Many with Bipolar Disorder are originally misdiagnosed and suffer for years

S. Nassir Ghaemi, MD

How often are people misdiagnosed and why?

About 40% of people with bipolar disorder are misdiagnosed with unipolar (major) depression. This excludes people who just have depression before they show any manic symptoms.

There are many issues around misdiagnosis. First, patients may only experience depression for years before having any manic episodes. Second, clinicians often just don't know about manic symptoms or don't ask about them. Third, patients often don't describe the manic symptoms. They have what is called a 'lack of insight.'

What is lack of insight?

Lack of insight means a lack of awareness of your illness, that there is something wrong with you. Some bipolar patients and many patients with schizophrenia have a lack of insight. 50% of bipolar patients have lack of insight and do not realize they are ill. For example, bipolar patients may just think they are a high-energy person.

Half of bipolar patients do not describe their manic symptoms, because they do not realize they are abnormal. These patients will deny their symptoms. On top of that, when patients are depressed when they come in, they may have a hard time remembering their manic symptoms in the past.

How do you diagnose patients if half of them have a lack of insight?

Clinicians need to talk not only to patients, but also to their family members. Half of bipolar patients appear to be extremely informed when I talk to them. But, when I pick up the phone and talk to a spouse, parent, sibling, or a good friend who has known the patient for a while and ask about the manic symptoms, in five to ten minutes I can find that the patient has manic symptoms, but doesn't realize it. I need the patient's permission to talk to their families.

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Reviewed: 04/2006