More False Bipolar Diagnoses?

Bipolar disorder may have more false diagnoses as a result of changes to the criteria

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) The current guidelines to detect bipolar disorder are admittedly flawed.  The newly proposed criterion lessens the threshold for diagnoses and may do more harm than good for the patient says psychiatrist.

A review of the long-term studies on bipolar diagnosis looked at issues related to finding the bipolar in patients who had other disorders (false positives) and not-finding the bipolar in people who, in fact, did have it (false negatives).

The researcher concluded that false positives were more risky, so he is speaking out against the new guidelines.  He explains that under-diagnosing the illness is, by far, safer than over-diagnosing it, considering the risk of medications.

"Always report mood or behavior changes to your doctor."

Mark Zimmerman, MD, psychiatrist and researcher at Rhode Island Hospital, through extensive analysis, has determined that the new criterion for diagnosing bipolar disorder is more likely to harm patients rather than help them. 

In his analysis, he looked at various issues including finding the disorder in depressed patients, over-diagnosis of the disorder and missing the diagnosis completely when it exists in a patient.

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) provides a common language and standard criteria for the classification of mental disorders.

The new edition in progress, Fifth Edition (DSM-5), is considering a broadening of the criteria for diagnosing bipolar disorder. 

While Dr. Zimmerman recognizes errors in the currently used DSM-IV, he does not believe the proposed changes will do anything to address the errors and may actually be damaging to patients instead.

Dr. Zimmerman warns that some of the unintended consequences may include inappropriate treatment due to misdiagnosis and medication abuse. 

He believes that the changes to the criteria may only enhance the errors that already exist in the definitions and that lowering the threshold will ultimately blur the lines between bipolar and non-bipolar. 

The medications commonly used to treat the bipolar disorder can also cause serious medical side effects. Giving the medication to a patient who has been falsely diagnosed could be dangerous without having any benefit.  

Dr. Zimmerman’s commentary was published in the April 2012 issue of the Journal of Clinical Psychiatry.

Reviewed by: 
Review Date: 
May 3, 2012
Last Updated:
May 5, 2012