Dg. Bipolar in children but not adolesc/adults?????

[Shell5]

I work at a psych facility where the psychiatrist uses the diagnosis of Bipolar with the children, but uses Borderline Personality with Adolescents. On the adult unit we have different pychiatrists. They mainly use Adjustment Disorder. It seems I used to see Bipolar used moreoften years ago. This may seem suspicious but I wonder if they are using these diagnosis so patients won't be able to go and get social security as easily. What is your opinion?

[Meraki]

I find that very odd. The diagnostic criteria for bipolar, borderline personality disorder and adjustment disorder are all so different - I can't see the overlap if they are being carefully assessed. And the treatment is very different for each...

We don't see almost any bipolar in children (very rarely) and even in adolescents it isn't that often (not rare but not in the top 5). Maybe they have just refined their diagnostic skills are are more accurately diagnosing patients with mood swings (related to trauma etc) rather than just calling them bipolar? I don't know.

We had one psychiatrist who diagnosed everyone as bipolar!! Thankfully he left and our bipolar admissions dropped significantly.

[Whispera, MSN, RN]

Where I've worked, the psychiatrists generally diagnosed children and adolescents as bipolar if there was clearcut evidence, but it had to be quite clear. They tried to avoid saddling a young person with that diagnosis or with schizophrenia, because they'd carry it for life, if there was another disorder that fit too. They'd pick the least of the evils whenever possible.

[Smitty08]

It always makes me laugh or tear my hair when clinicians get all political with diagnosing. Its always the client who suffers. I worked at one place where the doc NEVER would dx with Borderline because of the stigma. Those clients were clearly borderline. It's wacky and poor care not to dx with Bipolar or any other dx if the client meets the criteria. After all - thats the whole point of diagosing - that treatment follows diagnosis, without the correct diagnosis you will not be providing the correct treatment. Its very simple, hard to believe what is going on in practice sometimes....Ugh!

[Orca, ADN, ASN, RN]

Since bipolar disorder is an Axis I diagnosis and borderline personality disorder is an Axis II, I don't see how they can be used interchangeably. Borderline would be treated primarily with behavioral therapy with possible chemical augmentation, while bipolar disorder is primarily a problem of chemical imbalance corrected by anti-manic medication.