Bipolar disorder is characterized by uncontrollable mood swings typically from a depressed state of functioning to either mania or hypomania. Most people with Bipolar disorder tend to have a genetic predisposition to the illness, but even those without a genetic predisposition can develop it. The trend in society among psychiatrists and mental health professionals is to make sure that a person with this condition is correctly diagnosed so that they can be properly treated.
Typically Bipolar Type 1 is relatively easy to diagnose. It is characterized by mood swings or “cycles” from depression to mania. The mania is generally easy to observe because the individual will appear highly talkative, stimulated, and euphoric. In Type 1, the “cycles” are relatively quick, resulting in shifts from depression to euphoria in hours or days. Bipolar Type 2 on the other hand, is more difficult to diagnose because “cycles” aren’t generally as rapid as Type 1 and “hypomania” (as opposed to mania) may get mistaken for personality features.
Bipolar Type 2: Misdiagnosis
Due to the difficulty of diagnosing Bipolar 2 disorder, it can easily be falsely diagnosed. Misdiagnoses are often the result of neurochemical changes as a result of someone that has pursued psychiatric treatment for another condition. Over time, psychiatric medications can alter brain chemistry and lead a person to behave abnormally. In some of these cases, a person will experience medication-induced hypomania and/or discontinuation-induced mood swings.
Although over time a person’s brain will revert to homeostatic functioning after discontinuation from psychiatric treatments, many psychiatrists see evidence of hypomania and assume that it was a result of Bipolar 2 rather than induced from neurochemical changes stemming from psychiatric treatment. They may also assume that it was “latent” and the person has always had Bipolar 2 disorder, when they never did.
What could lead to a misdiagnosis?
There are typically several factors and/or conditions that can lead to a Bipolar 2 misdiagnosis. Many of these conditions can lead to symptoms that are nearly identical to those of BP2, therefore it takes keen observation and a historical perspective of the patient for proper diagnosis.
- Adrenaline addiction: Individuals with adrenaline addiction could be the most easily misdiagnosed population for having BP2 disorder. Those with high levels of adrenaline may work longer, be more productive, and perform at a high level. They may also feel some degree of pleasure and have an eerily similar predisposition to that of hypomania. However, in the cases of adrenaline addiction, as soon as the adrenaline levels are lowered, the hypomania goes away and the person achieves homeostasis. Typically adrenaline addiction is developed as a result of a traumatic experience. A person can overcome adrenaline addiction with consistent efforts to induce relaxation.
- ADHD: Someone with attention-deficit hyperactivity disorder may display similar symptoms to a person with Bipolar disorder. Those who have ADHD may have mood swings and periods of functioning that may resemble hypomanic behavior, when in fact it is hyperactive behavior. Although hyperactivity and hypomania occur simultaneously, generally the individual with ADHD doesn’t actually have hypomania.
- Anxiety: People with anxiety are unlikely to be diagnosed with bipolar 2 disorder. However, those with extremely high levels of anxiety, generally resulting from some sort of trauma may develop hyperactivity and become hyperaroused. This state of hyperarousal can lead to behavior that resembles hypomania. However among these individuals, as soon as the anxiety is treated, their behavior appears less hypomanic.
- Antidepressant-induced hypomania: Many people notice that when they take an antidepressant, they may exhibit symptoms of hypomania. In many cases, the person would have never experienced hypomania had the drug not made significant changes to their brain. We now know that antidepressants alter brain activity within 3 hours of taking them, so it’s likely a result of changes being made by the drug. This is very common among individuals who take SSRI or SNRI medications as the serotonin system can temporarily create this state.
- Cocktail of psychotropics: A person who is on a poly-drug combination may exhibit unpredictable symptoms. Although we have a general idea of how a person will respond to certain medications, the effects are not universally predictable. When individuals take a cocktail of psychotropic drugs, they may display both symptoms of major depression (if the combination is bad) and periods of hypomania (if they have a certain reaction to the combination). Therefore it is clearly possible that drugs could lead to a misdiagnosis of BP2.
- Illicit drugs: People using illicit drugs of any sort may be prone to hypomania. Drugs that would likely contribute to the portrayal of hypomanic symptoms include: stimulants such as that of cocaine and/or methamphetamine. The “high” derived from these drugs could be mistaken as a person being hypomanic, when in reality it’s a result of the drug.
- Medication withdrawal: During withdrawal from psychiatric medication, a person’s entire nervous system goes through a bevy of changes. Depending on the individual, the dosage of drug they were taking, how quickly they withdrew, and how long they had been on the medication can all influence withdrawal symptoms. During discontinuation, a person may exhibit symptoms that may resemble bipolar disorder. Therefore, it is important to distinguish between temporary changes during withdrawal and a factual bipolar diagnosis.
- Non-responsive to antidepressants: Many people who fail to respond to antidepressant treatment are thought to have Bipolar disorder. Although the evidence for this is somewhat flawed, many psychiatrists suspect that something “must” be wrong if the patient isn’t responding to “clinically proven” treatment options. In some cases a mood stabilizer may be used as an antidepressant augmentation strategy, and if effective (in any way) a psychiatrist may try to “pry” a Bipolar 2 diagnosis out of a patient. In some of these cases, a person ends up being wrongfully diagnosed.
- PTSD: Many people with PTSD experience high anxiety, high levels of stress hormone (cortisol), high adrenaline, and rapid beta brain waves. This may make a person seem stressed, on edge, and the person may clearly be overstimulated. Due to the stress response by the body and blocking of the “trauma” a person’s body may flood with adrenaline, giving them excess “anxious” energy. As enough adrenaline accumulates in the body, a person can develop a PTSD-induced hypomania. In this case, the person doesn’t have bipolar disorder, rather hypomania that was caused by their trauma. As the person learns how to overcome PTSD or some good coping techniques, they can achieve a more stable mood.
- Stimulants: Individuals taking psychostimulant medications may appear to exhibit hypomanic symptoms. This is especially common among those who are taking high doses and/or are new to using stimulants. Initially a person may appear to be “hypomanic” when initially administered a stimulant, but over time, the effects may wear off and/or a person could become depressed – leading to a potential misdiagnosis of BP2.
Problems with Bipolar 2 diagnostic criteria…
While most people have no qualms when it comes to diagnoses of Bipolar I, many people aren’t so sure that they have Bipolar II.
Bipolar 2 diagnostic criteria:
In order to be diagnosed with Bipolar 2 disorder, an individual must fit the criteria listed below.
- The presence of a hypomanic or major depressive episode.
- If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
- Significant stress or impairment in social, occupational, or other important areas of functioning.
There are several problems with this definition for Bipolar II disorder. The first major problem is that all a person needs to have in order to be diagnosed with this condition is: one-time occurrence of hypomania, one-time occurrence of major depression, and stress or impairment in various areas of life.
- Cycle-length unspecified: Perhaps the worst aspect of the BP2 diagnosis is that cycle-length estimates are unspecified. Although we know the person must have one episode of hypomania lasting more than 4 days, how long does it take (on average) for the hypomania usually take to shift to depression? What if a person had hypomania for 5 years followed by depression for 2? If a person had a favorable ratio of hypomania to depression would they really benefit from treatment? Most people with BP2 diagnoses claim that their moods shift “weekly” or “monthly.”
- Marketing/media portrayal: Many people see Bipolar disorder in the news and among celebrities and believe they also have it. Although the illness “bipolar disorder” is thrown around like hot-cakes among news programs, gossip sites, and celebrities – it is seldom used correctly. Many individuals in the media hypothesize that certain celebrities are “bipolar” simply because they have other issues or exhibit some mood swings. The reality is that everyone that is human has changes of mood, but this does not indicate bipolar disorder. The problem is that someone may see a news article speculating that a celebrity has this diagnosis, even when the speculation is completely misinformed. That same person will read something vague about bipolar disorder such as “mood swings” and may think they have the same condition – even when they clearly don’t. A major problem is when a person takes it one step further and markets the symptoms to fit a “bipolar diagnosis” even when they don’t actually have it.
- Organic hypomania: In a legitimate diagnosis of bipolar II disorder, the hypomania should be organic, rather than induced by a medication, trauma, or another condition. In cases that the hypomania is a result of a traumatic experience, does the person really have Bipolar 2 disorder? According to the actual definition, “yes” – but in reality, once a person learns to overcome and cope with the trauma, the hypomania will naturally reduce. Only those who became hypomanic without influences from trauma and/or medication are likely to have a genuine diagnosis of BP2.
- Psychiatric “interpretation”: Different psychiatrists interpret what patients tell them differently. A patient may say that they have mood swings, without much detail and the psychiatrist may initially assume that the person could have bipolar disorder. They may then note any (even tiny) details that may even partially suggest BPD2. Other psychiatrists may be better at distinguishing between someone who has “mood swings” and a person who truly has the disorder.
- Vague diagnostic criteria: One of the most unfortunate aspects of the Bipolar 2 diagnosis is that the criteria is relatively vague. Someone treated for major depression may experience hypomania during their treatment, are they automatically classified as having bipolar disorder? What if the hypomania would have never occurred had they not taken an antidepressant? Does that still qualify for the diagnosis? It shouldn’t.
How to understand if you were misdiagnosed with Bipolar II disorder
There are several questions you can ask yourself to understand whether you were wrongfully diagnosed with bipolar II disorder.
1. Did you have bipolar symptoms prior to taking psychiatric medication?
In other words, think about your life from an objective perspective. Did you have periods of hypomania followed by periods of depression (or vice-versa)? If you did, well then your diagnosis is likely correct, however if you never had these symptoms prior to taking medication, you may be a victim of misdiagnosis.
2. Do you really have a history of hypomania?
Many people who are misdiagnosed with this mental illness do not have a history of hypomania. The hypomania may have been induced by a traumatic experience and/or medication that they took. Certain people who are resistant to depression treatments may continue trying medications and find no relief. A psychiatrist may then experiment with drug combinations that may trigger hypomania-esque symptoms.
3. Do any immediate relatives have bipolar disorder?
If immediate relatives have bipolar disorder, your chances of also having it significantly increase. First determine whether there are any people in your immediate family with a bipolar diagnosis. Then think about whether any blood-relatives have the illness. Assuming no relatives have the illness, the odds that you have it are less likely.
4. Have you suffered any sort of trauma?
If you have suffered some sort of trauma, it may have created an ideal breeding grounds for the misdiagnosis for BP2. Although trauma at a young age can affect various brain networks and functioning, and may be a potential cause of an actual bipolar disorder diagnosis, in certain cases trauma leads to development of symptoms that may be mistaken for BP2. For example, some individuals become hypomanic in response to trauma, does that mean they have bipolar disorder? Not usually.
5. Do symptoms occur in homeostasis?
Do your symptoms occur in your natural state of functioning without the influence of outside substances? Take the time to think about when you felt “normal” and evaluate whether you were prone to bouts of hypomania and/or depression. Many people get too caught up in how they feel after taking a medication and sometimes forget that their current symptoms may me more related to the medication than their actual state of functioning.
6. Do you use illicit drugs?
Individuals who use illicit drugs may be prone to mood swings as a result of this drug usage. Before an accurate diagnosis of Bipolar II disorder can be made, a person must be free of illicit substances. For example, a user of methamphetamine may display signs of mania and/or hypomania while high on the drug, followed by bouts of depression when they “crash” – this does not qualify for a diagnosis.
7. How frequent are your mood “cycles”?
Although you only need one episode of hypomania and one of depression to fit this diagnosis, most people have multiple episodes. Organic Bipolar II disorder is generally something that was present prior to any sort of psychiatric treatment and/or outside intervention. Mood cycles may occur each week, each month, but for many people, they seldom experience more hypomania than depression. Most professionals would agree that it is rare for hypomania to persist for years.
Dangers of misdiagnosing Bipolar 2 disorder
If a person has Bipolar 2 disorder and doesn’t get properly diagnosed, it may significantly impair their functioning and livelihood. However, there are also some dangers associated with falsely diagnosing the condition including: exposing patients to unnecessary medications, forcing additional stigma upon the patient, and further confusing the patient (especially when a diagnosis doesn’t really make sense and is done out of speculation).
- Hopelessness: A person who is wrongfully diagnosed as having Bipolar disorder may become hopeless and feel as if they have no way out. This may trigger deeper depression and the person may end up feeling suicidal as a result. Although this happens among people who actually fit the criteria, patients who are misdiagnosed as having this condition are put through unnecessary stress.
- Medications: Most people with Bipolar II disorder are put on mood stabilizers like Lithium and/or antipsychotics. The medications tend to carry a variety of side effects and typically a patient must have blood-work done often to avoid any adverse reactions.
- Side effects: People often have a difficult time putting up with the side effects from medications used to treat this condition. A person may gain a significant amount of weight, become lethargic, and lack zest for life. Although they work well for balancing out those with bipolar disorder, exposing someone to these side effects who doesn’t have the disorder is wrong.
- Stigma: Many people have to deal with stigma from family members, friends, and society for carrying this diagnosis. Although those who understand the illness are empathetic to sufferers, those who lack understanding may poke fun at a person with it. In the event that someone is wrongfully diagnosed, they may have to deal with the burden of putting up with the stigma.
Do you really have bipolar 2 disorder?
Most people who have this condition are well-aware of it. People who transition between mania and depression are aware of these frequent shifts in mood. Bipolar Type 1 is less frequently misdiagnosed than Type 2 because it’s easier to notice manic symptoms such as talkativeness, happiness, compulsive shopping, etc. Bipolar Type 2 is tougher to diagnose, but also significantly easier to misdiagnose.
If you know that you never had any Bipolar disorder symptoms prior to psychiatric treatment, chances are good that you do not have this condition. Medications such as antidepressants can trigger hypomania even among those who do not have Bipolar disorder – it all depends on how an individuals’ neurochemistry reacts to a certain class of drugs. Additionally during a transitional phase coming off of a medication (e.g. in withdrawal) a person may experience hypomania-like symptoms until their brain readjusts to homeostatic functioning.
Others may experience hypomania as a result of elevations in arousal such as in cases of PTSD and anxiety. Therefore, it is important to distinguish between whether the individual actually has Type 2 Bipolar disorder or another condition that mimics many of the symptoms. Although self-diagnosis should never be encouraged in mental health, most people are aware whether they have always had Bipolar disorder or were misdiagnosed.
Note: It seems I am no longer alone in recognizing this rampant misdiagnosis by psychiatrists… Read this: http://www.madinamerica.com/2015/01/antidepressant-induced-mania/