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Thursday, February 7, 2013

How do I know if I have Bipolar Disorder?

Misdiagnosis is very common in the field of mental health. So, if you have been diagnosed with Bipolar disorder, start with a second opinion; but, be careful where you go for that opinion. In the last 15 years, mental health practitioners have been over-diagnosing bipolar disorder. Prior to 1990, the use of the label "Bipolar disorder" was limited to less than 2% of the US population; now it has been applied to 4.4% of the US population. Why the increase?

It's not that we're having an "epidemic" of bipolar disorder; 
we're having an epidemic of mental health practitioners 
diagnosing people with bipolar disorder,
and prescribing them psychoactive drugs.


Serious diagnosis require serious time to properly diagnosis.
A second or even third opinion is highly recommended.
The Bipolar syndrome has become more controversial than ADHD; in part because the drugs used to treat the symptoms of bipolar are dangerous in the short and long-term. This latest wave of bipolar diagnosing seems to have started with the book, The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder. So many parents engage in self-diagnosis, and this book provided them with a laundry list of vague symptoms that included many developmentally normal behaviors and misbehaviors common in negative parent-child relationships. But, a major problem with that book is that  there is no such thing as childhood bipolar disorder (here's a terrible story about a couple whose child was diagnosed with bipolar disorder http://www.nytimes.com/2007/02/15/us/15bipolar.html?pagewanted=print).  The authors of that book applied an adult syndrome to child behavior. Coincidentally, it coincided with a time when pharmaceutical corporations were attempting to market neuroleptic drugs (Zyprexa, Abilify, Seroquel, etc..) to children and teens, just like they did with SSRI's and other antidepressants.

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Like the ADD craze in the 1980's and 1990's, people became manic about Bipolar. In other words, it became much easier to "see" bipolar in a patient when you are looking for it; this is because the symptoms of bipolar are very poorly operationalized (very vague).  New editions of The Bipolar Child are still printed every couple years. Then there was the book by, Dr. Niederhut who combined the ADD syndrome with the Bipolar syndrome, called it COBAD and claimed it was genetic. Dr. Niederhut does not take money from pharmaceutical corporations, but in 2005, 30% of the American Psychiatric Association's income was from pharmaceutical corporations. Apparently, Dr. Niederhut diagnosed his two children with COBAD.


So, if you have been diagnosed with bipolar disorder, you can get a 
second opinion from a mental health professional 
who does not adhere to the "biological model" of mental health.

What is the biological model of mental health? It is the belief that mental health problems, sometimes called "mental illnesses" or "mental diseases," are caused by biological substrates, like a "chemical imbalance," or genetics. However, these ideas have never been proven, and in fact, there is overwhelming scientific evidence that there is no such thing as a chemical imbalance and that genetics play a minor role in most mental health problems. All kinds of genes are correlated or associated with mental health problems, but these correlations are often misunderstood. For analogy: homes are made of building materials, but those materials are processed and shaped by industry and builders in such a way that their original form is unrecognizable; genetic material goes through a similar process - it produces the material that we call "brain" but brain is tremendously shaped by ecology (interaction with the environment).

But what about Bipolar  - that must be genetic right? No. There are biological or genetic correlations for bipolar disorder, but there is definitely no clear causal relationship between any genes and bipolar disorder. Also, as I mentioned before, just because you have been labeled with bipolar does not mean that you have bipolar, since misdiagnosis or over-use of the label is so common. 

Bipolar, like almost all other mental syndromes, 
are not diseases like cancer or diabetes where you can test someone for it. 
They are very subjective, and there is a large amount of overlap in symptoms from one syndrome to another. 

In fact, several studies have shown that people who are admitted to inpatient psychiatric units can be categorized with an average of 7-12 different syndromes; but, syndromes or labels do not tell us what is going on with that person - labels do not explain the cause of the problem, which is usually more complex. Mental syndromes like ADHD or Bipolar are just labels for a set of symptoms, like "feeling unmotivated," or "racing thoughts."

The theory of causation for mental illness and mental stability that I operate by is this: 
A variety of factors present to varying and changing degrees, over the course of some period of time, work together to cause our mental health status to change, and these factors are internal and external, they are thoughts, emotions, feelings, and behaviors and they are through interpersonal relationships, and in our relationship with society, and in the personal meaning of our life experiences - it is what some call the Ecological theory of mental health.

Since mental health is not taught in public schools, the average American has no understanding of the clinical definition of Bipolar and how that definition has been misused in children, teens, and adults. For example, just because someone is "moody," even extremely moody, does not mean that they have Bipolar disorder. Just because someone has a tendency to "fly off the handle," out the blue, or be grumpy for a days or even a week at a time doesn't mean that they should be labeled with bipolar disorder. The speed at which people are labeled Bipolar, by some mental health professionals, is actually egregious.

Another significant problem with being diagnosed with Bipolar is that you've probably been prescribed at least one neuroleptic drug, possibly along with 1-2 other drugs, like an SSRI and a benzodiazapine. In the last thirty years or so, the outcome of people who have been diagnosed with Bipolar disorder has become worse. Rapid cycling, which didn't exist prior to 1980, has become very common. Some scientific evidence and some psychiatrists have indicated that the drugs people take for bipolar might be responsible for the worsening of bipolar disorder and the advent of rapid-cycling. 

There's also the stigma of being labeled with bipolar. Some have argued that calling Bipolar "genetic" lessens the stigma of this label, however, some studies have shown it has increased the stigma. For example, many people might be reluctant to marry and have children with someone who is diagnosed with a "genetic disease." NAMI, which was started by parents who rejected the idea of being blamed for the mental health problems of their children, continue to support the biological model. At this point, some see NAMI as an extension of psychiatry and pharmaceutical corporations, reinforcing ideas that mental health problems are diseases and that people "need" drug treatment.

Bipolar disorder is a very serious diagnosis to incur. It shouldn't be taken lightly and diagnosed in one brief psychiatric visit; people shouldn't be prescribed drugs and told that they "need" these drugs for the rest of their life while at the same time not informed of the dangers of neuroleptic drugs and other drugs used to treat bipolar. Avoid self-diagnosing. Be careful of doctors or other mental health practitioners who diagnose you with bipolar in one visit or without conducting a thorough evaluation and history of your symptoms, but be honest with them about the severity of your symptoms. Navigating the complexity of America's mental health delivery system is difficult, so proceed with caution and consider a second opinion.



Mental Health Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship. 


http://www.childmind.org/en/posts/articles/2011-1-5-bieber-fever-hazardous-mental-health
Dr. Oz  Bipolar

2 comments:

  1. Good post. I think you might find a lot to agree with this guy:

    http://davidmallenmd.blogspot.com/

    Where you two might disagree is when it comes to true bipolar disorder and schizophrenia, which he thinks has higher biological loading. He does agree with you for other diagnoses, such as borderline, anxiety, and depression, that environmental factors tend to be the big factor, and that fixing those is necessary. Still, he's against the overdiagnosis of bipolar just like you.

    Also, I have a slight quib with your saying that other medical fields are necessarily more accurate in diagnosing, as mentioned here:

    http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=8&cad=rja&ved=0CHcQFjAH&url=http%3A%2F%2Fwww.personalsolutionscounseling.com%2Fnewsletter%2Farchive%2Fdocuments%2FSomeDocsManicaboutBipolar.pdf&ei=ExprUo2-Duru2wWsuIDICQ&usg=AFQjCNHvsEQW0DnjpxbKurTJCYSHWQ8jAw&sig2=PfxaxWnfOYEoL-smSashTQ&bvm=bv.55123115,d.eW0

    Also, I've read up on the criteria for diabetes, and they are actually somewhat arbitrary. There is controversy in the field about whether the criteria should be lowered or changed to catch diabetes sooner.

    Also, judging from what you've written, you might find this interesting:

    http://onlinelibrary.wiley.com/doi/10.1111/acps.12092/full

    Basically, modern diagnosticians don't like to look below the surface very much.

    ReplyDelete
  2. Thank you for your thoughtful critique of these posts. I appreciate your input!
    With regards to accuracy of medical diagnosis - I used diabetes as an example because it is often used as an analogy for medications - they myth that people need medications for mental health problems just like people need insulin when they have diabetes.
    Although the cut-offs for diabetes are somewhat arbitrary, just as they are for hypothyroidism for example, they still are able to test for bio-markers and then determine if someone is symptomatic, whereas in mental health there are no bio-markers to test for.
    Studies on genetic correlates for bipolar have consistently shown a broad range of genes and broad range of heritability, between 40-70% compared to downs syndrome which is 99%. There's no doubt that genes play a role in mental illness, but how they play a role is more complicated a question than can be answered presently.
    Regardless of cause, the treatments we have are the same, at least at this point, and chemo-therapies for bipolar are not necessary for most of the time that someone suffers from the disorder, if in fact they are really suffering from it to begin with.

    ReplyDelete