Bipolar misdiagnosis is probably more common than you think.
A 2018 review found that up to 40% of bipolar patients are misdiagnosed, and an earlier survey even reported an astonishing rate of 69%. Lacking knowledge in manic and hypomanic symptoms, the presence of psychotic symptoms, and comorbidity (state of having two or more diseases at the same time) of bipolar disorder may result in the diagnosis of disorders such as major depression disorder, schizophrenia, obsessive compulsive disorder, or anxiety disorder instead.
According to the National Institute of Mental Health, bipolar disorder is “a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration.” The three categories of bipolar disorder all include episodes of “mania” (irritable or energized) and “depression” (indifferent or sad). There are three types of bipolar disorder, listed below.
Bipolar I disorder: includes manic episodes at least seven days long or very severe manic symptoms that require medical care. Typically, depressive episodes for a minimum of two weeks occur as well. Depression with both factors of depressive and manic symptoms is another possibility.
Bipolar II disorder: also episodes of mania, but this time paired with episodes of hypomania (less severe mania compared to bipolar I disorder). No mania episodes. Bipolar II is not a less severe form of bipolar than bipolar I, as the less severe hypomania is often offset by longer periods of depression.
Cyclothymic disorder (aka cyclothymia): continual depressive and hypomania symptoms, albeit less intense. These are not classified as depressive or hypomania episodes.
Experiencing symptoms not listed above is categorized as “other specified and unspecified bipolar and related disorders.” Can be induced by certain drugs, alcohol, or a medical condition.
Symptoms
Manic episode | Depressive episode |
Abnormally wired, jumpy, elated, or irritable | Feeling sad, hopeless, tearful or anxious |
Increased energy and activity | Feeling restless or slowed down |
Elevated feelings of self-confidence | Feeling worthless or thinking about, planning, or attempting suicide |
Needing less sleep | Insomnia, waking up too early, or sleeping too much |
Atypically talkative (“flight of ideas”) | Very slow talking, inability to find anything to say, or forgetfulness |
Racing thoughts | Difficulty concentrating |
Experiencing unrestrained desire for food, drinking, sex, or other pleasurable activities | Lack of interest in nearly all activities |
Other symptoms include: anxious distress, psychosis, and melancholy.
Misdiagnosis
Symptom overlap, where the symptoms of bipolar disorder are similar to another condition, can result in misdiagnosis. For example, the neurodevelopmental disorder ADHD impacts focus and attention. Since some of its symptoms overlap with bipolar disorder (such as impulsivity, inattention, and restlessness), bipolar disorder can be mistakenly diagnosed as ADHD. The increased prevalence of ADHD compared to bipolar disorder, and the fact that the two often occur together, also confuse the process even further. Depression is another example, as a minimum of half of bipolar patients experience their depressive episode first. Because these last longer than manic episodes, patients are more likely to seek help during these periods, and therefore may be diagnosed as depressed.
Some other conditions that have overlapping symptoms with bipolar disorder are: borderline personality disorder (impulsivity, intense emotions, and suicidal tendencies), substance use disorder, and generalized anxiety disorder (restlessness, anxiety, and agitation).
Comorbidities can also result in the misdiagnosis of bipolar disorder. This was mentioned previously, with the ADHD example. A comorbidity, for this, is when the patient with bipolar also has another mental health disorder at the same time. Common comorbidities include: anxiety disorders, substance abuse disorders, and behavioral disorders.
Unfortunately, the lack of opportunities and prejudice also play a role in misdiagnosis. Lacking access to healthcare services reduces the chances of getting an accurate diagnosis. Discrimination similarly can cause misdiagnosis. For example, patients of African ancestry are misdiagnosed more often.
Signs and consequences of misdiagnosis
Misdiagnosed bipolar patients may still experience symptoms of bipolar disorder. They may still undergo the episodes of mania and depression. These include:
Irritability
Sleep disturbances
Impulsivity
Hallucinations
Risk-taking
Illogical thought patterns
Receiving a misdiagnosis is frustrating. It is possible to have a worsened condition when being treated for the wrong condition. For example, certain antidepressants may worsen the manic episodes.
If you suspect that you have been misdiagnosed, consider speaking with a medical health professional (such as your treatment team).
Works Cited
"Bipolar Disorder." National Institute of Mental Health, USA,
www.nimh.nih.gov/health/topics/bipolar-disorder. Accessed 17 Aug. 2024.
"Bipolar Disorder - Symptoms and Causes." Mayoclinic, Mayo Foundation for Medical
Education and Research, 14 Aug. 2024, www.mayoclinic.org/diseases
Farnsworth, Carolyn. "4 common bipolar disorder misdiagnoses." MedicalNewsToday, 13
misdiagnoses#major-depression. Accessed 17 Aug. 2024.
Ferguson, Sian. "Signs of Bipolar Misdiagnosis." Healthline, Healthline Media, 1 Feb. 2023,
Pedersen, Traci. "Can Bipolar Disorder Be Misdiagnosed?" PsychCentral, 5 Aug. 2022,
psychcentral.com/bipolar/misdiagnosed-bipolar#adhd. Accessed 17 Aug. 2024.
Shen, Hui., et al. "Analysis of Misdiagnosis of Bipolar Disorder in an Outpatient Setting."
Shanghai Archives of Psychiatry, vol. 30, no. 2, 25 Apr 2018, pp. 93-101,
Stiles, Brandie M., et al. "The Compelling and Persistent Problem of Bipolar Disorder
Disguised as Major Depression Disorder: An Integrative Review." Journal of the American Psychiatric Nurses Association, vol. 24, no. 5, 28 June 2018, pp. 415-25,
https://doi.org/10.1177/1078390318784360. Assessed and Endorsed by the MedReport Medical Review Board
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