Misdiagnosed as bipolar disorder

Misdiagnosis as bipolar disorder may be related to factors such as symptom similarity, lack of doctor experience, vague patient statements, comorbidity interference, and differences in diagnostic criteria. Bipolar disorder is often misjudged due to intense emotional fluctuations, but similar symptoms may also occur in anxiety disorders, depression, personality disorders, thyroid dysfunction, medication side effects, etc.

1. Symptom Similarity

The core feature of bipolar disorder is the alternating occurrence of high mood and depression, but many other mental disorders can also manifest as emotional instability. For example, patients with borderline personality disorder often have strong emotional fluctuations and are easily mistaken for manic episodes. Emotional outbursts in patients with post-traumatic stress disorder may also be misunderstood as bipolar symptoms. Clinical diagnosis should be comprehensively judged based on the duration of the disease, triggering factors, and degree of social dysfunction.

2. Inexperienced doctors

Non psychiatrists or less experienced physicians may overly rely on symptom scales and neglect longitudinal observation. Some doctors directly diagnose normal emotional fluctuations in adolescents as bipolar disorder, or misjudge manic episodes caused by antidepressants as a manifestation of the disease itself. Referring to a specialized psychiatric hospital and improving the collection of medical history can effectively reduce the probability of misdiagnosis.

3. Vague patient statements

Patients may conceal key information due to cognitive biases or shame, such as exaggerating depressive periods and downplaying manic symptoms. Cultural differences can also affect symptom description, and patients in certain regions tend to express emotional issues through somatic symptoms. Using standardized interview tools and collaborating with family members to provide supplementary information can help improve diagnostic accuracy.

4. Comorbidity interference

About half of bipolar disorder patients have comorbid anxiety or substance abuse, and these comorbid symptoms may mask core features. Physical diseases such as hyperthyroidism and epilepsy can also lead to manic like symptoms. Improving physiological examinations such as thyroid function testing and electroencephalography are necessary steps for differential diagnosis.

5. Differences in diagnostic criteria

There are differences in the definition of subtypes of bipolar disorder among different diagnostic systems. Some cases diagnosed with bipolar disorder by DSM-5 may be classified as other emotional disorders in ICD-11. The use of a multi axis evaluation system in clinical practice, combined with objective indicators such as functional imaging, can reduce diagnostic bias. If there is suspicion of misdiagnosis, it is recommended to keep complete medical records and seek a psychiatric review diagnosis from a tertiary hospital. Daily emotional change logs can be recorded, including objective indicators such as sleep duration and social activity intensity. Avoid self-adjusting medication, as certain antipsychotic drugs may worsen symptoms in non bipolar patients. Adding deep-sea fish rich in omega-3 fatty acids to the diet and engaging in regular aerobic exercise can help improve various emotional problems. In terms of social support, one can join a psychological education group to understand the characteristics of the disease and self-management skills.