An article in Psychology Today, published on April 29, 2010, examined the claim of bipolar overdiagnosis.


Allen Frances, M.D., said, "The ratio of bipolar diagnoses at least doubled since the introduction of Bipolar II in DSM IV and the extraordinary drug marketing campaign promoting antipsychotics and mood stabilizers. This has undoubtedly helped some people and harmed some others- the exact extent of each is unknown and perhaps unknowable. But my bet is that this is a fad that has overshot- they always do. I would assume that anyone now presenting with anything suggesting equivocal bipolar disorder is much more likely to be overdiagnosed and overtreated than to be missed."

Actually this matter has been studied, and the last statement has been proven false.  In that study[1] the data of which was reanalyzed in the British Medical Journal, 30% (27/90) of patients with unequivocal Structured Clinical Interview for DSM-IV (SCID) diagnosed bipolar disorder had never been previously diagnosed with bipolar disorder by clinicians in the community.This data directly contradicts the last quoted sentence stated above.

To continue with that study:  Evidence for overdiagnosis of bipolar disorder indicated a lower frequency than underdiagnosis.  

This article stated that bipolar disorder had been mistakenly diagnosed in the community in 13% (82/610) of people in whom the gold standard Structured Clinical Interview for DSM-IV (SCID) determined that they did not have bipolar disorder.

This is why we can conclude that, as a matter of relative risks, bipolar disorder is more than twice more frequently underdiagnosed in those who have it than overdiagnosed in those who do not have it (30% > 13%).  

The absolute frequency of bipolar disorder is low, however, so, ignoring the denominator, more people were misdiagnosed who did not have it, than those who had it.  

This still does not entail generalized "overdiagnosis" if by that phrase we mean that almost all people who have the diagnosis are diagnosed with it, and many who do not have the diagnosis are diagnosed with it. This is not the case with bipolar disorder.

Obviously, science does not entail absolute knowledge, but to the extent available, scientific considerations should grow from valid scientific evidence.


[1] J Clin Psychiatry. 2009 Jan;70(1):143; author reply 144.