A funny thing about bipolar -well, perhaps not “funny” but certainly very intriguing – is that the symptoms look a lot like cocaine addiction. Just to be clear, here are some symptoms of mania:
- going for days without sleep
- high energy levels
- talking fast, words spilling out
- delusions of grandeur
- promiscuity
- aggression
… and here are some symptoms of cocaine abuse:
- going for days without sleep
- high energy levels
- talking fast, words spilling out
- delusions of grandeur
- promiscuity
- aggression
See the similarity? To blur the line even more, drug abuse is considered to be a symptom of a manic episode! The question, then, is how a doctor, faced with a patient who has been taking cocaine and exhibiting manic symptoms, can say that the patient is experiencing a manic episode, rather than drawing the more banal conclusion that the patient is just doing too many drugs. Yet many doctors make a bipolar diagnosis in exactly this high-uncertainty situation.
These concerns have been raised in the psychiatric literature. For example, the Journal of Clinical Psychiatry published two articles in 2008 that found widespread over-diagnosis of bipolar. In a systematic study of people with dual diagnosis of bipolar and substance abuse, only 33% were actually bipolar according to a structured DSM interview.
And a large scale study over 4 years of psychiatric outpatients found that less than half those who were diagnosed with bipolar could be classified as bipolar i or bipolar ii.
The most common situations where misdiagnosis occurred were major depression; borderline personality disorder; and substance abuse.
In a letter in Psychiatric Services, Dr Burton Hutto of the University of North Carolina drew attention to problems with the self-reports that are so often a critical part of diagnosis. He said:
Patients may overendorse manic symptoms for a variety of psychological reasons or they may misunderstand the severity of symptoms the clinician is looking for. For example, simple inquiries into whether a patient’s thoughts ever “race” can receive a range of replies depending on the patient’s subjective grasp of the word “race.”
The nice thing about a bipolar, for a doctor, is that treatment is straightforward: the patient needs to take the right drugs, and that’s about it. For personality disorders, talk therapy is needed, something that doctors don’t know much about. And drug addiction is a messy business for which there are often no easy answers.
If you have been diagnosed as bipolar, look into it. Your doctor could be wrong.