In my years as a psychotherapist, one of the most over and misdiagnosed things I have observed is bipolar disorder. In fact, I believe the majority of clients I have seen with a bipolar diagnosis do not have bipolar disorder.
Now there is legitimate bipolar disorder, and I know it when I see it. My first job in the mental health field was at a psychiatric hospital working with severe mental illness. When you see something in its most extreme form, it is more apparent. Having experience working with client’s with severe levels of bipolar disorder allows you to observe lower level traits others would miss.
The Cause of Overdiagnosis
What I have discovered as the chief cause of this overdiagnosis is a large percentage of clinicians are untrained in the nuances of trauma, and they mistake the manifestations of trauma for bipolar disorder. The result is the client’s trauma goes untreated. And in almost every case, they are also placed on antipsychotic medications to control their presenting symptoms.
In either case, the underlying trauma remains unresolved. If you have an incorrect diagnosis, you will have an ineffective treatment. I have had client’s come to me on seven or eight psychiatric medications that are causing a host of side-effects. Some of these clients are given medications to manage the side-effects of the other medications they are taking. I hope this gives you an idea of how dysfunctional the mental health field can be.
The Danger of Drugs
Some of the drugs recommended for bipolar disorder can decrease a person’s trauma symptoms, while others will escalate them. A client may have been put on antipsychotic medications for years. A percentage of clients can develop long-term or permanent side effects from these drugs.
Furthermore, these individuals are typically given no information about the potential side-effects of the medications or how they can cross interact with each other in a negative manner. Moreover, these drugs can cause damage to the liver and other organs. Clients are left to their own to educate themselves and figure all this out.
Even in cases where an individual has valid bipolar disorder, it is never as simple as a chemical imbalance. Having genetic markers alone is not sufficient to trigger the disorder. There are environmental factors, such as trauma or other types of stressors required to activate the symptoms of the disorder.
Complexity of Bipolar Disorder
In addition, each individual’s expression of bipolar disorder is unique to them. There is not a standard set of symptoms people with bipolar disorder exhibit. Even with those who have bipolar disorder it can be difficult to diagnosis when there are such a plethora of symptom profiles.
If you are now wondering if you or a loved one may not have bipolar disorder let me illustrate some of the reasons I believe bipolar disorder is so misdiagnosed. As I mentioned earlier, the primary cause of mis and overdiagnosis is confusion of bipolar symptoms with those of complex trauma.
Two Types of Trauma
Let me begin by differentiating between single incident trauma and complex trauma. An example of a single incident trauma would be an assault of some sort, an automobile accident, or experiencing a natural disaster. As the definition states, it is a one-time event. Even if you encountered multiple one time events, they were not chronic or recurrent.
From a therapeutic perspective, these types of traumas are much easier to resolve than complex trauma. This is not to diminish in any way the pain and suffering they cause. If untreated, they can change the trajectory of an individual’s life. However, they are fully resolvable, and they do not have to negatively impact your future.
The second type of trauma is defined as complex trauma. There are two defining characteristics of these types of trauma: they were chronic and recurrent; and they occurred during one’s developmental years (birth through adolescence). They have a much bigger effect on the brain as a result of taking place during development and being prolonged. Furthermore, they are often perpetrated by someone who was supposed to be a safe person for the child, such as a parent or family member.
When someone close is the abuser, this leaves a deep, relational wound. This manner of trauma and abuse affects a person in five main areas: they have difficulty regulating their emotions in a functional way; somatic symptoms, such as trauma-based asthma, irritable bowel symptoms, migraines, fibromyalgia, neuropathy, and low immunity; dissociative symptoms, which I will explain in more detail in a minute; deep-seated feelings of shame and worthlessness; and relationship difficulties.
Dissociation and Trauma
The main reason complex trauma is misdiagnosed as bipolar disorder is due to dissociation. Whenever we experience overwhelming emotions in the face of aloneness or helplessness, the brain will initiate a level of neurological dissociation. Think of this process being like a circuit breaker. Emotions are chemical, electrical energy that moves through the nervous system carrying information.
When this energy comes through dysregulated, it can damage cells in the brain and nervous system. Whenever we cannot reach for safety or fight or flee, our last line of defense is a freeze state, which in humans we call dissociation. This process has survival advantages when we cannot take action or to do so would place us at greater risk.
Physical and Psychological Threat
Think of a person being sexually assaulted and threatened physically if they do not comply. They go into a submissive state and dissociate from their body and the present situation to survive. Even if there is not physical danger, emotional dysregulation is deemed by the brain as a survival threat to one’s psychological self. Dissociating helps us endure and survive the present situation.
The brain splits off what we cannot handle and places it into its own memory network in our implicit memory system. This type of memory is stored as a felt sense in the body. These memories have no sense of time and cannot differentiate people, time, or place. Anything that is even remotely associated with the original incident, such as time of day, smell, sound, etc., will activate the body memory in the present.
Dissociative Parts Confused for Bipolar Disorder
Particularly, during complex trauma that is recurrent, there are numerous dissociative emotional memories and parts of self that are frozen in time. You could have an event from five, twelve, and sixteen held in implicit memory. When these memories are activated, they could be expressed as panic, rage, numbness, erratic behaviors, or various addictions. On the surface, they can make a person appear to be experiencing bipolar disorder due to the emotional swings they can initiate.
If a treating clinician cannot distinguish the nuances of complex trauma, they often misdiagnose the client as having bipolar disorder. As mentioned earlier, the majority of clients I have worked with who were diagnosed with bipolar disorder actually were suffering from complex PTSD. To further compound the confusion, individuals who have bipolar disorder manifest their symptoms in a multiplicity of ways: severe depressive symptoms with little mania; mania or hypomania with few depressive symptoms; racing thoughts with attention deficits with moderate depressive symptoms, etc.
How to Distinguish
Furthermore, a person can have bipolar disorder and complex trauma. Confused yet? Don’t lose hope. There are ways to distinguish between bipolar disorder and complex trauma. The first step is to take a history for trauma and bipolar disorder. There are definitive markers for each. One of the main things I would emphasize for clients and therapists is just because you have erratic behaviors, angry outbursts, addictive behaviors, or severe depressive symptoms does not mean you have bipolar disorder.
All of these symptoms can be generated by trauma. Additionally, bipolar disorder does seem to have genetic markers and should exhibit some family history. However, genetic vulnerabilities are not sufficient to manifest the disorder. In my experience, there is always some type of stressor that will interact to trigger the initial symptoms, such as death of a loved one, trauma, social or relational stress, first time substance use, etc.
The chief way to get clarity is to process your trauma history. In my experience, as my client’s resolve these incidents their symptoms tend to go away. This gives us certainty they were suffering from complex trauma and not bipolar disorder. If there are any remaining bipolar type symptoms, we know there may be a legitimate bipolar issue.
Lack of Training
I have worked with thousands of clients at this point in my career and can attest to the bipolar diagnoses being markedly overused. Again, the main reason is the deficiency of understanding of complex trauma by clinicians. In defense of other clinicians, advanced trauma trainings are very expensive and require a long-term commitment of a therapist’s time to become proficient at them. Moreover, the mental health system can often be chaotic and staff is frequently overworked and untrained. Nonetheless, we can do much better as a mental health community.
If you suspect you may have been misdiagnosed as having bipolar disorder, please contact me anytime to schedule an evaluation. In addition, if you are a clinician who would like to learn more about complex trauma and how to differentiate it from bipolar disorder, please reach out as well.