Duration of untreated bipolar disorder

Bipolar disorder can be difficult to diagnose. Hallmark symptoms of moodiness and irritability are common to many other conditions and it is rare for the disorder to present in an immediately obvious manner.

Occasionally, an individual with bipolar disorder will present with psychotic symptoms or mania early in their illness, when this happens, an accurate diagnosis can happen quickly, but otherwise the process often takes years.

Researchers in France recently studied more than 400 individuals with bipolar disorder to determine how long it took for them to accurately be diagnosed and properly treated.

Results of this study showed it generally takes almost 10 years from the start of symptoms to the initiation of appropriate treatment of bipolar disorder.

In this group of patients, the mean age for symptoms to begin was 25.3 while the mean age for psychiatric treatment of any kind was 28.6. Appropriate treatment took much longer with the mean age being 34.9 years.

Children with bipolar disorder are often not recognized and, indeed, some people still believe, incorrectly, that children cannot be bipolar. They can present as attention deficit, oppositional, depressed or anxious. Adults can present as depressed, anxious or irritable. They are often diagnosed as having Borderline Personality Disorder.

Bipolar disorder is difficult to diagnose and also difficult to treat. When it is undiagnosed for many years, individuals suffer many adverse consequences such as substance abuse problems, legal problems, marital failure, educational and vocational failures.

By the time treatment begins, most patients and those around them will have come up with other explanations for all of these problems. These other explanations are often not very flattering and may lead to poor self-esteem, hopelessness and frustration.

A diagnosis, as serious as it is, may be accompanied by a sense of relief in finally having an explanation for a myriad of problems that previously seemed unrelated. A chaotic life comes into perspective and there is now at least hope for solutions.

It may also be a relief for loved ones who have been coping with (and sometimes blamed for) difficult, irrational behaviour for years without an understanding of what is happening.

I wish I could tell you a simple strategy to shorten the duration of this undiagnosed and untreated period. There is no simple way. The diagnosis requires skill and interest. If one doesn't ask the right questions the diagnosis will not be made except in the most extreme cases.

I do believe the chances for an accurate and timely diagnosis are improved for those who see a psychiatrist. As trained specialists in mental illness, psychiatrists have the most experience with this group of patients. Nevertheless, it is not uncommon even for psychiatrists to miss this diagnosis or to make the wrong diagnosis. The two most common wrong diagnoses will be unipolar depression and Borderline Personality Disorder.

Wrong diagnoses do more than delay appropriate treatment. Incorrect treatment can make things worse. For example, treatment for depression or attention deficit disorder can induce mania or a mixed state if mistakenly given to someone with bipolar disorder.

Counseling is always recommended for everything and there is no doubt that most people feel better having someone who will listen and be supportive. This, however, can be mistaken for effective treatment and they may spend years exploring issues that are not really as important as they believe. This is both time consuming and expensive. Counseling can also cause harm when it is misdirected.

Keep an open mind, read, ask lots of questions, seek other opinions and hopefully you will get appropriate diagnosis and treatment early.


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