Many patients with borderline personality disorder or other forms of moodiness are wrongly diagnosed as having bipolar disorder. On the other hand, it is simultaneously true that many patients with bipolar disorder (especially bipolar II disorder) continue to be misdiagnosed as having a depressive disorder. Because the treatment of depression and of bipolar disorder is very different, this rampant misdiagnosis is a tragedy.

Many patients have been diagnosed with bipolar disorder for the first time who had not been previously diagnosed as such, even those who were seeing a psychiatrist. And this is not the so called “Bipolar spectrum” — but  DSM-5 bipolar II disorder. Those should NOT be missed.

In a 2000 survey of 600 patients with bipolar disorder (Hirschfeld et al., 2003), the following key findings emerged:

• 69% of patients had been misdiagnosed, most frequently as having unipolar depression.
• Those who who had been misdiagnosed had consulted an average of four physicians prior to receiving the correct diagnosis.
• Over one third of patients had waited ten years or more before receiving an accurate diagnosis.
• One reason for misdiagnosis was underreporting of manic symptoms. However, more than half of these patients said that they thought that their physicians’ lack of understanding of bipolar disorder was a reason why the correct diagnosis was not made earlier.

It requires some skill to correctly interview the person and his/her family to identify bipolar disorder. Sometimes it takes a LOT of skill.  Asking things like, “Have you ever felt on top of the world?” “Have you ever felt that you didn’t need to sleep or that you were full of energy?” and so on will identify only a fraction of the cases. For years I have been teaching medical students, residents, and fellows about how to methodically interview patients to identify bipolar disorder. A lot more attention needs to be paid to this issue. Patient’s lives are harmed significantly when clinicians fail to identify bipolar disorder.