There are two main categories of bipolar: individuals with bipolar I disorder have episodes of sustained mania and often experience depressive episodes; those with bipolar II disorder have one or more major depressive episodes with at least one period of a less severe manic episode.
Bipolar disorder occurs in approximately four percent of the population worldwide. It is an extremely misunderstood and often devastating disease. The risk of suicide is 20 times that of the general population.
There are many complex contributing factors that lead to this chronic disease. Recently, the role of genetics has come into play. Scientists recognize there is a strong genetic component to bipolar disorder; unfortunately, it is extremely difficult to identify the genes that cause it. Historically, a standard clinical interview was used to determine whether individuals met the criteria for a clinical diagnosis of bipolar disorder. Within the past year, researchers took an additional step by also combining the results from brain imaging, cognitive testing, and a variety of temperament and behavior measures. Using this new method, investigators identified approximately 50 brain and behavioral measures that are both under strong genetic control and associated with bipolar disorder. These discoveries could be a major step toward identifying the specific genes that contribute to the illness. The hope is that one day genetics may be used to predict the onset and management of bipolar disorder.
Today, a full 69% of people with bipolar disorder are initially misdiagnosed and more than one-third of patients remain misdiagnosed for ten years or more. One study suggests that that on average patients remain misdiagnosed for 7.5 years.
Bipolar disorder can be confused with other medical or psychological disorders, such as thyroid disease, a metabolic disturbance, or medication induced mood symptoms. It can also co-occur with substance use disorders, attention deficit hyperactivity disorder, anxiety and post-traumatic stress disorder.
Primarily, those with bipolar disorder are misdiagnosed with major depressive disorder (MDD). This is not a surprise, considering that people often seek treatment when they are in the depressed phase of bipolar disorder. In fact, it is thought that 50 percent of those with bipolar disorder seek treatment in a depressed phase, never yet having experienced a manic state. However, if a person seeks help for a manic episode, bipolar disorder is much easier to correctly diagnose.
Misdiagnosis of bipolar disorder is problematic on so many levels. Not only does it lead to poor treatment that is ineffective, but it can actually make bipolar disorder worse. Delays in appropriate treatment can cause a greater chance of recurrence and increase the chronicity of the disease. Longer treatment results in higher treatment costs. The greatest cost is to the patient who must exist in a less than optimally state.
Relapse and Remission
Mood stabilizing medication and psychotherapy are important components in bipolar treatment. Living a structured life that includes quality sleep, healthy nutrition and reasonable exercise will also go a long way in maintaining mental health. However, it is important to recognize that relapse can occur. It can result from something as seemingly benign as a life transition such as going away to college or starting a new job. With that said, the most common cause of relapse is discontinuing prescribed medication. Unfortunately, this is extremely common. Perhaps a person has taken the medication for a couple of months and is doing well. Instead of attributing the improved well being to the medication, she begins to erroneously believe that never really needed the medication in the first place and therefore, decides to stop taking it.
Regardless of the reasons, relapse does happen, so it is important for the individual, as well as family and friends to understand that this does not indicate failure; it is simply a bump on the recovery road, one which can be overcome, and the more quickly it is identified, the better
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Dr. Kim Dennis is a board-certified psychiatrist and addiction specialist who specializes in eating disorder treatment, addiction recovery, trauma / PTSD and co-occurring disorders. As CEO and Medical Director at Timberline Knolls Residential Treatment Center, she supervises the medical staff and sets the overall vision and direction for the treatmet program. Dr. Dennis maintains a holistic perspective in the practice of psychiatry. She incorporates biological, psycho-social and spiritual approaches into the individually tailored treatment plan for each resident. Dr. Dennis is published in the areas of gender differences in the development of psychopathology, co-occurring eating disorders and self-injury, and the use of medication with family-based therapy for adolescents with anorexia nervosa. She is also on the editorial board of Eating Disorders: the Journal of Treatment and Prevention. Dr. Dennis contributes regularly to news networks, such as ABC News and CNN, other national press such as the Huffington Post, Chicago Tribune, Boston Globe and WebMD, and professional magazines such as Addiction Professional and Behavioral Healthcare. She contributes a monthly column to Dailystrength.org. She has been featured on TLC Discovery Channel’s “My Strange Addiction” and ABC’s “20/20.” In 2011, she was featured in the DVD NORMAL in Schools: ED 101 and in the documentary America the Beautiful 2: The Thin Commandments. In 2013, she was given the “Outstanding Clinician” award by Addiction Professional Magazine. Dr. Dennis received her undergraduate degree from the University of Chicago. She obtained her medical degree from the University Of Chicago Pritzker School Of Medicine and completed her psychiatry residency training at the University of Chicago Hospitals, where she served as chief resident. She is a member of the American Medical Association, Academy for Eating Disorders, the American Academy of Addiction Psychiatry and the American Society for Addiction Medicine. She is on the medical advisory board for the National Association of Anorexia Nervosa and Associated Disorders (ANAD).