Part 4 increase in bi-polar diagnosis

Part 4 increase in the diagnosis of bi-polar disorder.

“Oh my God! Mrs. Johnson totally freaked out on me for being like 5 minutes late, she is so bi-polar!”

I cringe when I hear statements like this, and I hear them a lot. A person having mood swings does not make them bi-polar. In fact most people with bi-polar disorder do not cycle (change from low to high or vice versa) on a daily or even weekly basis. One of my relatives lived in a hypo-manic (really up) cycle for over two decades but when he crashed, he was down big time.

All bi-polar (aka manic-depression) means is that a person at times suffers from depression and at other times gets into extremely highly energetic impulsive phases. During the up phases the person can be incredibly bright and productive which is why bi-polar is sometimes called the genius disorder. When I say extremely energetic and impulsive I mean the person might go days without sleeping, spend several thousand dollars they don't have, engage in indiscriminate sex and drug use, and feel like there is nothing that they cannot do.

Some great books on bi-polar include: Kay Redfield Jameson's An Unquiet Mind, Alex Vonnegut's The Eden Express and (the extreme and disturbing but good) Marya Hornbacher's Madness.

Why is bi-polar being diagnosed so often now? Like ADHD Bi-polar did not exist as a disorder until relatively recently. Until the 1980's Bi-Polar was lumped under schizophrenia and many of the medications that are used for it even today are also used to treat schizophrenia. The main difference between the two is the cycling and energy. People with schizophrenia have good days and bad days but the change in energy in a bi-polar patient is much different. Also, while some people with bi-polar will, at the ultimate end of the Up (manic) phase, have hallucinations and delusions, many people will never reach that level. Some people with schizophrenia will have hallucinations and delusions even when calm and in a low period.

In the past many people who self medicated their bi-polar symptoms and ended up on “skid-row” were simply diagnosed as drunks and looneys. Those people are now more correctly diagnosed as bi-polar. There is very high degree of co-morbidity (two disorders occuring side by side) between bi-polar and addictions.

On the false positive side, today many children with hyperactivity and behavior problems who are unsuccessful with treatment for ADHD are often by default diagnosed as bi-polar. This is particularly true if they have a family member who also has a diagnosis of bi-polar. While the genetic link is very strong with bi-polar, as with ADHD, it is poor diagnostic work to just assume that because one family member suffers from bi-polar so does the other, but it happens.
I have heard people complain that once they mention a family history of bi-polar to a psychiatrist it is as if the interview is over and the diagnosis is made. I hate that.

Bi-polar is usually not diagnosed until the late teens, because many symptoms will not emerge until then and will often not appear into the middle 20's. In addition, depression or ADHD is often diagnosed first until other symptoms emerge because these disorders respond better to treatment and doctors like to be hopeful until the evidence demands they must change course.
Bi-polar symptoms respond very well to medication. The problem is getting the person to take their meds because they often miss the Up phases, and to be honest who wouldn't. People are more likely seek and follow treatment when they are feeling depressed because no one enjoys depression.

I feel that in the future what we now call bi-polar will be split into several different conditions and diagnosis will be far more accurate, especially in children and early teens.