The Overreaching Net of the Bipolar Disorder Diagnosis

Bipolar disorder: A troubling misunderstanding outside the therapy office

Bipolar disorder is one of those therapy diagnoses that has made it from the world of psychotherapy into pop culture to such an extent that it is now a slang term. You might hear someone say, outside of a therapy office, “oh, he’s so bipolar” to describe someone who is moody or changes his or her mind very suddenly. This, of course, is a gross misuse for the term. The swings in emotional state for someone with bipolar disorder are extreme and go far beyond "moodiness". The moods also change over a period of weeks or months, not a period of hours. To be considered a manic or depressive “episode”, the person needs to have experienced these symptoms for at least a week but usually the episode typically lasts longer and can have a great impact on the person’s ability to live his or her life as they usually do.

To have misinformation circulating the public about bipolar disorder is unfortunate but not entirely surprising. People with mental health issues and disorders are often painted in the public eye in clumsy and oversimplified ways and can be characterized as erratic or even dangerous. Yet the most upsetting misinformation seems to be in the psychiatric community itself, especially when it comes to bipolar disorder. Roughly 1 in 4 new patients that I see in our NYC therapy practice has been told at some point that he or she has bipolar disorder. For the vast majority of them, that has been a misdiagnosis that has greatly missed the mark.

Bipolar disorder Therapy: What’s In a Name?

Getting a diagnosis of any kind can have a great impact on how we view ourselves and our futures. Many of my patients who have gotten an incorrect diagnosis have described feeling like something was “wrong” with them and as if their futures might have limitations. And to have an incorrect diagnosis of Bipolar Disorder carries a great deal of weight: Bipolar disorder is chronic and usually starts the late teen’s and early 20’s. People with bipolar disorder typically have to take some pretty heavy-duty medication that can come with some bad side effects. Symptoms can be so difficult to manage, even with a great treatment plan and good supports. Both depressive and manic episodes are painful, disruptive, and can impact people’s performance at work and relationships.

The Cause of Bipolar Mood Swings: A Gray Area

So why is there so much misdiagnosis when it comes to bipolar disorder? Well, first off, the most identifiable symptom, “mood swings”, is very vague and can mean so many things to so many people. Mood swings are typical of the human experience and can be exacerbated during times of stress. Typically, any mental health symptoms become diagnosable when they begin to negatively impact your day-to-day life. So when mood swings become more frequent or become something that interferes with relationships and other everyday stuff, it is definitely time to address them. The root cause of mood swings can vary so greatly and can be impacted by your sleep patterns, your hormones, your stress level, just to name a few. More severe mood swings can have significantly deeper roots in attachment, safety, and past trauma.

Bipolar Disorder vs. PTSD

Trauma is characterized by an event or events that are a threat to our physical or emotional safety. Post Traumatic Stress Disorder are the after effects of this trauma and can manifest itself in many troubling ways, including flashbacks, and nightmares. It can also be triggered by things that remind you of the event, which can vary from the concrete, such as a smell that takes you back to the trauma, or other more subtle things, such as a facial expression or another nuance of a social interaction. When triggered, people with PTSD get the message from their bodies that they are back in the trauma and they are in danger once again.

People who have grown up in abusive and/or chaotic households are exposed to repetitive trauma and instability that can affect them greatly through out their lives. Although they may not have very obvious PTSD symptoms, such as flashbacks, they may experience more subtle triggers of have a broader feeling of unsafety in the world. These more subtle symptoms can present as mood swings or sudden changes in behavior and affect. Close relationships in particular can be emotional landmines for people who have had an unsafe experience with parents or caregivers during the most formative years. The psychiatric field seems to be misinterpreting shifts in mood as bipolar disorder, rather than the visceral reactions of someone whose past (or current) trauma is being triggered.

So What To Do?

This issue is just one of the myriad reasons that we here at Tribeca Therapy use a non-diagnostic approach. Presenting symptoms have complex roots and I think it unwise for us as mental health providers to believe that we know what is going on in such concrete terms. Because of pressure from insurance companies and other perceived and real time limitations, mental health providers often come up with a diagnosis on day one of meeting a new patient, often after a mere hour of interaction. Diagnoses, assumptions, or labels of any kind should be given with great care and should never be rushed. Believing that we “know” limits our ability to be curious and to get to know someone. This is a major barrier to treatment and to connecting with the person sitting across from you on a human level.