Study: Doctors Over-Diagnosing Bipolar Disorder

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A new study suggests that many people are being diagnosed as bipolar even though they do not meet the criteria for the disorder. Researchers at Rhode Island Hospital found that about half of 700 patients who'd been diagnosed as bipolar should not have been.

MICHELE NORRIS, host:

This week, psychiatrists are gathering from around the world for a meeting of the American Psychiatric Association, a meeting here in Washington, DC. One topic of research and concern: the overdiagnosis of bipolar disorder. As NPR's Jon Hamilton reports, some patients are being told they have bipolar disorder even though they don't.

JON HAMILTON: Bipolar disorder used to be called manic depressive illness. People who have it may swing from sad and listless to energized and euphoric and then back again. It can be tricky to diagnose. So for the past decade, Mark Zimmerman has been studying how doctors are doing. Zimmerman works at Rhode Island Hospital and Brown University. He says at first, he found that doctors tended to miss bipolar disorder. But about six years ago, the opposite problem began to surface.

Dr. MARK ZIMMERMAN (Rhode Island Hospital; Brown University): Individuals were coming to us saying that they had previously been diagnosed with bipolar disorder. And even after administering a comprehensive, thorough diagnostic interview, we were unable to find evidence of that.

HAMILTON: So Zimmerman studied 145 people. They'd come to the hospital after someone else diagnosed them as bipolar.

Dr. ZIMMERMAN: About half we did not confirm the diagnoses.

HAMILTON: Most had some form of depression, but they didn't seem to be bipolar. To make sure, Zimmerman studied the patients' families. People who are bipolar tend to have close relatives with the same problem. But that pattern didn't hold for the people classified as misdiagnosed. Zimmerman will present his findings during a scientific session tomorrow. He says overdiagnosis is important because it can hurt people.

Dr. ZIMMERMAN: You don't want individuals to be treated for something that they don't have, because then they may be taking medications that they shouldn't be taking and therefore being exposed to side effects unnecessarily.

HAMILTON: Side effects like tremor, weight gain, sedation or liver problems. Zimmerman says he's not sure why so many people are being mistakenly put in the bipolar category these days, but one factor could be educational sessions for doctors, especially the ones sponsored by drug makers.

Dr. ZIMMERMAN: Almost invariably, there will be these admonitions of don't miss the diagnosis and a citation of a number of studies in which underrecognition and underdiagnosis is highlighted.

HAMILTON: Another scientist presenting research on misdiagnosis was Gary Sachs of Harvard. Between talks, he explained that the symptoms of bipolar disorder are a bit like the stars in a constellation.

Dr. GARY SACHS (Harvard University): When you see them together, you recognize the Big Dipper. If you're only going to look at one or another star, it's hopeless to sort that out.

HAMILTON: Sachs says that in academic settings, doctors use a long and highly structured interview to identified all those stars.

Dr. SACHS: On the other hand, if you were to go out into ordinary clinical practice, you would see the process is nothing like that. It's less of the formal question and more of a general discussion.

HAMILTON: He says that can lead to overdiagnosis. It can also mean that some people who actually have bipolar disorder aren't being treated for it.

Dr. SACHS: The sad reality is that when patients are treated, they lose relationships, they lose jobs, they often lose marriages. Sometimes they lose their life. So there's quite a bit at stake, and it's a very serious proposition.

HAMILTON: Sachs says there's really no excuse for diagnostic sloppiness. The tools to accurately diagnose bipolar disorder have been around for 30 years.

Jon Hamilton, NPR News.

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