depression, followed by a period of mania or hypomania, which is a milder, less pronounced form of mania. In some instances, the depressive symptoms are the only symptoms that are readily noticeable and would be most suggestive of major depression.

Other times it’s the mania that will be more pronounced with the individual manifesting symptoms that are congruent with a condition like attention-deficit hyperactivity disorder. When manic symptoms reach their peak, a person’s symptoms can be misinterpreted as being indicative of schizophrenia.4 It’s also quite common for symptoms of bipolar disorder to include risk-taking and impulsivity, which happen to also be symptoms of borderline personality disorder and a number of other conditions. This makes it very difficult to diagnose bipolar disorder, especially when you consider that patients are most likely to seek treatment when experiencing crisis-level symptoms that could be readily mistaken for other conditions.

Mind-Altering Substances Prevent Accurate Diagnosis

Unfortunately, substance abuse happens to be another common symptom among people who suffer from many mental health conditions, including bipolar56 percent of individuals with bipolar disorder will suffer from chemical dependence disorder. Many of these individuals turn to alcohol or drugs as a means of self-medicating, which can be very self-destructive. According to studies, approximately 56 percent of individuals with bipolar disorder will suffer from some type of chemical dependence in their lifetimes.5 On the other hand, the act of abusing alcohol or drugs induces intoxication, which can result in risk-taking and reckless behaviors that are often characteristic of bipolar disorder. The latter illustrates how a person can appear to display symptoms of bipolar while actually suffering from depression and addiction, illustrative of the reverse of the bipolar diagnosis problem.

When it comes down to it, bipolar disorder is a psychological affliction in which the brain’s neurochemical balance is known to be a factor. Similarly, there are known to be biological and neurological factors that underscore addiction, so there is undeniably some overlap between bipolar disorder and substance abuse in terms of where both these conditions originate. Alcohol and drugs can affect one’s neurochemistry and emotional stability in such a way as to prohibit the detection of certain symptoms of bipolar disorder. Alternately, substance abuse could cause behaviors that might be construed as being indicative of bipolar disorder.

Even with the difficulties inherent in diagnosing bipolar disorder, there is hope to be found in treatment. Becoming aware of the difficulties of diagnosing bipolar disorder has allowed psychiatric professionals to develop better screening and identification methods. While there are certainly characteristics of bipolar disorder that can make its diagnosis elusive, simply being knowledgeable about these difficulties greatly increases one’s likelihood of receiving an accurate diagnosis and getting timely treatment.


1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945875/
2 https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
3 https://www.drugs.com/health-guide/bipolar-disorder-manic-depressive-illness-or-manic-depression.html
4 http://www.everydayhealth.com/bipolar-disorder/is-it-bipolar-disorder-or-something-else.aspx
5 http://www.dualdiagnosis.org/bipolar-disorder-and-addiction/

Written by Dane O’Leary