Bipolar: The Challenges of Diagnosis and Treatment

Bipolar affects people of many ages and demographics, and it is a very difficult condition both to diagnose and to treat. Over the past year, various reports have supported this: some indicate that bipolar is over-diagnosed (by as many as half the diagnoses delivered), while others suggest that it’s under-diagnosed (with patients receiving an incorrect “borderline personality disorder” diagnosis instead).

The University of Cincinnati’s Caleb Adler, MD, who works as a UC Health psychiatrist and associate professor at the University’s psychiatry and behavioral neuroscience department, recently spoke with for a feature on the multiple symptoms that can point to bipolar. Symptoms can include deep depression, strong mania, or a both. Because these symptoms run the gamut of high and low, it’s easy for bipolar to look like something else if the person is only evaluated in their current frame of mind. Depressive moods that last for a long period of time may be diagnosed as depression or anxiety, and frenetic moods may simply appear to just be high energy or creativity.

But in reality, these extremes can be far more debilitating, and that’s when the problem becomes profound enough that bipolar may be an appropriate diagnosis. Adler gives the example of someone who, in a manic episode, stays up all night studying, but retains none of the information because their brain jumps from one idea to another the whole night. Manic episodes can be either negative (the person may become extremely irritable or even aggressive) or positive (such as over-indulging in otherwise pleasurable things, like impulsive shopping or traveling). “In the end, it comes down to behavior [that’s] out of proportion to the circumstances,” he explains. Genetics and family history can also play a role in reaching a secure diagnosis. Treatment is equally complex, and while medication is often considered necessary, it’s far more effective when paired with appropriate therapy, which differs from individual to individual.

© Copyright 2010 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Lance T.

    Lance T.

    July 5th, 2010 at 7:23 AM

    I have experienced this first hand.I generally do not study in early mornings but tend to stay up late.This often leads me into patchw situations wherein I study all night long but do not retain much of it.

  • larry c

    larry c

    July 5th, 2010 at 10:23 AM

    I cannot even imagine the challenges that must go along with being diagnosed with having bipolar disorder. I know that in my own pretty sane life there are those difficult times when I feel I am swinging from one end of the spectrum to the other so to have that happening to you for real must feel like the most horrible ride you have ever been on! I know that sometimes too this is a disorder that is overlooked and hard to diagnose, with the one who needs the most convincing that there really is something bad going on is the one who is suffering from it. I look forward to more progress being made in the treatment of bipolar as this could help so mnay lives return to normal once again.

  • Cathy


    July 5th, 2010 at 3:31 PM

    It is very sad that even after science and the medical field has gone so far ahead,we still have trouble in diagnosing certain disorders.If diagnosis takes a long time,it leads to the treatment being delivered late,thereby reducing the chances of total cure.This in turn affects the rate of survival or perfect survival in victims.

  • triple rainbow

    triple rainbow

    July 6th, 2010 at 2:33 AM

    over-dependence on conventional medication types and pharmaceuticals are the main cause of problems in over-diagnosis and under-diagnosis.if a person is only suspected of having bipolarity,he/she cannot be treated for it because of the uncertainty.but therapy can be started because even if he/she is not affected,there is no harm or side-effect,as is the case with pharmaceuticals!

  • Cara


    July 6th, 2010 at 4:28 AM

    Seems like this would be one the most difficult of the mental illnesses for anyone to live with. How crazy you must feel all of the time! I know that there have been some advances made in the past but it still seems like it would even be a struggle to get someone to take the necessary medications daily. You know, you get to feeling better and regulated and then you conveniently forget to keep your medications in your daily routine. I would think that this is something that families living with bipolar disorder would face on a regular basis.

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