Borderline?

August 5, 2009 at 1:16 pm

According to last year’s study from Rhode Island Hospital and Brown University, more than half of those diagnosed with bipolar disorder were misdiagnosed. These findings were the result of a comparative review of previous diagnoses with a more involved interviewing process. 

…Researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool — the Structured Clinical Interview for DSM-IV (SCID).

   Keeping in mind that the average amount of time it takes most doctors to spit out a mental health diagnosis is 18 minutes, one might wonder why such an involved process isn’t the norm for diagnosing people and attaching such a substantial label to them. Perhaps as a result of such studies, doctors will invest more time into their patients and more thoroughly address the best approach to their well being but I won’t be holding my breath.

   The point of this recent article, however, is to address the follow-up study as to the “true” diagnosis of the participants. As it turns out, they were more likely to suffer not from the over-diagnosed bipolar disorder but the vague borderline personality disorder among other things.

“In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder.”

The results of the study also indicate that patients…were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders. 

Aside from what I see as the cursory nature with which people are interviewed and the general rush to pathologize the human condition, the researcher’s assertion is that doctors’ diagnoses are geared more toward quickly bringing about the desired end result.

Zimmerman and colleagues note that “We hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive.” 

    That is what psychiatry has evolved to. It’s not about identifying problems and their causes, biological or otherwise, but identifying and suppressing behaviors. We should not be allowing them to attach to someone a life changing label and stigma then prescribing potent drugs based on a short talk in a rushed facility. That said, it seems unreasonable to think one would be able to find the supposed biological root of a mental “illness” in an interview of any length or intensity.

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