In recent years there has been much talk and research devoted to the increase in psychological disorders, especially those that are diagnosed in children. There have been news articles and television specials about “Attention Deficit Disorder on the rise!” or “Autism hits new high in our youth!” One of these disorders that has become increasingly diagnosed over in the past two centuries is bipolar disorder, formally known as manic-depressive disorder. The question is, does this mean that there is an increase of bipolar disorder, or is we simply over diagnosing this condition?
In case you are unfamiliar with this disorder, it is in some ways a depression. However, instead of a unipolar depression in which the individual continually varies between feeling normal and depressed, a bipolar individual alternates between two poles, depression and mania. Being the opposite of depression, mania is most often distinguished by restless activity, excitement, laughter, self-confidence, rambling speech, and loss of inhibitions (Kalat 445). Individuals who experience full on episodes of mania are said to have bipolar I disorder, while those with bipolar II disorder experience hypomania. Hypomania is mostly characterized by anxiety or agitation and is much more mild than full-blown mania.
The rise of diagnosed conditions of bipolar disorder is pretty shocking. From 1994 to 2003, bipolar disorder in youth increased from 25 to 1003 cases in every 100,000 people, while in adults it increased from 905 to 1679 cases per 100,000 (Moreno et. al, 2007). This is a significant increase in the period of about ten years. The current estimate is that near 1% of people will have bipolar I disorder at some point in their life, with another 1% having bipolar II disorder, and 2-3% will have a minor case not quite strong enough for diagnosis called “subthreshold” bipolar disorder (Merikangas et al., 2007).
So what has caused the increase in diagnosis of bipolar disorder? Some psychologists would like to argue that it is because there are more legitimate cases than there has ever been before. In fact some researchers say that it is under diagnosed. Hirschfeld et al. (2003) conducted a study where they distributed the MDQ (the Mood Disorder Questionnaire) to 127,800 people selected to represent the US population. The results were suggested that nearly 4% of American adults could be suffering from bipolar I and II disorders. Such individuals that argue to legitimate increase of the disease can attribute it to changing environmental and the continuation of genes that increase the risk (Hirshfeld et al. 2003). Although some think that the increased diagnosis of bipolar disorder may be a good thing, there are many researchers who think that bipolar disorder is being over diagnosed.
What would cause this? McClure, Kaslow, and Kubiszyn (2002) discuss in their study some reasons why over diagnosis may happen. First, especially in children, manic symptoms are more difficult to distinguish from other, more general disruptive behaviors in children. Along with that it remains unclear whether the diagnostic criteria that most psychologists use are appropriate for use in individuals who have not reached adolescence yet. Second points is that assessment of a patient should be as comprehensive as possible, and include collections of family, medical, developmental, attachment, psychosocial, and other histories from multiple informants along with facilitated interviews including detailed background questionnaires along with other measures currently being taken. The problem is that this is very time consuming and often isn’t taken care of as it should be.
Another proposed reason that the diagnosis of bipolar disorder is becoming more common is because it is becoming an umbrella term for a few different disorders, similarly to how some say autism is becoming an “umbrella” disorder. Some psychologists are questioning that diagnosed conditions of bipolar disorder aren’t something else (McClure). In some ways it has become a “catchall” for any child that is explosive or aggressive. Attention deficit hyperactivity disorder (ADHD), depression, schizophrenia and Tourette syndrome all have a possibility of being diagnosed as bipolar because of commonalities in symptoms.
“So what is the problem with the overdiagnosis? If it’s one problem or another than as long as it is being treated it’s all fine right?” One of the problems with over diagnosis is that we are now having even more children on drugs than before. That’s why Moreno et al. (2007) say that this is such an important and dire topic to investigate. The study concludes that we must continue to observe this topic because we need to, “to evaluate the effectiveness and safety of pharmacological treatment regimens commonly used to treat youth diagnosed with bipolar disorder.” If you look at the “Bipolar Medication Guide: Medications and Drugs for Bipolar Disorder,” you will see how many different drugs can be prescribed and how dangerous they can be. Many of them have harmful side affects as well. For example, not only does lithium often come with weight gain, but also a high dose can be toxic (Kalat, 446). Some of the drugs that are used for bipolar are also used on individuals with schizophrenia. It could be very possible to assigned a drug that costs a lot of money and not even have it help, an in fact possibly harm.
This is the reason that some argue that bipolar disorder is over diagnosed. They say that it is because the drug industry is making so much money off of it. While there may be more “conspiracy theory” in this that truth, there may be some be some hints of truth. Many effective treatments for bipolar disorder especially in youth are lifestyle habits. Sleep is an important indicator and treatment for polar episodes, and when sleep is healthy it can help increase severity of mood swings. Also, diet can be an important facet of bipolar disorder as well. For example, polyunsaturated fatty acids can help counteract some the arachidonic acids that help cause some of the manic episodes (Kalat, 446). So perhaps some who are diagnosed are just kids that need better nutrition and sleep, not drugs.
There has recently been more research in the area of scans in order to find abnormalities in the brain that bipolar patients have that others don’t. This could prove to be very helpful once we fully understand how to use them. Not only could MRI and EEGs be able to help in identifying the difference in brain structure in those with bipolar and those who are normal, but it could help in identifying those who have similar disorders such as ADHD (Preidt 2010). Children with ADHD and bipolar disorder show dysfunction to the prefrontal cortex, but those with ADHD had more while individuals with bipolar disorder showed more abnormalities in other areas of the brain. This could help in identifying if we are misdiagnosing individuals or if there exist other facets to bipolar that we haven’t labeled yet. Similarily, Basso, Lowery, and Rod (2002) conducted a study where they looked to see if there were neurological differences in variations of bipolar disorder. They found that there were no noticeable differences in neurological impairment between mainly manic, mainly depressive, and those that have a mix of both. This could help show that all three are a variation of the same disease and could help in diagnosis using MRI scans.
It is a difficult call to make whether we are over diagnosing our generation with bipolar disorder or if we have been under diagnosing all along. Although we don’t know for sure, one thing is certainly evident. We need to be careful in our diagnosis of this disease and all of our others. With new drugs and new technology we need to fully research what we are doing and what will help before we begin prescribing it to everyone who seems to have symptoms. As for now, we need to continue researching bipolar disorder and develop a more intensive and accurate process, potentially using EEG and MRI scans, to help make sure diagnosis of bipolar disorder and other such disorders are accurately achieved.
Works Cited
Basso, Michael , Natasha Lowery, Jackie Neel, Rod Purdie, and Robert Bornstein. "Neuropsychological impairment amoung manic, manic depressed, and mixed-episode inpatients with bipolar disorder." Neuropsychology 16.1 (2002): 84-91.
Hirschfeld, R., R. Calabrese, J. McElroy, K. Wagner, M. Weissman, M. Reed, M. Davies, M. Frye, P. Keck, L. Lewis, and S. McElroy. "Screening for bipolar disorder in the community." JClin Psychiatry 64.1 (2003): 53-9.
Kalat, James W. Biological psychology. 10th ed. Belmont, Calif.: Wadsworth, Cengage Learning, 2009.
McClure, Erin, Tom Kubiszyn, and Nadine Kaslow. "Advances in the diagnosis and treatment of childhood disorders." Professional Psychology: Research and Practice 32.2 (2002): 125-134.
Merikangas, K. R., Akiskal, H.S., Angst, J., Greenberg, P. E., Hirschfeld, R. M. A., Petukhova, M., et al. (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry, 64, 543-552. (15)
Moreno, Carmen, Gonzalo Laje, Carlos Blanco, Huiping Jiang, Andrew Schmidt, and Mark Olfson. "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth." Arch Gen Psychiatry 64.9 (2007): 1032-1039.
Preidt, Robert . "Brain Scans May Help Identify Bipolar, ADHD Kids: Study: MedlinePlus." National Library of Medicine - National Institutes of Health. Health Day, 15 Oct. 2010. Web. 6 Dec. 2010. <http://www.nlm.nih.gov/medlineplus/news/fullstory_104440.html>.
"The Bipolar Medication Guide: Medications and Drugs for Bipolar Disorder." Helpguide.org: Understand, Prevent and Resolve Life's Challenges. Web. 3 Dec. 2010. <http://helpguide.org/mental/bipolar_disorder_medications.htm>.
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