Why Emotional Dysregulation is misdiagnosed as Bipolar

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August 8, 2017

Why Trauma-Related Emotional Dysregulation is frequently misdiagnosed as Bipolar Disorder

At PCH Treatment Center, we are often referred clients who are diagnosed with “Bipolar II” due to poorly regulated or “dysregulated” mood states. Most of these clients are on multiple medications for Bipolar Disorder that don’t seem to be working very well.

Diagnostic criteria for Bipolar II include at least one episode of major depression and at least one episode of hypomania (a less severe form of mania). However, we find that many clients are misdiagnosed with Bipolar Disorder because careful attention has not been paid to their symptomatology. Rapid mood changes or dysregulation is mistaken for “rapid cycling” and is followed by a diagnosis of the mania commonly associated with Bipolar II.

Clients with a history of psychological trauma are also often labeled with “Borderline Personality Disorder (BPD).” BPD is a commonly used diagnosis for mood instability, difficulty in regulating emotional states, and being easily triggered. These are also symptoms of psychological trauma which, in our view, is a more empathic and accurate diagnosis. At PCH Treatment Center, we believe the term “Borderline Personality Disorder” is pejorative and counterproductive to healing. We refer to a client who is experiencing emotional dysregulation or the symptoms related to ‘Borderline Personality Disorder’ as suffering from psychological trauma and treat that accordingly.

In a person with a history of trauma who is easily triggered or dysregulated, it is crucial to properly identify the cause of their internal conflict and avoid disparaging diagnoses. Throughout their life, every individual is repeatedly exposed to disruptive or upsetting events, such as conflict in a relationship, stressful events, or personal criticism or bullying. A person with poorly regulated emotions will react in an exaggerated manner to environmental and interpersonal challenges through bursts of anger and crying, withdrawal, passive-aggressive behaviors, or creation of chaos or conflict. These reactions point to underlying relational psychological issues intertwined with dysregulated emotions and not necessarily Bipolar Disorder.

It is important to carefully dissect out the timeframe of these emotional states and potential triggering events in order to differentiate between trauma-related emotional dysregulation and the symptoms of Bipolar Disorder and reach an accurate diagnosis.

  • For example, clients with trauma and emotional dysregulation will have high emotional energy states for short periods of time (even fluctuating within the course of hours or a day).
  • This is important to distinguish from a true Bipolar illness, where clients have manic and irritable mood states that last days to weeks to even months in the case of major depression.
  • Clients with emotional dysregulation can often identify a triggering event such as the breakup of a relationship, criticism or failure at work or school, or family stress.
  • Bipolar Disorder, on the other hand, is a mood disorder with less day-to-day volatility around mood states (though it is often triggered by stress).

When emotional dysregulation is mislabeled as Bipolar II, psychiatrists and physicians treating mental health problems will often medicate their clients in accordance with this diagnosis. Frequently-used medications in the misdiagnosis of Bipolar II include Lithium, antipsychotics, and anticonvulsants (medications initially used for seizure disorders). However, these medications do not effectively treat emotional dysregulation, and psychiatrists believing the patient to have Bipolar II often make the mistake of adding more medications to try to stabilize the client. Because their cocktail of medications provides little to no positive results (and often increasing side effects), these clients become more frustrated and hopeless than before the start of their medication regimen. Psychological trauma and emotional dysregulation are resolved through psychotherapy and other modalities; medication is not the primary treatment modality and it may actually worsen the person’s psychological well-being due to side effects such as anxiety, mental confusion, and other somatic symptoms. The best way to address psychological trauma is through various therapeutic modalities.

At PCH Treatment Center, our psychiatrists frequently take clients off of these unnecessary medications once we have determined the proper diagnosis and treatment plan for those symptoms potentially misdiagnosed as Bipolar II. There are many modalities of psychotherapy that we apply to clients with trauma and emotional dysregulation. Psychodynamic (relational) therapy, somatic therapies such as somatic experiencing, sensorimotor therapy, and Eye Movement Desensitization and Reprocessing (EMDR) have been shown to be useful individual modalities for those suffering from what was thought to be Bipolar Disorder. Trauma groups, trauma timelines, and process groups, along with mentalization and Dialectical Behavioral Therapy (DBT), help clients reach a point where they can regulate their emotions within a normal range and manage their Bipolar-related symptoms.

Trauma-informed yoga, neurofeedback, art therapy and an arts program also provide emotional support for our clients. By addressing core issues, many of which stem from early childhood events, our clients will be equipped with the tools to lead happier and more emotionally balanced lives.

To learn more about how we avoid misdiagnosing psychological trauma-related emotional dysregulation as Bipolar Disorder, as well as the appropriate treatment that they each require, visit our website at www.pchtreatment.com.

 

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