Bipolar is a relatively common yet debilitating mental health condition that that affects over 1 million people in the UK alone. While it affects everyone differently, it’s characterised by high, euphoric, or irritable periods called mania and low periods of depression that can lead to suicidal thoughts.
While there isn't currently a cure for bipolar, it can be successfully managed using the right treatment - if an accurate diagnosis is made. And here's where the real problem lies: of all the mental health disorders, bipolar is one of the most commonly misdiagnosed.
Almost 70 percent of people with bipolar disorder are incorrectly diagnosed initially and more than one-third remained misdiagnosed for 10 years or more. This often leads to ineffective treatment and further distress for people with the condition.
Dr Simon Surguladze is a Consultant Psychiatrist with over 30 years of clinical experience that includes treating and diagnosing people with bipolar affective disorder. We spoke to Simon to find out why bipolar is often misdiagnosed, and what people can do to help their clinicians make an accurate assessment of their symptoms.
Several manic symptoms of bipolar disorder and ADHD resemble each other, which often leads to misdiagnosis. The manic swings of bipolar can be mistaken for hyperactivity while the low spells can look like inattention and lack of motivation, which are symptoms common in people with ADHD.
Two studies conducted in 1999 and 2000 respectively concluded that almost 40 percent of bipolar disorder patients are initially diagnosed with unipolar depression. While the symptoms of depressive episodes of bipolar can look similar to unipolar depression, there are important differences between how each condition makes people feel and behave, and differences in how they are supported through treatment.
Bipolar is perhaps best understood as a spectrum disorder with a wealth of different levels of depression, mania and hypomania. One of the most challenging things for diagnosing individuals with bipolar is the difficulty in identifying hypomania, as Simon explains, "Hypomania refers to an elevation in mood that is less drastic than mania. Sometimes hypomania can be enjoyable due to the increased energy and confidence that often comes with it. However, it can still lead to impulsive, elevated and irritated behaviour with adverse consequences, such as overspending and damaging personal relationships. Due to the nuances in how it’s experienced, it’s harder to identify.”
Because it can be enjoyable, people often don’t seek treatment during a hypomanic episode and are more likely to seek treatment during a depressive episode. Furthermore, hypomania doesn't tend to end in hospitalisation, as mania sometimes does. For these reasons, hypomania is less likely to be recognised.
Bipolar is often an overlooked condition, which can take years to diagnose - and more awareness is needed. One reason it can take so long to recognise is how challenging it is to obtain a full and accurate history of someone’s mental health, which is a key part of any psychiatric assessment. This can be for several reasons.
For a start, it can be hard for someone with Bipolar to be able to accurately recall their moods and when they happened. Depressive and manic states make it hard to remember the detail of what you experienced. Anyone with a mental health illness will know how hard it is to verbalise their symptoms and experiences and therefore be able to clearly describe them to a clinician.
Simon also explains how people feeling unworthy, bad, or wrong can be lead to them holding back when speaking to a clinician, or even from seeking help at all, “It’s really important to be able to speak with the individual’s family, partner or close friend to understand another more objective view on the symptoms, but unfortunately this isn’t always possible. Sadly, people with Bipolar often feel shame or embarrassment with their symptoms and this becomes an additional barrier to diagnosis.”
If there is a more ‘pressing’ or immediate mental health condition, it could lead to bipolar going undiagnosed. For example, people with Autistic Spectrum Disorder (ASD) who also have bipolar disorder may not receive an accurate diagnosis because of what is called ‘diagnostic overshadowing.’ In this instance, it is when symptoms of bipolar disorder are interpreted as autistic traits, and it may happen because there are overlaps in symptom presentation.
Autistic people with bipolar disorder are also more likely to have mood states with mixed or atypical features, such as irritability and aggression as opposed to euphoria, which can also make an accurate diagnosis more difficult.
There isn’t a quick fix for these challenges but if you think you or a loved one has been misdiagnosed, it's always worth checking with your GP or seeking a second opinion from another health professional.
The following may help if you are considering a bipolar assessment:
For more information about bipolar disorders, you can speak to someone at www.bipolaruk.org or your local GP. If you would like a private assessment for Bipolar you can call 0203 326 9160 to speak to one of our experienced Assistant Psychologists who can talk you through your next steps.