Is There an Overdiagnosis of Bipolar Disorder?

July 11, 2025

Authored by: Taylor Shaw, B.S.

Edited by: Anand Mehta, LMFT

Bipolar disorder diagnosis can be complicated, due to the mood swings that make up the manic-depressive disorder. Because the symptoms of Bipolar Disorder can also look like Borderline Personality Disorder, Major Depressive Disorder, ADHD, Schizophrenia, or other other mood disorders, some studies have argued that bipolar disorder is overdiagnosed. However, other studies have found that the disorder can be underdiagnosed, or misdiagnosed when compared to other psychiatric disorders. One study of outpatients found that not only is there a problem with underdiagnosis of bipolar disorder, but also an equal if not greater problem exists with overdiagnosis.¹

In cases of misdiagnosis, or misattribution of symptoms to another disorder, the consequences of misdiagnosis can result in ineffective treatment, which may even further worsen the outcome of the management of bipolar disorder.² Because bipolar disorder is a manic-depressive mental illness, the depressive symptoms may be the only ones a patient draws attention to when seeking help, and as a result, a psychopharmacology treatment may completely miss the manic mood episodes, only treating depression.

There are variables to be considered in all diagnostic criteria, whether it’s observation of clinical practice, diagnostic interviews, false positives, unreliable family history, or leading questionnaires. There are also variables of comorbidity that may lead to faulty psychiatric diagnoses. If you or a loved one are struggling, and you’re unsure of your mental health diagnosis, call and get started with our AMFM Mental Health Treatment, where these biases can be taken into consideration and treated on a comprehensive and holistic basis.

Overdiagnosis and Comorbidity

When community-based types of bipolar disorders–bipolar II disorder, bipolar disorders NOS (not otherwise specified) and cyclothymia were added to the DSM (Diagnostic and Statistical Manual of Mental Disorders)–there was also an increase in the prevalence of bipolar disorder (as tracked by involving an episode of hospitalization for mania from .1% to 5% of the population.³ Some studies have argued that the increase in prevalence came from advertisements for antipsychotic and mood stabilizer drugs that spread “awareness campaigns” surrounding Bipolar Disorder. However, there are also higher rates of prevalence of co-occurring disorders in cases of Bipolar Disorder. Previous diagnosis of bipolar disorder was also associated with significantly higher lifetime rates of major depressive disorder, PTSD, impulse control disorders, and eating disorders.⁴

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Bipolar Disorder Misdiagnosed as Major Depressive Disorder

Because Bipolar Disorder includes depressive episodes, it can often be confused for Major Depressive Disorder (MDD), even though MDD is still its own disorder. Several investigators noted that bipolarity might be underdiagnosed by the DSM-IV criteria as the diagnosis of bipolar II disorder (BP-II) requires the presence of a major depressive episode plus a hypomanic episode, and they also noted that some MDD cases might be better reclassified as bipolar.⁵ Research has shown that the most frequent lifetime diagnosis in patients previously diagnosed with bipolar disorder was major depressive disorder 82.9%.⁶

DSM-5 Criteria for Major Depressive Disorder

The DSM-5 is a clinical index that includes many mental health diagnoses. According to the DSM-5, an individual must be experiencing at least five of the following diagnostic criteria during the same two week period that are a change from previous functioning, and these symptoms may also occur when an individual with Bipolar Disorder is experiencing a depressive episode:⁷

Depressed mood
Loss of interest/pleasure
Weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue
Feeling worthless or excessive/inappropriate guilt
Decreased concentration
Thoughts of death/suicide

If you or a loved one are struggling with depression, whether it’s major depressive disorder or bipolar depression, don’t hesitate to call AMFM Mental Health Treatment for support today.

Bipolar Disorder vs. Borderline Personality Disorder

Bipolar Disorder and Borderline Personality Disorder (BPD) may look very similar at first glance, due to the impulsive and extreme mood shifts. They are very often misdiagnosed for one another, as mood swings, impulsive behavior, and suicidal thoughts can be characteristic of both BPD and Bipolar Disorder, causing even mental health professionals to sometimes be unable to note the key differences without extensive attention. In one study, the researchers found that the patients overdiagnosed with bipolar disorder were significantly more likely to be diagnosed with borderline personality disorder compared to patients who were not diagnosed with bipolar disorder.⁸

However, there are key differences between those diagnosed with BPD and Bipolar Disorder. For example, when a person who is diagnosed with Bipolar Disorder is not experiencing a depressive or manic episode, the individual is more likely to be able to maintain emotionally stable relationships. Additionally, because Bipolar Disorder is more biologically-based and more easily managed with medications like mood stabilizers, antidepressants or antipsychotic medications, a person with Bipolar Disorder will remain more emotionally stable between episodes, with more random and less frequent triggers.

Meanwhile, in a person with BPD, environmental factors can be more triggering, and these triggers come “from a combination of an emotionally charged temperament and the lack of a solid sense of self.”⁹ BPD is more psychologically centered, and a person triggered into an episode with BPD will engage in impulsive behavior, unstable self-image, emotionally high-risk interpersonal relationships, and mood instability. These mood episodes may look like overlapping symptoms at first glance, but the disorders are very much different, with a possibility of comorbidity.

Psychiatric Care for Bipolar Disorder

AMFM Mental Health Treatment provides comprehensive psychiatric care, along with traditional therapeutic modalities for ultradian cycling and ultra-rapid cycling bipolar disorder. Our on-staff clinicians are equipped to design personalized treatment plans for your continued success. In combination with psychotherapy, psychiatry is handled safely, to help you or your loved one overcome mental health challenges.

Lithium

For over half a century, Lithium has been used as a mood stabilizer to treat bipolar disorder, treating both the manic episodes as well as the bipolar depression.¹⁰ However, Lithium treatment can have side effects and complications in long-term use on the kidney and thyroid, and it’s important that an individual keep his or her clinical team in the loop on any side effects as they come up.

Antidepressants and Antipsychotics

Antidepressants and antipsychotics are both commonly used (alone and in tandem) in the treatment of Bipolar Disorder as mood stabilizers. However, rapid cycling is sometimes a side effect that is associated with antidepressant treatment in bipolar disorder.¹¹ Conventional antipsychotics have been proven to be effective for short-term treatment of Bipolar Disorder, but there has been little research on the long-term efficacy of antipsychotics and antidepressants for BD.

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Symptoms of Bipolar Disorder

Bipolar I Disorder is considered the most severe form of Bipolar Disorder, and is diagnosed when an individual enters a manic state, characterized by an intense mood episodes “up”, consisting of high-energy, uncomfortable irritability, racing thoughts and impulsivity. While Bipolar II Disorder is also characterized by manic episodes, they may be shorter or less severe, referred to as hypomania. A person struggling with Bipolar II will experience depressive episodes, while an individual struggling with Bipolar I may or may not experience depression.

Manic Episodes

In order to be diagnosed with Bipolar I Disorder, according to the diagnostic and statistical manual of mental disorders (DSM-5) an individual must experience at least one manic episode. Episodes of mania are generally characterized by mood changes, increased energy levels, rapid talking, increased grandiosity, (an overinflated sense of self), angst, distractibility (which may be misattributed or related to attention deficit hyperactivity disorder), engaging in impulsive or risky behavior, occasionally psychosis, and more.

Hypomanic Episodes

Hypomania refers to a shorter duration of manic symptoms, with generally milder symptoms. In order to be diagnosed with Bipolar II, an individual must experience at least one episode of hypomania, in addition to an episode of depression.

Depressive Episodes

In order to be diagnosed with Bipolar II, an individual must experience both a hypomanic and a depressive episode. Depressive episodes are characterized by low moods, low energy, suicidal thoughts, or other common symptoms of depression like loss of interest, low self-esteem, fatigue, or changes in appetite.

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Popular Forms of Therapeutic Treatment for Bipolar Disorder

Therapeutic Treatment for rapid cycling bipolar disorder is always recommended, whether in combination with psychiatric care, or separately from psychiatry. While small lifestyle changes like daily physical activity, regular exercise, and stepping outside into the sunlight when possible are helpful tactics, psychotherapy is highly regarded as the most effective method of mental health care for those struggling with mental disorders.

Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is a form of therapy that’s focused on restructuring and reprogramming maladaptive and negative thought processes. Psychologists are trained to help you change your cognitive and emotional processes in order to outgrow coping mechanisms that may no longer be serving you.¹²

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is most commonly referred to as “talk therapy,” and is designed to help process emotions and strive for emotional regulation, as well as mood regulation. Qualified professionals offer psychological therapy to move forward with healthy ways of engaging in interpersonal relationships and alleviating physical and emotional distress.

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

EMDR Therapy is a renowned method of reprocessing most often used in trauma therapy. By activating the prefrontal cortex through a series of bilateral stimulation, qualified professionals can lead you through traumatic experiences, helping you to alleviate the distress symptomized by trauma.¹³

Electroconvulsive Therapy (ECT)

ECT is a form of “Shock Therapy,” designed for brain stimulation, and only utilized in cases of severe depression. While ECT has historically gotten a bad reputation, when properly administered it can be a useful tool for those who cannot accept psychiatric assistance.

Transcranial Magnetic Stimulation (TMS)

TMS is a type of therapy that uses magnetic pulses to treat depression by stimulating certain areas of the brain. This is a noninvasive method of treatment that some mental health programs offer.

Citations

Zimmerman M, Ruggero CJ, Chelminski I, Young D. Is bipolar disorder overdiagnosed? J Clin Psychiatry. 2008 Jun;69(6):935-40. doi: 10.4088/jcp.v69n0608. PMID: 18466044. Healy, D. (2006). The latest mania: Selling bipolar disorder. PLoS Medicine, 3(4). https://doi.org/10.1371/journal.pmed.0030185 Singh T, Rajput M. Misdiagnosis of bipolar disorder. Psychiatry (Edgmont). 2006 Oct;3(10):57-63. PMID: 20877548; PMCID: PMC2945875. Healy, D. (2006). The latest mania: Selling bipolar disorder. PLoS Medicine, 3(4). https://doi.org/10.1371/journal.pmed.0030185 Zimmermann P, Brückl T, Nocon A, et al. Heterogeneity of DSM-IV Major Depressive Disorder as a Consequence of Subthreshold Bipolarity. Arch Gen Psychiatry. 2009;66(12):1341–1352. doi:10.1001/archgenpsychiatry.2009.158 Zimmerman M, Ruggero CJ, Chelminski I, Young D. Psychiatric diagnoses in patients previously overdiagnosed with bipolar disorder. J Clin Psychiatry. 2010 Jan;71(1):26-31. doi: 10.4088/JCP.08m04633. Epub 2009 Jul 28. PMID: 19646366. “DSM-5 Criteria for Major Depressive Disorder.” MDCalc, https://www.mdcalc.com/calc/10195/dsm-5-criteria-major-depressive-disorder#when-to-use. Accessed 12 April 2025. Flayton, L. (2024, November 19). Understanding the difference between bipolar and borderline personality disorder. NewYork-Presbyterian. https://healthmatters.nyp.org/understanding-difference-bipolar-borderline-personality-disorder/ Burdick KE, Millett CE, Russo M, Et. al, The association between lithium use and neurocognitive performance in patients with bipolar disorder. Neuropsychopharmacology. 2020 Sep;45(10):1743-1749. doi: 10.1038/s41386-020-0683-2. Epub 2020 Apr 29. PMID: 32349118; PMCID: PMC7419515. Kusumakar V. Antidepressants and antipsychotics in the long-term treatment of bipolar disorder. J Clin Psychiatry. 2002;63 Suppl 10:23-8. PMID: 12392350. “APA Dictionary of Psychology.” APA Dictionary of Psychology, https://dictionary.apa.org/cognitive-behavior-therapy. Accessed 20 February 2025. “What is EMDR?” EMDR Institute, https://www.emdr.com/what-is-emdr/. Accessed 20 February 2025.