Misdiagnosis

MDI has so many different presentations that a high rate of missed diagnosis and wrong diagnosis is not surprising. Several factors account for the high rate of misdiagnosis in MDI. These include:
 Hypomania is difficult to diagnose clinically.
 Patients are not reliable historians regarding manic/hypomanic symptoms.
 Short-term follow-up precludes observation of manic/hypomanic phases.
 Strict criteria make the diagnosis of hypomania difficult.
 Clinicians’ bias towards diagnosing depression and anxiety disorders.
 The stigma associated with MDI.

The routine use of research criteria has deprived a majority of people with MDI of proper diagnosis and treatment. For example, a survey conducted by the National Alliance for the Mentally Ill (NAMI) in 1992 reports that 48% of the patients with BPD received a correct diagnosis only after being evaluated by more than 3 psychiatrists over 5-10 years after symptoms’ onset. (Lish)

A new survey repeated recently using the same methodology in 2000 revealed that the average delay between symptoms’ onset and treatment is still more than 10 years, 69% were misdiagnosed, mostly (3/4) by psychiatrists, and the average number of doctors seen was 4.4.

As BPD is a subset of MDI, current statistics represent only the tip of the iceberg of the effects of MDI in the general population.

The age at onset of symptoms, the clinical presentation and the presence of comorbid conditions lead to different types of diagnostic errors.
Some diagnostic errors occur in patients of any age depending on the clinical presentation. Common misdiagnoses are:
 Schizophrenia when psychotic symptoms are present.
 Depression and Dysthymia when depressive symptoms dominate the clinical picture.
 Anxiety Disorders when panic, obsessive-compulsive, social phobias or generalized anxiety symptoms are prominent.
 Alcohol or Substance abuse when self-medicating behavior is most evident.
 Borderline, Narcissistic or Dependent Personality Disorder when symptoms affect mostly interpersonal relationships.
 Gambling, Shoplifting and other Impulse-dyscontrol symptoms are common in a subgroup of patients with MDI.

Other diagnostic errors are somewhat more age specific:
• Attention Deficit Disorder, Oppositional Defiant Disorder, Conduct Disorder and Separation Anxiety in children and young adolescents.
These children are over-represented in most psychiatric clinics and often receive antidepressants and stimulants without protection from the possible precipitation of manic or mixed states.

• Substance Abuse, Antisocial Personality Disorder, Borderline Personality Disorder, Eating Disorders, Intermittent Explosive Disorders in older adolescents and young adults.
Many adolescents fail school, have chaotic social, work and family life, often incur in serious debt or are the victim of impulsiveness. Many commit criminal acts either to support their substance abuse or to pay debt or due to poor judgement and impulsiveness.