{"id":108626,"date":"2024-09-30T07:10:49","date_gmt":"2024-09-30T00:10:49","guid":{"rendered":"https:\/\/hotvideos24.online\/?p=108626"},"modified":"2024-09-30T07:10:49","modified_gmt":"2024-09-30T00:10:49","slug":"how-the-label-can-steer-some-patients-wrong","status":"publish","type":"post","link":"https:\/\/hotvideos24.online\/?p=108626","title":{"rendered":"How the label can steer some patients wrong."},"content":{"rendered":"<p> <script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-3711241968723425\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-format=\"fluid\"\r\n     data-ad-layout-key=\"-fb+5w+4e-db+86\"\r\n     data-ad-client=\"ca-pub-3711241968723425\"\r\n     data-ad-slot=\"7910942971\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script><br \/>\n<\/p>\n<div itemprop=\"mainEntityOfPage\">\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"45\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9isxf000yt5konrwqbnj1@published\">By age 11, Kassondra Ola had been prescribed the following psychiatric medications at one point or another: Zoloft, Concerta, Celexa, Lexapro, risperidone, Neurontin, Depakote, Seroquel, lithium, Topamax, Trileptal, Abilify, and Adderall. It\u2019s a mix of antidepressants, antipsychotics, a stimulant, and a few things for seizures.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"80\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbe8001f3b6z7n8zrp1f@published\">Growing up in northern Virginia, Ola was a skinny and anxious preteen. She got good grades, but she was withdrawn and easily distracted. She ate little; the textures of some foods did not seem right. Internally, she was processing the rift between her parents that would eventually lead to their divorce, as well as the aftermath of a childhood trauma. Her parents got her into mental health treatment, and when she was 10, a psychiatrist diagnosed her with bipolar disorder.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"53\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbgw001h3b6zoal4k19g@published\">The meds he prescribed made her sleepy and caused tremors and body pains. They brought on a mental haze, and the frustration of struggling against it led to more moodiness and outbursts, Ola recalls. She once yelled at a teacher that she was in so much pain she didn\u2019t want to live anymore.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"50\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbka001j3b6zewtmanos@published\">\u201cThe medications seemed to induce more behavioral problems than they helped,\u201d said Ola. \u201cI was always in trouble for something, and they were always adjusting the meds or sticking me in the psychiatric unit for something.\u201d She felt as if she had little self-esteem or even a sense of identity.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"58\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbms001k3b6zgcchnkee@published\">By age 20, Ola was living with her grandmother and muddling through community college classes. At church, she met someone who was diagnosed with Asperger\u2019s syndrome, a condition that today would be considered <a href=\"https:\/\/www.psychologytoday.com\/us\/basics\/aspergers-syndrome\">autism spectrum disorder<\/a>. He noted that, like him, she had trouble socializing and experienced sensory aversions. They even had the same slow, precise speech pattern.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"27\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbq8001l3b6zmzomcmkn@published\">After a neuropsychological test, Ola was diagnosed with Asperger\u2019s too. Her signs of maladjustment as a preteen? Maybe they were how a neuroatypical kid dealt with stress.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"62\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbss001m3b6zi5fvhoel@published\">By the time Ola was categorized bipolar in the early 2000s, the diagnosis was taking off. <a href=\"https:\/\/www.nih.gov\/news-events\/nih-research-matters\/bipolar-disorder-diagnoses-increasing-youth\">One study<\/a> found that from 1994 to 2003, bipolar diagnoses doubled for American adults. Cases of pediatric bipolar, <a href=\"https:\/\/www.cambridge.org\/core\/journals\/acta-neuropsychiatrica\/article\/paediatric-bipolar-disorder-and-its-controversy\/A37A4D621BBD9CF7AD526EC5729A975D\">a controversial concept<\/a>, went from anomalies to an estimated count of <a href=\"https:\/\/www.npr.org\/2010\/02\/10\/123544191\/children-labeled-bipolar-may-get-a-new-diagnosis\">1\u00a0million by 2010<\/a>. The swell of people labeled bipolar, <a href=\"https:\/\/psychiatryonline.org\/doi\/10.1176\/appi.ajp.2020.19091000\">according to recent research<\/a>, appears to be continuing.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"61\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbvg001n3b6zvj29mptp@published\">Today there are about <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4005415\/\">3.3\u00a0million Americans<\/a> with a bipolar disorder diagnosis. Many experts think that this figure is an undercount of the true number of people living with the condition. As with any disorder, some diagnosable people are never seen by a clinician. And many patients who wind up with the label of bipolar disorder are initially <a href=\"https:\/\/www.nature.com\/articles\/s41398-021-01760-6\">misdiagnosed with unipolar depression<\/a>.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"102\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xbxi001o3b6zwnj2ertl@published\">But some psychiatrists think that the bipolar diagnosis has actually gone too far\u2014that there is a large contingent of patients who have been slapped with a trendy label, the definition of <em>bipolar<\/em> having drifted far beyond its original meaning. Research indicates that false positives for bipolar disorder <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3856145\/\">may be alarmingly common<\/a>. In a landmark study <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18466044\/\">published in the Journal of Clinical Psychiatry in 2008<\/a>, more than half of bipolar patients who were reevaluated were determined to have been misdiagnosed. It\u2019s possible that misdiagnosis and underdiagnosis are widespread issues\u2014but the field continues to be divided on whether misdiagnosis is an issue at all.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"58\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xc0h001p3b6zo1p1tvpu@published\">Perhaps no topic in 21<sup>st<\/sup>-century adolescent psychiatry has <a href=\"https:\/\/psycnet.apa.org\/record\/2007-14442-001\">been more controversial<\/a> than pediatric bipolar, a diagnosis that can be <a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/14669-bipolar-disorder-in-children\">applied to kids<\/a> as young as 5 who have severe problems with emotional control. Critics say the label pathologizes normal but challenging parts of growing up. Proponents say it\u2019s a needed intervention for kids not helped by other means.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"59\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xc43001q3b6zla7nlyh2@published\">No matter their age, when a patient receives the diagnosis of bipolar disorder, they are usually routed toward prescription drugs and can be blocked off from other diagnoses\u2014and therefore other avenues of treatment. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19646366\/\">Borderline personality disorder<\/a>, <a href=\"https:\/\/www.medicalnewstoday.com\/articles\/bipolar-and-autism#misdiagnosis-and-diagnosis\">neurodivergence<\/a>, and <a href=\"https:\/\/link.springer.com\/article\/10.1007\/s11920-015-0604-y\">ADHD<\/a> can all be misdiagnosed as bipolar but have vastly different treatment regimens. The first two are often treated without meds.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"63\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xc6g001r3b6zzqe32ox9@published\">Misdiagnosed patients like Ola often look back on years of worsening symptoms and missed opportunities\u2014a life that would have been different, better, if only doctors hadn\u2019t misunderstood something so fundamental about them. \u201cWhat misdiagnosis has done is it\u2019s delayed the diagnosis of important things,\u201d Ola said, \u201cdelayed the grieving of important things.\u201d Further, she said, \u201cit\u2019s allowed for underlying conditions to get worse.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"23\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xc9m001s3b6z8gp8ksqt@published\">Bipolar disorder entered the American Psychiatric Association\u2019s <em>Diagnostic and Statistical Manual of Mental Disorders<\/em> in 1980, replacing the depression <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5039514\/\">subtype of manic depression<\/a>.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"50\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xccj001t3b6zyuf657aa@published\">It was defined as a cycle of extremes; patients experienced recurring episodes of depression symptoms, then separate intervals of mania, which could include \u201chyperactivity, pressure of speech, flight of ideas, inflated self-esteem, decreased need for sleep, distractibility, and excessive involvement in activities that have a high potential for painful consequences.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"79\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xceu001u3b6zeh6d6aiz@published\">A manic episode was \u201cintrusive, domineering, and demanding,\u201d according to the <em>DSM-III<\/em>. A patient might drive, spend, or fornicate recklessly. They might dole out candy, money, or advice to strangers. They might take on a \u201cdisorganized, flamboyant, or bizarre quality, for example, dressing in colorful or strange garments, wearing excessive, poorly applied make-up.\u201d This kind of spectacle and the bouts of depression\u2014involving symptoms like hopelessness, lethargy, and loss of interest in life\u2014were the two distinct \u201cpoles\u201d of the illness.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"95\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xchb001v3b6z8n09tv9f@published\">Over time, the criteria for bipolar loosened\u2014a lot. In 1994 the <em>DSM-IV<\/em> introduced <a href=\"https:\/\/journalbipolardisorders.springeropen.com\/articles\/10.1186\/s40345-019-0175-7\">a controversial twist<\/a> on the original bipolar label. Bipolar\u00a0II lowered the threshold for diagnosis from mania to hypomania, a boost in mood but a milder one. The checklist for a hypomanic episode included some of the tamer symptoms of a true manic episode, like decreased sleep, greater sociability, and a zeal for new activities. But, the <em>DSM-IV<\/em> stated, \u201csuch activities are usually organized, are not bizarre, and do not result in the level of impairment that is characteristic of a Manic Episode.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"57\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xcja001w3b6zw3j46pl1@published\">On a surface level, the person might seem the opposite of mentally ill, as if they are simply seizing the day, the <em>DSM-IV<\/em> acknowledged. \u201cAlthough the person\u2019s mood may have an infectious quality for the uninvolved observer,\u201d it noted, \u201cit is recognized as a distinct change from the usual self by those who know the person well.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"23\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xclk001x3b6zi0gj9r6d@published\">The lowering of the threshold for a bipolar diagnosis didn\u2019t stop there. Clinicians were soon talking about a \u201c<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3361834\/\">bipolar spectrum<\/a>\u201d and \u201csubclinical bipolar.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"56\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xco2001y3b6zlf9lv63v@published\">\u201cThat\u2019s sort of the idea, that there\u2019s this invisible, less severe form of bipolar [even] less severe than bipolar\u00a0II,\u201d said Paul Doyen, a clinical social worker in New Orleans who <a href=\"https:\/\/journals.library.columbia.edu\/index.php\/cswr\/article\/view\/7388\/4228\">has written about<\/a> what he sees as overdiagnosis. That assertion led to estimates of the prevalence of the disorder, Doyen argues, \u201cthat were really pretty wild.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"44\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xcs3001z3b6z0fpu1r7d@published\">Mania (and, later, hypomania) was once a key criterion for the disorder, says Fernando Goes, the director of the Mood Disorders Clinic at Johns Hopkins University. But along the way, psychiatrists stopped requiring that patients experience such an episode to warrant a bipolar diagnosis.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"59\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xcvn00203b6z3niw9sm2@published\">\u201cMania is a relatively rare event in the life course of somebody with clearly established bipolar disorder,\u201d he said. What if a patient will, at some point, have a manic episode but hasn\u2019t <em>yet<\/em>? Rather than keep an eye on such patients, doctors might instead diagnose them with bipolar disorder based on other symptoms\u2014ones that aren\u2019t unique to bipolar.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"70\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xd0100213b6z9ceb7pls@published\">The bipolar spectrum became a big bucket for cases of emotional dysregulation that did not neatly fit any other category. <a href=\"https:\/\/www.webmd.com\/bipolar-disorder\/bipolar-spectrum-categories\">Under some definitions<\/a>, the bipolar spectrum has been stretched further to gobble up entire other conditions, like substance use disorder and bulimia. In 2003 one researcher claimed that <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/14504992\/\">25\u00a0percent<\/a> of the population might fall on the bipolar spectrum. And for any kind of bipolar-ish condition, drugs are the primary intention.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"42\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xd0300223b6z82uzuh0v@published\">Some clinicians found the \u201cspectrum\u201d idea a useful way to talk about all mood disorders that also included highs, mixed with periods of calm. But <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19499419\/\">others saw it<\/a> as a drift toward a quick, easy, and bendable label that rendered diagnosis meaningless.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"104\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xd2i00233b6z6vlak86p@published\">As the concept stretched, and as the range of patients considered suitable for a bipolar diagnosis expanded, more and more people got one, according to research that tried to track rates of psychiatric disorder diagnoses. <a href=\"https:\/\/ajp.psychiatryonline.org\/doi\/10.1176\/appi.ajp.2020.19091000\">One study<\/a>, from 2020, used surveys from ambulance visits. The frequency of calls about people with bipolar doubled from 1997 to 2016. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34664344\/\">Another used data<\/a> from hospital psychiatric units. An adult was 45\u00a0percent more likely to leave one with a bipolar diagnosis in 2010 than in 1996. For adolescents (ages 14 to 18), the increase was 123\u00a0percent. For children (ages 5 to 13), the uptick was even steeper: 326\u00a0percent.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"41\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xd8300243b6zua0ga150@published\">American psychiatry\u2019s perception of the frequency of bipolar disorder has not extended to similar regions. U.S. estimates of its bipolar population, at around 3\u00a0percent, <a href=\"https:\/\/library.neura.edu.au\/wp-content\/uploads\/sites\/3\/2019\/04\/Factsheet_spatial-variation-4.pdf\">are higher than<\/a> those of Australia, where the estimate is around 2.1\u00a0percent, and Europe, where it\u2019s 1.7\u00a0percent.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"26\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdby00253b6zfc1mnkt2@published\">Doyen, the New Orleans social worker, said he first noticed slapdash bipolar labeling when he volunteered at the city\u2019s St.\u00a0Thomas House of Hospitality, a temporary shelter.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"37\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdea00263b6zqrhi5q5u@published\">\u201cI kept meeting all of these people that had either experienced homelessness or were in danger of experiencing homelessness and had all these various severe needs,\u201d he said. \u201cI saw a lot of them had bipolar diagnoses.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"47\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdgl00273b6zcnx09bqf@published\">Mental illness does <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7282102\/\">increase the odds<\/a> someone will end up homeless. But it didn\u2019t seem as if severe bipolar was pushing his clients into the streets. Few had experienced manic episodes, few were in treatment for bipolar, and, said Doyen, \u201cthey didn\u2019t necessarily identify with being bipolar.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"44\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdje00283b6zo61mvrnt@published\">Doyen found that most had been diagnosed during a crisis situation that put them\u2014briefly\u2014in front of a doctor. He reasons that a bipolar label might have been \u201cthe easiest application\u201d to get them released with a diagnosis and therefore eligible for Supplemental Security Income.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"15\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdlc00293b6z2wwvg51o@published\">\u201cWhat I do know is that a lot of the diagnoses are wrong,\u201d he said.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"67\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdnp002a3b6zb2t2au9m@published\">In the 2000s, as this sea change was underway, Mark Zimmerman was the director of outpatient psychiatry at Rhode Island Hospital, in Providence. When he saw patients who had been diagnosed with bipolar, he looked at their medical histories for examinations from the diagnosing clinician describing episodic highs and lows. They often weren\u2019t there. \u201cWe couldn\u2019t find evidence of why they were diagnosed with bipolar,\u201d he said.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"37\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdq8002b3b6z4mm23t94@published\">Zimmerman is a stickler for by-the-books diagnostic techniques. <a\/><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27253697\/\">As a resident<\/a>, he said, he took longer than his colleagues with initial interviews with patients, and in my talk with him, he rarely deviated from precise, clinical language.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"72\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdsg002c3b6zgfq70cwt@published\">It was during that time that Zimmerman, who was also affiliated with Brown University, set up the landmark 2008 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18466044\/\">Journal of Clinical Psychiatry study<\/a>. He and a team interviewed 700 psychiatric patients, 145 of whom said they had been diagnosed with bipolar disorder. But when tested using the lengthy <em>DSM<\/em> questionnaire, only 43.4\u00a0percent met the standard for it. No other study has ever tried to systemically determine the rate of bipolar misdiagnosis.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"40\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdud002d3b6ze3hy4y2s@published\">The results were convincing to Zimmerman, though: bipolar is frequently misdiagnosed. He thinks a few factors were\u2014and continue to be\u2014at play. Clinicians don\u2019t put enough time into the diagnosis. As awareness of bipolar grew, patients self-diagnosed, leading clinicians to agree.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"42\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdxn002e3b6z4yknw1ba@published\">And there\u2019s Big Pharma. A litany of mood stabilizers, antidepressants, and antipsychotics are prescribed for bipolar disorder, usually rotated around until a regimen fits well enough. Not coincidentally, Zimmerman said, pharmaceutical companies <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2386635\/\">have impressed on<\/a> prescribers the idea that bipolar is underdiagnosed.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"63\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xdzv002f3b6ziqgcuwqj@published\">More than that, consider the adage that a man with a hammer sees every problem as a nail. Clinicians whose main tool is the prescription pad\u2014like psychiatrists or nurse practitioners\u2014are prone \u201cto make a diagnosis where you can prescribe a pill,\u201d said Zimmerman. \u201cIf you\u2019re practicing mental health treatment from a psychopharmacologic perspective, under the FDA, there\u2019s no pill for borderline personality disorder.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"55\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xe2j002g3b6zkuodcyv0@published\">For some conditions mistaken for bipolar, psychiatric drugs are not the go-to. People on the autism spectrum make <a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/6436-asperger-syndrome\">highly individualized changes<\/a> to their lives to function at work and in social settings. The first line of treatment for borderline personality disorder is dialectical behavioral therapy, a talk therapy centered on examining and countering negative emotions.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"20\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xe4w002h3b6zx1uktykc@published\">There is particular risk that signs of borderline personality disorder will be lost in the rush toward a bipolar diagnosis.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"67\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xe77002i3b6zo0gu800p@published\">Like bipolar, borderline can involve seemingly sudden bursts of extreme behavior, but there is one key difference: Relationships are the trigger. People with borderline personality disorder have a pattern of intense, unstable relationships, often stemming from a fear of abandonment. Interpersonal friction can cause an emotional whirlwind of fear, anger, and depression. With an estimated prevalence of <a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/personality-disorders\">1.5\u00a0percent of the population<\/a>, borderline personality disorder is not rare.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"62\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xe9z002j3b6z4cr43bj8@published\">Marie-Paule de Valdivia, a Connecticut-based licensed clinical social worker who specializes in borderline personality disorder, explains the difference between that disorder and bipolar like this: Imagine the patient alone on an island. \u201cIf they have bipolar, they still have hypomanic episodes, manic episodes, depressive episodes,\u201d she said. \u201cIf they have borderline, if they\u2019re alone on a deserted island, the borderline symptoms disappear.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"62\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xec4002k3b6zt2sa60ev@published\">In group seminars, de Valdivia asks participants to raise their hands if they have been diagnosed as bipolar. \u201cDay in, day out, two-thirds of the room raised them,\u201d she said. It is possible to be diagnosed with both\u2014the best estimates are that <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3811087\/\">20\u00a0percent<\/a> of people with borderline are also bipolar, a portion far less than what de Valdivia sees among her patients.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"58\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xeep002l3b6zq1ue1hdm@published\">In a <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19646366\/\">follow-up study<\/a> to his 2008 look at misdiagnosis, Zimmerman and his collaborators looked for conditions that were masked by possible bipolar misdiagnoses. Patients with a bipolar diagnosis that didn\u2019t stand up to scrutiny were five times as likely as patients never dubbed bipolar to be rediagnosed with borderline personality disorder. That\u2019s more than any other condition.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"29\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xeh5002m3b6z0vh8gzne@published\">Lynette Nelson, a former casino blackjack manager in Minnesota, said that in her early 20s she was misdiagnosed with bipolar disorder, a label she \u201cwent with\u201d for nine years.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"49\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xekm002n3b6zy3bulri9@published\">\u201cI just figured, <em>Well, this doctor knows what they\u2019re talking about; I\u2019m bipolar<\/em>,\u201d she said, \u201c<em>and I guess it makes sense<\/em>, because I had been struggling with my mental health since I was about 15, and I had been on all sorts of different medications and nothing really worked.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"74\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xew6002o3b6zc4qp1mzg@published\">Nelson, now 40, admitted she \u201cwas very non-med-compliant, or therapy-compliant,\u201d back then. She didn\u2019t stick with that doctor\u2019s regimen of medication and group therapy. After an intense experience with postpartum depression, she left her job at the casino and was placed on total disability. She saw a nurse practitioner who doubted the bipolar diagnosis for a simple reason: Nelson had never had a manic episode. Instead, the NP gave her a borderline personality diagnosis.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"44\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xeyt002p3b6z5w7ccwkl@published\">After that, Nelson began dialectical behavioral therapy and credits it with a turnaround. \u201cMy close relationships, those have been repaired,\u201d she said. \u201cI have learned that it\u2019s OK to have emotions and feelings and everyone has them.\u201d She works on not exploding from feelings.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"67\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xf19002q3b6z1b97h9o0@published\">Ola, too, found that her new diagnosis helped her turn things around. After unburdening herself from the bipolar diagnosis she had received as a child, she got off psych meds. \u201cI was able to start understanding some of the emotional struggles I have and start understanding myself and accepting myself,\u201d she said. She has since earned an associate degree in science and is working toward a bachelor\u2019s.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"28\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xf3k002r3b6zl5mjp2hs@published\">She was also diagnosed with Ehlers-Danlos syndrome, a connective tissue disorder, which she thinks was overlooked when her body pains were categorized as a psychosomatic outgrowth of bipolar.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"47\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xf61002s3b6z7855fjv4@published\">You can see the appeal in a bipolar diagnosis, however counterproductive. For patients, it\u2019s easier to accept that something is wrong with their mood than with their personality, said Goes, from Johns Hopkins. Clinicians \u201cwill go towards the less stigmatizing diagnosis, which is bipolar disorder,\u201d he explained.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"48\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xf86002t3b6zh02xc0j2@published\">When a diagnosis becomes troublesome or confusing, the American Psychiatric Association has a remedy: revise its entry in the <em>DSM<\/em>. In 2022 the committee in charge of the <em>DSM<\/em> <a href=\"https:\/\/www.hmpgloballearningnetwork.com\/site\/pcn\/news\/significant-dsm-5-text-revisions-be-released-march-2022\">restored the diagnosis<\/a> of unspecified mood disorder for conditions that don\u2019t fully meet the standards of depression or bipolar.<\/p>\n<aside class=\"recirc-line\" data-via=\"recirc-line\" data-uri=\"slate.com\/_components\/recirc-line\/instances\/cm1l9isxf000zt5kod31m9l5x@published\">\n<p>    <a href=\"https:\/\/slate.com\/life\/2024\/09\/mental-health-teenagers-money-envy.html\" class=\"recirc-line__content\"><\/p>\n<div class=\"recirc-line__img\">\n          <img decoding=\"async\" src=\"https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=140\" width=\"141\" height=\"94\" srcset=\"https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=320 320w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=480 480w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=600 600w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=840 840w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=960 960w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=1280 1280w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=1440 1440w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=1600 1600w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=1920 1920w,&#10;https:\/\/compote.slate.com\/images\/b19730f1-c238-4a43-894a-e732f14fd810.jpeg?crop=1560%2C1040%2Cx0%2Cy0&amp;width=2200 2200w\" sizes=\"auto, 141px\" alt=\"\" loading=\"lazy\"\/>\n        <\/div>\n<p><h4 class=\"recirc-line__byline\">Emi Nietfeld<\/h4>\n<h3 class=\"recirc-line__promoline\">I Thought My Wealthy Roommate Had the Perfect Life. It Turns Out We Had the Same Tormentor.<\/h3>\n<p>        <b class=\"slate-link--bold recirc-line__read-more\">Read More<\/b>\n      <\/p>\n<p>    <\/a><br \/>\n<\/aside>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"76\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfdl002u3b6z7bityx0j@published\">Goes hopes that the next wholesale revision will offer some clarity about \u201cgray areas\u201d where bipolar symptoms overlap with those of other conditions. \u201cI don\u2019t think that\u2019s a panacea,\u201d he said. \u201cI don\u2019t think most clinicians follow the <em>DSM<\/em> very carefully. That may never have been the intention of <em>DSM<\/em>. It\u2019s a prototype to help provide clinical guidance, but it definitely helps you with the gray [areas], and more emphasis on the gray will be helpful.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"30\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfim002v3b6zi56bq8yr@published\">Of all the conditions that a sloppy bipolar diagnosis might conceal, the most concerning are social, according to Doyen, whose experience <a href=\"https:\/\/journals.library.columbia.edu\/index.php\/cswr\/article\/view\/7388\/4228\">inspired an article<\/a> in the Columbia Social Work Review.<\/p>\n<aside data-uri=\"slate.com\/_components\/in-article-recirc\/instances\/cm1l9isxf0010t5kogeq21mhq@published\" class=\"in-article-recirc\" data-via=\"article-inline_recirc-section-technology\">\n<ol class=\"in-article-recirc__list\">\n<li class=\"in-article-recirc__item\">\n          <a href=\"https:\/\/slate.com\/technology\/2024\/09\/meta-facebook-orion-smart-glasses.html\" class=\"in-article-recirc__link\"><\/p>\n<p>            I Simply Refuse to Accept What Mark Zuckerberg Has in Store for Us Now<br \/>\n          <\/a>\n        <\/li>\n<li class=\"in-article-recirc__item\">\n          <a href=\"https:\/\/slate.com\/technology\/2024\/09\/finale-music-notation-software-shutting-down-how-the-program-became-so-widely-used.html\" class=\"in-article-recirc__link\"><\/p>\n<p>            The Most Important Music App of the Digital Age Is Closing Down for Good<br \/>\n          <\/a>\n        <\/li>\n<li class=\"in-article-recirc__item\">\n          <a href=\"https:\/\/slate.com\/technology\/2024\/09\/silver-spring-rachel-carson-environment-chemicals-fear.html\" class=\"in-article-recirc__link\"><\/p>\n<p>            This Book Helped Save the Planet\u2014but Created a Very Harmful Myth<br \/>\n          <\/a>\n        <\/li>\n<li class=\"in-article-recirc__item\">\n          <a href=\"https:\/\/slate.com\/technology\/2024\/09\/trump-kamala-vaping-e-cigarettes-safer-tobacco-juul.html\" class=\"in-article-recirc__link\"><\/p>\n<p>            The Future of Safer Tobacco Use Is Here. Why Aren\u2019t Democrats On Board?<br \/>\n          <\/a>\n        <\/li>\n<\/ol>\n<\/aside>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"70\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfkm002w3b6zokmonp1u@published\">\u201cPerhaps the most insidious result of inflating BD diagnoses, and the one which may be of most concern to social workers, is the masking of oppressive social conditions,\u201d he writes. Poverty, crime, and racial discrimination are correlated with the emotionally disruptive symptoms that may get explained away with a convenient bipolar diagnosis. But, like almost all mental disorders, bipolar is partially <a href=\"https:\/\/www.nhs.uk\/mental-health\/conditions\/bipolar-disorder\/causes\/\">attributable to inborn factors<\/a>, like genetics and chemical imbalances.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"29\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfmk002x3b6z3coak79d@published\">\u201cAs a result,\u201d Doyen writes, \u201cthere are serious concerns that the rise in BD diagnoses, with their biological underpinnings, is concealing increasing social and environmental distress among marginalized Americans.\u201d<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"31\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfp6002y3b6z4o290p7z@published\">He told me: \u201cMy well-meaning colleagues may have accidentally stigmatized their clients or disguised their actual problems or contributed to the broader medicalization for this need for resources by applying diagnoses.<\/p>\n<p class=\"slate-paragraph slate-graf\" data-word-count=\"22\" data-uri=\"slate.com\/_components\/slate-paragraph\/instances\/cm1l9xfr6002z3b6ztzeepe44@published\">\u201cIt\u2019s a long way of saying: I don\u2019t think we have a good systematic sense of where these diagnoses are coming <span class=\"slate-paragraph--tombstone\">from.\u201d<\/span><\/p>\n<aside class=\"slate-kicker-promo\" id=\"kicker\" data-uri=\"slate.com\/_components\/slate-kicker-promo\/instances\/cm1l9isxf0011t5koo7zgje0v@published\"\/>\n<\/div>\n<p><script type=\"text\/javascript\">\n!function(f,b,e,v,n,t,s){\nif(f.fbq)return;n=f.fbq=function(){n.callMethod?\nn.callMethod.apply(n,arguments):n.queue.push(arguments)};if(!f._fbq)f._fbq=n;\nn.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0;\nt.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window,\ndocument,'script','https:\/\/connect.facebook.net\/en_US\/fbevents.js');\n<\/script><br \/>\n<br \/><script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-3711241968723425\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-format=\"fluid\"\r\n     data-ad-layout-key=\"-fb+5w+4e-db+86\"\r\n     data-ad-client=\"ca-pub-3711241968723425\"\r\n     data-ad-slot=\"7910942971\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script><br \/>\n<br \/><div data-type=\"_mgwidget\" data-widget-id=\"1660802\">\r\n<\/div>\r\n<script>(function(w,q){w[q]=w[q]||[];w[q].push([\"_mgc.load\"])})(window,\"_mgq\");\r\n<\/script>\r\n<br \/>\n<br \/><a href=\"https:\/\/slate.com\/technology\/2024\/09\/bipolar-disorder-misdiagnosis-overdiagnosis-treatment-pediatric-psychiatry.html\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By age 11, Kassondra Ola had been prescribed the following psychiatric medications at one point or another: Zoloft, Concerta, Celexa, Lexapro, risperidone, Neurontin, Depakote, Seroquel, lithium, Topamax, Trileptal, Abilify, and &hellip; <a href=\"https:\/\/hotvideos24.online\/?p=108626\" class=\"more-link\">Read More<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-108626","post","type-post","status-publish","format-standard","hentry","category-health","entry"],"_links":{"self":[{"href":"https:\/\/hotvideos24.online\/index.php?rest_route=\/wp\/v2\/posts\/108626","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hotvideos24.online\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hotvideos24.online\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hotvideos24.online\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/hotvideos24.online\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=108626"}],"version-history":[{"count":0,"href":"https:\/\/hotvideos24.online\/index.php?rest_route=\/wp\/v2\/posts\/108626\/revisions"}],"wp:attachment":[{"href":"https:\/\/hotvideos24.online\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=108626"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hotvideos24.online\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=108626"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hotvideos24.online\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=108626"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}