An Epidemic of Diagnosis

Contrary to what the eye-popping statistics might suggest, there is not an epidemic of bipolar disorder among children and adolescents in this country. However, there is seemingly an epidemic of diagnosis of this disorder. This phenomenon is primarily due to two key factors: (1) a dangerous increase in the influence of the pharmaceutical industry (not just in promoting the off-label use of their products but also in funding the research which supports the need for such use), and (2) the tendency among a great many psychiatrists (often in collusion with parents) to ignore or minimize the role played by environmental stressors and developmental trauma. Thus, the “madness” that is afflicting children is not simply in the emotional and behavioral disturbance that makes their lives at home and school inordinately stressful and difficult to manage. The madness is also in their diagnosis and treatment. And that is simply unacceptable. Indeed, it is malpractice.

From Benedict Carey of the New York Times:

Bipolar Illness Soars as a Diagnosis for the Young

The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers report today in the most comprehensive study of the controversial diagnosis.

Experts say the number has almost certainly risen further since 2003.

Many experts theorize that the jump reflects that doctors are more aggressively applying the diagnosis to children, and not that the incidence of the disorder has increased.

But the magnitude of the increase surprises many psychiatrists. They say it is likely to intensify the debate over the validity of the diagnosis, which has shaken child psychiatry.

Bipolar disorder is characterized by extreme mood swings. Until relatively recently, it was thought to emerge almost exclusively in adulthood. But in the 1990s, psychiatrists began looking more closely for symptoms in younger patients.

Some experts say greater awareness, reflected in the increasing diagnoses, is letting youngsters with the disorder obtain the treatment they need.

Other experts say bipolar disorder is overdiagnosed. The term, the critics say, has become a catchall applied to almost any explosive, aggressive child.

After children are classified, the experts add, they are treated with powerful psychiatric drugs that have few proven benefits in children and potentially serious side effects like rapid weight gain.

In the study, researchers from New York, Maryland and Madrid analyzed a National Center for Health Statistics survey of office visits that focused on doctors in private or group practices. The researchers calculated the number of visits in which doctors recorded diagnoses of bipolar disorder and found that they increased, from 20,000 in 1994 to 800,000 in 2003, about 1 percent of the population under age 20.

The spread of the diagnosis is a boon to drug makers, some psychiatrists point out, because treatments typically include medications that can be three to five times more expensive than those for other disorders like depression or anxiety. [full text]

One thought on “An Epidemic of Diagnosis

  1. I agree there is an epidemic of diagnosis not only of bipolar disorder but of many childhood conditions which require a lifelong regime of medications. The conclusion I draw from this is either we have done a great deal of harm to our children over the last 5 decades or the pharmaceutical companies have much more power over physicians than what is in our best interest as patients. The reality is that most doctors are unaware of medications and their consequences unless a drug representative gives them the information. The doctors learn to rely on this information as gospel regardless of how factual it actually is. The easiest prey are of course are the elderly but if need to push an expensive antipsychotic drug what we need is another market. That market is your children.

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