Thursday, January 27, 2011

59% of Therapists Missed Bipolar Diagnosis

This week I read an article at About.com that reported the disturbing results of a study published in the Journal of Affective Disorders. They found that only 41% of psychotherapists correctly identified bipolar disorder even when symptoms of hypomania were present. (Purse, 2011)

That leaves over half of those living with bipolar disorder undiagnosed. That’s frightening considering that those incorrectly diagnosed are at a greater risk for the wrong medication and therapy. If a person with undiagnosed bipolar disorder is given an antidepressant only, mania can be induced with catastrophic results.

It’s no wonder that it takes up to 10 years or more for some to get a proper diagnosis. But what always bewilders me is that when parents read books about bipolar children, they see with clarity that their child fits this diagnosis. When parents share stories with those diagnosed with bipolar, their stories are identical, but when a parent goes to a therapist, all we hear is, “we just don’t know”.

Why is that? Seriously, why does it seem so crystal clear in books and support forums, but within the room of a therapist, it becomes so foggy. Are the books too matter of fact, not taking into consideration the children that aren’t bipolar but look it? Are the parents seeing the same symptoms, yet there are two illnesses that mimic one another? Is there a “bipolar copycat” illness that exists and isn’t yet defined?

Or, because children’s brains are still developing, it is possible for a child to outgrow bipolar illness? For example, if a 22 year old develops the illness as a young adult, their brain is too developed to outgrow it, thus making it a life long illness. But for some children that develop the illness while still young, their brain has the ability to “outgrow” the illness, or have a less severe disorder as an adult? Could this explain why it appears that there are more children with bipolar illness than there are adults living with it?

Or are therapists missing what’s obvious to us? Do they think parents make these symptoms up, so they are skeptical? I know our previous doctor was skeptical, she said “statistically your son does not have bipolar disorder because only 1% of the population have it”. My obvious response was that maybe he’s the 1%. But beyond that, could this statistic be making doctors hesitant to diagnosis bipolar symptoms as being a bipolar illness? In reality, is that statistic much higher?

I don’t have the answers obviously, but what are your thoughts?

* * *

You can read the full article below:
http://bipolar.about.com/b/2011/01/03/in-study-59-of-psychotherapists-missed-bipolar-diagnosis.htm?r=et

References:
About.com
In Study, 59% of Psychotherapists Missed Bipolar Diagnosis
By Marcia Purse

January 3, 2011
Consulted: January 27, 2011

9 comments:

  1. Our society has a bias against major psychiatric disorders and a lot of clinicians are reluctant to stick a label on a child that will last for life. Just my experience.

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  2. I still can't believe that your previous doctor said he doesn't BP disease because only 1% of the population has it. Only 1% of the general population has congenital heart disease. We do 40-50 ultrasounds a day on this 1% of the general population. I couldn't imagine a doctor ignoring a heart murmur because only 1% of the population has CHD. I believe GB's mom's comment. What you need is more awareness.
    Love ya,
    Sis

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  3. I was one that was reluctant to 'label' or have my daughter labeled for life. I was reluctant to have her medicated for mental illness. Somehow epilepsy was more acceptable an illness for me to deal with, and thought if I could just parent her better it would work out ok. I did that for years. BIG MISTAKE! Not only was it a disservice to my daughter and her quality of life, it was unnecessary pain for the whole family. Once I had her labeled, medicated and in treatment she has never looked back. She has a fantastic quality of life now, very happily married but follows her treatment plan to a T, always acutely aware that Bipolar is a life long illness. I look back now and wonder why i was so stupid. As a society we have to be less afraid of this. I always knew she had bipolar but was afraid of the consequences to her life if she was labeled, not really regarding fully the consequences to her for not. She is not ashamed or afraid of her epileptic/bipolar label. I am staring down the barrel of a second child with both illness and when I brought it up with the neuro he dismissed the bipolar. i will wait and watch for a short while but i will not make the same mistakes again.

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  4. Donna-Wow! What a powerful testimony, thank you so much for sharing your story. I’ve always wondered if they did a study on outcomes to determine if it was better to label the child with a bipolar illness or to wait until they are much older. It would be very interesting to see the differences in these two paths.

    As for my family, we don't have an official diagnosis, just a lot of head nods that it could be bipolar, but they just don't know for sure since he’s so young. However, they’re still treating him like he had the official bipolar diagnosis with both meds and therapy.

    It’s funny that society has such a stigma with the diagnosis. If you think about it, those with the diagnosis are most likely getting appropriate treatment and therefore a productive member of society. If anything, a diagnosis should been seen as a positive thing.

    Sis- It sure is an eye opener to see how many people you see a day in the 1% of the population for heart disease. Autism also affects about 1% of the population, but it doesn't seem so rare. Autism also doesn't have a blood test for screening, yet it seems more acceptable in society.

    Babysitting an autistic child myself, I have recognized the schools easy acceptance of the disorder, I’ve also had many parents in my small town share that their child is autistic. I think it all comes down to fear. People are afraid of people with mental illness, in the case of autism, people aren't afraid, but if you mention bipolar, it brings on a layer of fear.

    Which is a shame because most violent crimes are committed by people who DO NOT have a mental illness. I just think the public believes it to be much more because these type of criminal cases tend to be high profile.

    People shoot people every day, but when someone does it with a mental illness it becomes national news. Just yesterday a baby was shot when a man started shooting at the family while they were in their car, did this become national news, nope, it was just another act of gang violence.

    The truth is that those who aren’t receiving treatment for a mental illness are more likely to cause harm to themselves than to anyone else.

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  5. Our family has been a victim of this very same thing. At first we were advised that most pdocs don't like for you to tell them what you think your child has. They just want to know what symptoms your child is exhibiting and then they like to make the diagnosis. We tried that with the first pdoc we took my daughter to. Big mistake. It was not only a waste of her time, our time, and our money, but it ultimately led us to try to "parent her better" which resulted in many more months of frustration on her part. We had decided if it was all our fault for not being good parents then we would just be hard nosed about parenting her. If a place was overwhelming, well suck it up kid. This is life. Everyone else in the family is compliant, you have to be too.
    When we finally got up the courage to see a different pdoc, I went in with a completely different attitude. I was up front in what I thought my daughter was suffering from. We had read a book called "If Your Child is Bipolar" and I had highlighted everything in there that was my daughter (which was most of the book). I had a 3 page word document that I had printed out with a list of things that we had seen and experienced. I took pictures that my daughter had drawn of what she thought was going on in her brain. I gave the pdoc the book and said, "THIS IS OUR LIFE!" By the end of the visit, she had confirmed that there was something not right, it was not our parenting style. It took 3 more visits before she would give the diagnosis, but at least she was on board with us. She actually saw my daughter cycling on the 3rd visit which was what confirmed for her and for us that it is bipolar disorder.
    My advice to any parent out there who thinks that their child has a mental illness is not to take "no" for an answer. Keep searching until you find someone who will listen to you. You may not get the diagnosis that you think you will get, but don't settle for someone telling you that it is all your bad parenting. Yes, we are all bad parents at one point or another. But that is not the end of the story. Our kids deserve an answer as to why their brains work differently than other kids brains. Believe me, there is comfort in knowing why and being able to verbalize it to themselves.

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  6. Kelly- Thank you so much for sharing, you are so right about not taking "no" for an answer. I believe parents know in their gut when something is wrong. And for many parents, we have other children that are living under the exact parenting methods without any problems.

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  7. Thank you soooo much for writing this MB, and thank you to all of you who responded with so much intensity. I frequently wonder about the relevance of questioning early onset too. If the children are displaying such obvious symptoms that are effecting so many aspect of their lives and are quite obviously suffering (as well as those who are struggling to raise them) then why should there even be a question of validity? I think if is insane to deny a diagnosis simply because it is rare. WHY is the stigma of mental illness such a detrimental thing?! If the illness is identified, treated, and managed then it is a wonderful thing. If the illness is not identified or denied, not treated and left to run rampant then it is tragic can be devastating to more than just that individual. So what is the problem with diagnosing children I ask you!?

    I wholeheartedly believe that we should not take no for an answer when we are looking for people to help us. It just makes us crazy. We too are going through the trials with our beloved pediatrician. We really do love him but we are now finding it clear that he is NOT on board with any mood disorder diagnosis and is strongly recommending serious corporal punishment (he just doesn't get it). He feels they need to be sad, cry, show remorse for their behavior, and experience OUR control over their lives. Yeah, umm, he just doesn't get it! I am ready to find a new pediatrician :(. Recently, he made my husband feel like such a poor parent that Dh came home and drastically changed his interactions with our son, he started screaming at him, threatening him that every time he said "NO or talked back" to my husband he was going to get hit, he's since refused to listen to any discussions from our son when he tells him something and is immediately irate. This week, he scared our son so badly with his mistreatment that the poor little guy wet himself :( THIS HAS TO STOP! I am holding my husband accountable and demanding that he think about our son and the reality of the situation, that no matter what the pdoc said he was not a bad parent, but now he is abusing our son because of his own insecurities and fears. Well too bad! What may work for others do not work with these kiddos!

    I am demanding that he educate himself about bipolar and to go back to learning other parenting techniques! To be sure, the best parenting in the world is not going to "fix" these kiddos, but can improve the situation. They need to be held consistent to their medications, sleep routines, dietary intake, daily schedule, respectful responsiveness from us, and support for their safety when they are struggling with extreme feelings. I believe THAT is the best we can do in a nutshell!

    I pray that my husband will soon get on board with some measure of understanding for mental illness that is at play here with our children. As of yet, he -like other many people today- does not believe there should be any diagnosis, "they are only kids". Therefore, he doesn't believe there should have to be any medication given either. What irks me the most about this is that he verbalizes his opinions in front of the kids or with the kids which sews seeds of defiance with medication compliance for later. I'm sure it doesn't help their self esteem either.

    I'm sorry for rambling here. I am so glad to have found others out there struggling with these same issues. I have two children with mood disorders, most likely bipolar for both. MY father is schizophrenic and two of my maternal aunts are bipolar. I think the deck was stacked! :(

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  8. Mel- Your post just breaks my heart. I can't imagine the position you’re in with the doctor not believing it’s a mood disorder and placing the blame on the parenting, bringing out your husband's reaction. This is a perfect example why early diagnosis is important. If people don’t recognize that an illness is the source of the child’s behavior, only more damage will occur.

    I hope you can change doctors asap! We’re on our 3rd set of doctors and finally have recognition from them that this may be bipolar disorder. It doesn't matter so much what they write in his file, as long as they’re treating the symptoms and supporting us in how to manage this illness.

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  9. Absolutely! As long as they are treating the symptoms and helping to help us in a way that helps... I have half q mind right now to write a letter to the pediatrician regarding the age old physicians oath, something about helping people in a way that does more help that harm...
    Anyway, it is wacky because my husb. just had this argument with me about his opinion that you can always find someone to support your opinion and do what you want them to do, for any matter of things, but that doesn't make any of them right. In his opinion, I believe the kids have this problem so I'm just going to go ahead and find some doctor who agrees with me and continue to pump medicine into them so they don't have to try and behave. He feels they use the meds as a crutch and as an excuse so when they don't have their meds yet, they can say they can't control themselves. He just feels like they need to gain self control and grow up. He makes me so mad when he is like this!!!!! It is selfish, ignorant, closed minded, and irresponsible! Aaaaaahhhh!

    Please read the blog entry I wrote today, and l linked back to you, after reading this this am:
    http://www.lifestwistedstitches.com/2011/02/letter-to-my-future-teen-mama-kats-link.html

    Mel~

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