What’s Your Diagnosis?
In my last blog post, “Am I a Fraud?“, I discussed imposter syndrome and whether I am bipolar at all. My former psychiatric mental health nurse practitioner considered me so stable that she said I did not need to come back for another appointment for six months unless, of course, I felt there was a need to see her sooner. She prescribed my medication with enough refills to get me through the 180 days. Even though I ended up getting pregnant with my first child after this appointment, was working towards my Master’s degree, and working night shift at my job all at the same time, I still felt no need to come into my provider’s office before the six-month mark. In fact, I canceled my six-month follow-up appointment.
Now, here I sit at five weeks pospartum. I have undergone and overcome significant challenges both physical and mental. If I had any doubt of my bipolar diagnosis before, that doubt has now been removed. However, the sort of confirmation that I have experienced is not the case for a lot of people with mental health struggles. There are a number of people getting through life everyday who are either undiagnosed or misdiagnosed. A misdiagnosis is an incorrect diagnosis; it can even be the lack of a diagnosis for someone who actually does have some sort of mental health disorder. One reason for this diagnostic dilemma is symptom or presentation complexity. For some people, an accurate diagnosis can take years. For me, it took ten months to get an accurate diagnosis. Fortunately for me though, my initial diagnosis and my current diagnosis present so similarly that the “label” didn’t matter. The treatment was essentially the same for both diagnoses.
Bipolar disorder is one of the most commonly misdiagnosed mental health disorders. Bipolar disorder, which, simply put, is characterized by extreme shifts between mania and depression, can be easily missed because individuals are more likely to seek professional help for depression than for mania – especially hypomania. When one is hypomanic, that person feels more energized than usual and has an inflated self-esteem. Who would seek out a therapist, psychiatrist, or other mental health professional for feeling good about themselves? Someone experiencing depression or even alternating periods of depression and elation might benefit from keeping a symptom journal or from finding some other way to track his/her moods. I review two mood-tracking apps in a former blog post. Be honest with yourself and with your mental health provider about how you are feeling and what you are experiencing.
Another reason for misdiagnosing bipolar disorder is that bipolar symptoms overlap with other mental health conditions like ADHD, depression, and schizoaffective disorder. My own mental health diagnoses have somewhat evolved over time as well. For example, a couple of weeks after the birth of my child, I was diagnosed with postpartum depression. I disagree. Was I pospartum? Yes. Was I sad? Yes. However, the reason for my sadness was not related to either pregnancy or childbirth. What I experienced towards the end of my pregnancy and just after giving birth was a complicated mess. A number of factors contributed to my emotional state. I had been in and out of the hospital multiple times prior to the diagnosis of postpartum depression. These hospitalizations kept me away from my newborn and my family during important occasions in my life, including my first wedding anniversary and my child’s first Christmas. Besides that, I have a history of bipolar disorder. This is, in part, why I am a proponent of a model of care called continutiy of care. Additionally, having the right mental health professionals – particularly specialists – on your team can increase your chances of receiving an accurate diagnosis the first time.
Someone without an accurate diagnosis will likely not receive appropriate and effective treatment when he/she needs it. This can have a cascading effect in that the affected individual may experience emotional distress because his/her symptoms are remaining the same or worsening instead of getting better. Accurate diagnoses are so important because symptoms become more difficult to manage as time goes on without any intervention. That being said, what works for one person with bipolar disorder may not work for another person with bipolar disorder. For this reason, some may argue that the diagnosis or label doesn’t matter. I think that it’s at least a good start.
Signed,
Lai (Bipolar I)
