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Did a mental health professional tell you that you are bipolar, when you know the real problem is that your family life is a war zone?  Since a large percentage of my fellow psychiatrists have become primarily prescription writers rather than psychotherapists, relationship problems have magically been turned into mental illnesses.  If all you have is a hammer, everything looks like a nail.

It is never too late to stop dysfunctional family patterns. Although medication can help calm you down, you cannot buy your way out of these patterns with pharmaceuticals.   The diagnosis of bipolar disorder, a serious mental illness, is now being falsely applied to anyone who is chronically moody and anxious due to such ongoing troubles.

Initial psychiatric diagnostic evaluations, which should last about an hour, are now often routinely shoehorned into thirty minutes.  This often includes the time the doctor needs to write a note in the patient’s chart, return phone calls, and go to the bathroom.    

To save time, some psychiatrists only ask about psychiatric symptoms.  They blindly accept the patient's yes or no answer without checking to see if the patient clearly understands what a symptom should look and feel like in order to be part of a psychiatric disorder. The patient may even be asked to fill out a "symptom checklist" before being seen by the doctor.  

The DSM, the diagnostic manual in psychiatry, does not merely list the symptoms of disorders and then specify how many of them a patient needs to exhibit in order to qualify for a given diagnosis. It also requires a doctor to make a clinical judgment about any symptom’s diagnostic significance.  

The use of a symptom checklist approach and a desire to medicate everything has led many psychiatrists to fail at accurately distinguishing acute phenomena in a given patient’s life, such as an episode of mania, from background disturbances such as ongoing interpersonal difficulties and chaotic lives.

True bipolar disorder or manic-depressive illness is characterized primarily by distinct periods of severe mood elevation and other periods of severe depression, separated by normal mood periods in between. The DSM, in order to prevent transient mood states from being misdiagnosed as manic or depressive episodes, requires that patients’ symptoms last a certain number of days.  The specified time period is admittedly arbitrary, but should be measured in terms of several days or weeks, not minutes. These DSM duration requirements are being routinely ignored by psychiatrists.

It gets worse.  Just because a patient reports staying up all night without feeling tired for seven days in a row - a symptom of mania – this does not mean that the patient also knew to report that he was taking daytime naps or was on a cocaine binge. Symptom checklists for manic episodes usually list symptoms such as agitation, impulsivity, racing/obsessive/cluttered/busy thoughts, hypersexuality, spending sprees, euphoria, and decreased need for sleep. They usually do not even allude to the fact that in mania these symptoms all have to occur at the same time and be totally atypical of the way the person normally functions. People in a manic state do things that are totally out of character for them. An understanding of such characteristics of the symptoms is absolutely essential for determining if they are part of true bipolar disorder.

The symptoms of manic and depressive episodes in bipolar disorder have to be pervasive, affecting every aspect of the person's life regardless of changing external circumstances. They have to be persistent, continuing unchecked for the specified period of time. They have to be pathological, causing the patient significant emotional distress or functional impairment.  A good psychiatrist should also take into consideration the state of a patient's current and past intimate relationships in order to rule out reactive mood changes.

Additionally, most symptoms mentioned in these checklists are non-specific.  That means that each one of them may be a symptom of several different psychiatric disorders, depending on other factors. Take irritability for example. It can be a symptom of mania, but it can also be a symptom of depression, generalized anxiety disorder, panic disorder, borderline personality disorder, drug abuse, excessive caffeine intake, or having just had yet another of a series of big fights with your parents a few days earlier.

Misdiagnosing patients who are not bipolar can have highly negative consequences.  Some of the medications used to treat bipolar disorder, while generally effective for properly-diagnosed patients who must have them, potentially have highly toxic side effects.  They can be expensive.  Worse yet, doctors who diagnose every moody patient they see as bipolar typically send the patient home with a prescription but rarely recommend a treatment – psychotherapy - which may have the potential to turn a patient’s life around.  Outrageous.

Originally posted to David M Allen MD on Mon Aug 30, 2010 at 03:08 PM PDT.

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