The misdiagnosis of bipolar disorder is widely prevalent as evidenced by patient surveys,
administrative claims data and studies measuring clinicians’ diagnostic accuracy. The consequences of
a missed or incorrect bipolar disorder diagnosis can have serious short and long-term repercussions for
a patient. In this review, a systematic analysis was conducted of over-diagnosis and under-diagnosis
rates calculated from all adult bipolar studies comparing patient reported diagnoses with diagnoses
resulting from DSM-IV based structured assessments/checklists. Five of the 368 publications were
selected using OVID medline and demonstrated under-diagnosis rates of 30-51% and over-diagnosis rates of 12-13%.
These results contrast with earlier publications suggesting over-diagnosis of bipolar disorder occurred more frequently
than under-diagnosis. An in-depth discussion of the various mechanisms contributing to the over and under-diagnosis of
bipolar disorder are provided. These include limitations in the design of structured research interviews, racial bias, and
patients’ memory impairment, to name a few. In this manuscript the authors also provide recommendations to improve the
diagnosis of bipolar disorder and discuss the implications of bipolar spectrum research on the diagnostic process.
Keywords: Assessment, bipolar disorder, misdiagnosis, sensitivity, specificity, test-validity.
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