For the past year, a debate has been raging regarding the misdiagnoses of bipolar disorder. New research seeks to clarify the initial findings by determining what the researchers believe is the appropriate diagnosis.
In the earlier study, investigators 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 — Structured Clinical Interview for DSM-IV (SCID).
That is, an overdiagnosis of bipolar disorder was occurring. In this followup study, the researchers have determined the actual diagnoses of those patients.
Under the direction of lead author Mark Zimmerman, researchers discovered patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.
The Structured Clinical Interview for DSM-IV (SCID) is considered the “gold standard” for accurate diagnosis of mental disorders. When properly administered, the interrater agreement rate is as high as it is for many common medical diseases. It has since been updated for the DSM-5.
The 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 overdiagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, post-traumatic 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 overdiagnosed, the researchers studied a total of 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 overdiagnosis 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, overdiagnosing 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 bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment.”
Bipolar disorder is a serious mental illness where a person experiences extreme swings in their mood from lows, called bipolar depression, to highs, called bipolar mania or hypomania. There are two primary types of this disorder: bipolar I and bipolar II disorder. In the latter, a person experiences hypomanic episodes rather than full-blown mania. Bipolar disorder is readily treated with medications, such as a the mood stabilizer lithium, and psychotherapy.
Their study is published in the online edition of The Journal of Clinical Psychiatry.