The Agony of Being Misdiagnosed Bipolar

An amputation can bring out strong emotions even years after the loss of a limb. This article teaches you how to not be misdiagnosed as bipolar or manic-depressive after your amputation. With the majority of people being misdiagnosed, this article will show you how a psychiatrist makes this determination. The difference between emotional reactions to a limb loss and the symptoms that define manic depression will be made clear.

This article will describe the point at which the expression of intense feelings becomes a bipolar disorder. There are some techniques to control your emotions and avoid this diagnosis and the inevitable medications that follow. This is the agony of being misdiagnosed bipolar after your amputation.

Diagnostic Criteria for Manic Depression

Bipolar disorder, also known as manic–depressive illness, is considered a medical condition that causes a person to experience intense mood swings that alternate between depression and mania. These mood swings can last for hours, days, or even weeks. The Diagnostic and Statistical Manuel, when it first came out, had a clear set of criteria for this disorder.

A “single disorder of mood, either extreme depression or elation, that dominates the mental life of the patient” and that the onset of mood state is not precipitated by any specific life event. This is an essential early distinction. Having strong emotions after an amputation is a specific life event and not a bipolar disorder.

Things have not changed much, but the most current symptoms are a bit more confusing. Mania is now an elevated, expansive, or irritable mood that must last for at least one week and be present most of the day, nearly every day. To be considered hypomania, the mood must last at least four consecutive days and be present most of the day, almost every day.

During this period, three or more of the following symptoms must be present and represent a significant change from usual behavior:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Increased talkativeness
4. Racing thoughts
5. Distracted easily
6. Increase in goal-directed activity or psychomotor agitation
7. Engaging in activities that hold the potential for painful consequences, e.g., unrestrained buying sprees

Normal Amputee Elation vs. Bipolar Mania

This is a far cry from the relief expressed by amputees. A study that investigated positive thoughts in amputation showed that 56% of people felt elation at some point after their amputation. This figure may be higher if the amputation reduces their physical pain and improves their overall health and mortality. In my case, it ended massive pressure ulcers that prevented venturing very far.

Participants stated many reasons as good things that happened following amputation: the independence was given to them by the amputation and the prosthesis, subsequent change in their attitude toward life, improved coping abilities, financial benefits, elimination of pain, and that amputation was a character-building for some of them. Anger may be more confused with mood disorders than elation and relief. The point of this discussion is to avoid being considered emotionally unstable, which is a short hop to mania. Such is the agony of being misdiagnosed bipolar.

Drug Companies Contribution

It is essential to look at the history of these criteria and the influence of the pharmaceutical companies. Marketing tactics by the drug industry are contributing to a massive overdiagnosis of bipolar disorder, researchers have said. They have created a whole new classification of drugs called “Mood Stabilizers.” They generate massive profits when the drug companies sell Manic Depression as a “chemical imbalance” that must be treated for the rest of your life.  

Amputee Depression vs. Manic Depression 

Thirty percent of amputees are troubled by depression. They talk of insomnia, loss of appetite, and hopelessness, according to their physiotherapists. Other depressive symptoms include withdrawal, denial, and self-neglect (personal hygiene, diabetic management, etc.) The online support groups are full of amputee’s laments of post-amputation depression. Psychological morbidity, decreased self-esteem, distorted body image, increased dependency, and significant levels of social isolation are other signs of long-term depression following an amputation. Here is a list of symptoms that the Statistical Manuel gives for the depressive phase of bipolar disorder. They are very different.

• Expression of a need to talk
• Depressive symptoms, e.g., insomnia, loss of appetite, hopelessness
• Withdrawal
• Irritability
• Anger
• Unrealistic expectations
• Denial
• Suspected residual limb abuse.
• Self-neglect (personal hygiene, diabetic management, etc.)
• Risk-taking (e.g., trying to do too much too quickly)
• Anxiety limiting progress in rehabilitation (e.g., can’t or won’t move)
• Regression or excessive dependence
• Sabotaging rehabilitation programs or discharge plans

How a Psychiatrist Makes a Diagnosis

A psychiatrist makes a diagnosis of manic depression by first determining if there is a long-standing depression. The doctor then looks for a period of mania using the symptoms listed above. These symptoms should be present for months to be bipolar disorder. The key to the diagnosis is the addition of at least one manic phase. A majority of the manic symptoms that are listed above must be present. In the last twenty years, the diagnostic criteria have become less precise. 

Depression used to have to be intractable, with suicidal ideation. Mania meant the extreme of not sleeping for days to the point of hallucinations from sleep deprivation. Other manic behavior, such as impulsive spending, explosive behavior, pressured speech, and chronic insomnia, may be present. Now there is a new form of bipolar disorder called rapid cycling, which means the mood changes every day. It can apply to almost anyone. 

The Agony of Being Misdiagnosed as Bipolar