Can Mania Be Mistaken By Doctors As Extreme Anxiety And Vice-versa?


Asked by Chrispy

Can Mania Be Mistaken By Doctors As Extreme Anxiety And Vice-versa?

I've been diagnosed with bipolar now and no one doubts it. But at first they diagnosed me with MDD because they didn't see the mania, when I was CLEARLY manic. I also have panic attacks and social anxiety. At the psych ward where I was diagnosed with MDD, they seemed to think I was talking so fast and pacing all the time (to the point of getting blood blisters on my feet) because of my extreme anxiety (to the point of not wanting to leave my house) and panic attacks. It didn't make sense to me how they would confuse the two. It was like they were reluctant to diagnose me as bipolar, so blamed it on my anxiety. Do doctors sometimes confuse anxiety and mania? And do doctors sometimes not want to diagnose bipolar?


Hey, Chrispy. Short answer: Yes. Very easily.

Now some background:

I have a friend who is a mental health advocate. She does a lot of public speaking. She talks with a southern drawl, but with the speed and delivery of a New Yorker during rush hour. It's easy to mistake her for being hypomanic or excitable, as pressured speech is one of the hallmark symptoms of mania and hypomania. But no, she tells me she gets anxious when she speaks in public, and her tempo picks up in response.

As she is perfectly rational and in control in every way, her explanation is obviously the correct one.

But people often judge us on how we talk, and when we are in a pdoc's office that's basically all we're doing. The pdoc is looking for all kinds of signs and indicators of our current condition - how we dress, body language, emotional range, etc, but our speech has to be the prime indicator.

Often, when we are anxious, we are not talking or behaving rationally. Same when we are manic. It's very easy to confuse one for the other.

Now the complications:

With bipolar, anxiety tends to come with the territory. Most of us have some form of full-blown co-occurring anxiety disorder, be it generalized anxiety, social anxiety, panic disorder, OCD, phobia, or PTSD . (I think I included most of the main ones.) Those that don't invariably have elements of anxiety - we get unduly anxious, but not to the point where it crosses an imaginary diagnostic threshold.

Also, the anxiety may trigger the mania. This is very important to keep in mind, because by the time you see the mania coming it may be too late - you're long gone. But if you are aware that you are anxious, you may be in a position to work on the anxiety before mania rears its ugly head.

Brain science is now showing that anxiety and mania and depression and a lot of other states share the same neuro-endocrine pathways. The common denominator is stress. Stress can result from conditioned reactions to buried memories or to present events or a combo of both. Our population tends to be extremely vulnerable to stress, and there is a lot about modern life that sets us up as sitting ducks.

Now to your situation: Your clinician can only make a broad generalization for you about what mental states your are PRONE to exhibit. YOU are the one who has to be attuned to the state you are in RIGHT NOW. Is it anxiety? Is it an early warning sign of mania? O a bit of both? Do you stop and smell the roses, take a day off work, pop a Klonnie, up your mood stablizer, get a good night's sleep, cancel that appointment, call your pdoc, take it out on your cat, one for colum A, two from column B, or just soldier on?

YOU have to decide. You're the one has has to figure out how to get through the next 24 hours, every day of your life, not your pdoc. You know yourself best, but your friends and loved ones generally spot changes in your behavior before you do., so you have to learn to trust them.

This may sound overwhelming to you, but the good news is that by taking charge you are in control. Granted, events may overwhelm us and our illness may get the better of us, but that will happen a lot less with you in charge.

Hope this helps -

Answered by John McManamy