In recent years, bipolar disorder diagnoses have become more common, particularly in adolescents and young adults. While the National Institute of Mental Health has been hesitant to attribute the rise to any one factor, they do point out that we can interpret the rise in a number of potential ways. Specifically, NIMH states that the increase in diagnoses may not actually indicate a rise in prevalence or incidence, epidemiological terms that refer to the number of people who suffer from bipolar disorder now and the number of new cases that occur annually.
What is Bipolar Disorder?
Bipolar disorder is a mood disorder that involves mood cycling between hypomanic episodes, which are characterized by abnormally elevated mood and energy levels, and depressive episodes, which are characterized by intense sadness, anxiety and apathy. It is important to differentiate bipolar disorder from major depressive disorder, as a bipolar patient will commonly experience depressive episodes more often than hypomanic episodes, which may result in an incorrect diagnosis. During a hypomanic episode, people with bipolar disorder may engage in impulsive or dangerous behaviors that can become self-destructive in a number of ways, financially, socially, or physically.
Increased Awareness of Mental Health Problems
It may be possible that the rise in new diagnoses of bipolar disorder is a result of better mental health education, particularly in young people, when compared to data from previous years. People who are able to recognize their behavior and mental states as abnormal for themselves are able to seek out treatment and describe their symptoms more accurately. Outreach organizations such as the National Alliance on Mental Illness focus on providing advocacy and awareness to the community, which also makes it more socially acceptable for many people suffering from mood disorders and other mental health disorders to seek out mental health services. Young people and adolescents who identify with underrepresented racial and social groups may also utilize mental health services more often, a study published in the Journal of Adolescent Health suggests. As such, there may not be an actual rise in the incidence of new bipolar disorder cases. It is possible that more cases are being diagnosed because of better resources being available to at-risk populations.
Epidemiology: Prevalence or Incidence?
When interpreting data on new diagnoses, it is important to distinguish between prevalence and incidence. The prevalence of bipolar disorder refers to the number of current cases of bipolar disorder, while the incidence of the disorder refers to the number of new cases that occur. Depending on the disorder, this data can be used to indicate the continuing trends of a disorder. It can also measure morbidity, or diagnoses that occur concurrently, and mortality, or the number of deaths occurring from a diagnosis. Bipolar disorder has seen rising incidence, which shows that more patients are being diagnosed with new cases of bipolar disorder. It also sees rising prevalence, which means that the overall mortality rate of bipolar disorder is relatively low with treatment.
The Possible Reasons for Misdiagnosis
While undoubtedly many of these cases are legitimate, a column by John M. Grohol, Psy D., points out that the epidemiological data showing the rise in diagnoses comes from healthcare surveys given by the National Center for Health Statistics over a weeklong period. As such, all of the diagnoses counted in the original study that appeared in Archives of General Psychiatry were diagnoses by family doctors and general practitioner operating out of private health practices and clinics, not by mental health professionals. Dr. Grohol suggests that because these doctors were operating out of their specialty in this case, not all of the diagnoses may have been accurate. The average mental health practitioner spends more time engaged in skillful questioning and examination to obtain the most accurate diagnosis possible. General practitioners, on the other hand, may offer the closest diagnosis they can recognize because it is easier both for the practitioner and for the patient than obtaining a referral to the right professional. As such, any discrepancy that may exist in these diagnoses may not necessarily be the product of ignorance on the doctor’s part, but rather a shorter path to treatment, even if the treatment may not be exactly right. Unfortunately, mood stabilizers do not necessarily provide the right results for every patient, and it may take several different psychoactive drug regimens or combinations of drug therapy with other intensive therapies to provide effective relief from mania. Mental health professionals may have better expertise regarding the highly individual process of treating bipolar disorder.