May 07, 2008

Bipolar Disorder Overdiagnosis Seen In Private Practice

In response to yesterday's news that bipolar disorder may be overdiagnosed by 50 percent, a psychologist in private practice left a comment here that I wanted to pass along:

"In my private practice as a psychologist, I frequently find people misdiagnosed with Bipolar disorder. If someone has an anger problem, they often end up diagnosed as Bipolar. This happens frequently by family doctors and also psychiatrists. In my opinion, it's really often a matter of justifying the meds they want to prescribe (most often an antipsychotic). I'd say, anecdotally, that the level of overdiagnosis I see is pretty consistent with the studies results (50-60%). I do evaluations for people seeking disability based on mental illness diagnoses, so I frequently see people labeled as Bipolar. More often than not, the diagnosis is more consistent with a cluster B personality disorder (erratic, unstable, and hyperemotional personality traits). But once you diagnose someone as being Bipolar, you can pretty well throw any class of psychotropic medication at them that you want to."

Yes, the mental health industry throws whatever they feel like at bipolars and schizophrenics. It's amazing that so many people are winding up diagnosed with bipolar in such a fashion.

I wonder when the backlash will begin because this kind of nonsense won't go unanswered for long.

Posted by Philip Dawdy at May 7, 2008 12:05 AM
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Comments

This is how screwed up the system is right here. Borderline is the most damaging, controversial and outright misogynist diagnosis, hands down. It's vindictive, because the PTSD diagnosis is given for roughly the same condition, and entails a totally different, non-punitive treatment course. Unlike Bipolar and PTSD, Borderline just happens to be a certificate of untreatability; insurance companies and state mental health authorities do not authorize treatment for BPD, since it's on the lifelong, untreatable AXIS II, unlike bipolar and the rest. And it's on AXIS II because Borderline is generally understood as an immutable and grotesque developmental adaptation to severe childhood abuse. But the 9 point checklist involves vague and ordinary human components, like "emptiness", "intensity" "unstable sense of self" and "extreme fear of abandonment" so labeling someone borderline differs from the self-report found in a depressive for example, and is "determined" by the observer. Unlike trendy, life-enhancing mental illnesses the person getting this one doesn't come up with it herself or participate in figuring out what's going on with her. It is foisted on her, she is completely acted upon. Which means the BPD dx is fraught with counter-transference, which amounts to a vindictive mh worker deciding "she's a bitch, she's a schemer, I don't like this woman might as well get my thrills from throwing her in the trash." Ugh.

It's not known as the "wastebasket" diagnosis for nothing.

Posted by: flawedplan at May 7, 2008 02:44 AM

I think a big driver of overdiagnosis is the mis-interpretation of drug side affects and withdrawal affects. When I experienced these, I became convinced along with those treating me, that the diagnosis was correct. The drugs prescribed nearly ruined my life and my health. When I came to understand that many of my symptoms could be drug side affects, they told me I was wrong. When I went off the drugs they tried to talk me out of it. They didn't tell me of the hazards of quitting abruptly so it was difficult. The experience could easily have convinced me further that I was mentally ill.

Posted by: Camas at May 7, 2008 06:12 AM

I'm glad the overdiagnosis of bipolar is coming out. I don't think Bipolar or Borderline or any other condition exist as discreet incurable medical diseases.

Posted by: Sally at May 7, 2008 06:27 AM

I'm w/ Flawed Plan. The psychologist acts like they have done the patient a service by slapping them w/ an Axis II diagnosis rather than a dx of Bipolar Disorder. They need to add this to the consent form:
"I understand that if I piss off my psychologist/psychiatrist I will be given an AXIS II diagnosis and this will prevent me from ever entering certain occupations. This is okay with me." Sign here.

Posted by: Lisa at May 7, 2008 02:03 PM

Let the wild rumpus begin!
http://www.nutritional-healing.com.au
http://www.nutritional-healing.com.au/content/condition.php?category=neuro&condition=Bipolar+Disorder

Posted by: Lilly NC at May 7, 2008 02:16 PM

LOL.

"emptiness"

God. It took two years to get my tdoc off that noun.

Yes, it was a fair description of how I felt. No, it was not who I am.

Posted by: adsf@af.com at May 8, 2008 02:07 AM

I agree that there is a lot of baggage that goes along with a personality disorder diagnosis. And rarely do I substitute a Borderline diagnosis for a bipolar (most often major depression, generalized anxiety, PTSD, or Personality Disorder, NOS). However, in terms of treatment, Borderline personality disorder is much more treatable by psychotherapy than Bipolar Disorder, meaning that some day they will be able to get off of medication in many cases. You are mistaken if you believe it will look better when you are applying for a job by having an Axis I diagnosis of Bipolar, which implies a lifelong disorder, versus Borderline, which research shows is very amenable to treatment. The other thing is, most of the people I see who are better explained by Borderline Personality Disorder than Bipolar disorder are not seeking a job, they are seeking disability.

Posted by: Parapraxis at May 10, 2008 01:45 PM

Seeking disability? Or truly disabled?
When your psyche is shattered and you are in almost constant emotional pain you're not likely to be able to take the stress of competing in today's society.
Give us a break, when we climb out of the last black hole we've fallen into we DO take up our lives again. And again and again...
But inevitably we are going to look as if we lag behind.

Posted by: Zephyr at May 16, 2008 04:13 AM
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