Bipolar Disorder and the Risks of Overdiagnosis

Over the past two decades, bipolar disorder has shifted from being a relatively rare psychiatric diagnosis to one that is applied with increasing frequency. What was once understood as severe manic–depressive illness is now often framed as a broad “bipolar spectrum,” encompassing mood swings, emotional reactivity, irritability, and changes in energy or motivation.

In Strictly Bipolar, psychoanalyst Darian Leader argues that this expansion reflects a fundamental misunderstanding of bipolar disorder. His concern is not that manic–depressive illness does not exist, but that contemporary diagnostic practice has stretched the concept so far that it risks losing clinical meaning altogether.

From manic–depression to bipolar spectrum

Historically, manic–depressive illness referred to clearly defined clinical states. Mania and depression were not simply intense emotions but involved profound shifts in thought, speech, behaviour, and the person’s relation to reality. These episodes were episodic, disruptive, and unmistakable.

Leader contrasts this with current diagnostic approaches, where the threshold for bipolar disorder has steadily lowered. Ordinary reactions to stress, trauma, or relational conflict can now be interpreted as evidence of an underlying mood disorder.

Diagnosis without meaning

A central critique in Strictly Bipolar concerns checklist-based diagnosis. Contemporary psychiatry relies heavily on observable symptoms counted over time: reduced sleep, increased activity, racing thoughts, or emotional intensity.

Leader argues that symptoms are increasingly detached from context and meaning. Reduced sleep, for example, may arise from anxiety, grief, work pressure, or avoidance of depressive thought — yet it is often treated as diagnostic evidence in itself.

Why overdiagnosis is dangerous

Leader is clear that this is not a harmless conceptual error. Overdiagnosis encourages standardised treatment pathways, often leading to medication-first approaches without sufficient exploration of personal history, relationships, or unconscious conflict.

Diagnostic labels also shape identity. When distress is explained exclusively in biological terms, individuals may come to experience their emotions as something that simply happens to them, rather than something that can be understood and worked through.

Childhood bipolar disorder

Leader is particularly critical of the growing tendency to diagnose bipolar disorder in children. Emotional volatility, impulsivity, or difficulty regulating affect are increasingly medicalised as early signs of lifelong psychiatric illness.

A psychoanalytic perspective

Rather than starting with diagnostic categories, Leader argues for starting with speech and experience. Mania may function as a defence against depression or helplessness; depression may carry meanings tied to guilt, loss, or unconscious conflict.

From this perspective, mood states are meaningful responses, not merely symptoms to be eliminated.

Why this matters

As mental health awareness has grown, so too has the temptation to explain suffering quickly. Strictly Bipolar offers a necessary caution: when diagnostic categories become too broad, they risk doing harm — not by naming suffering, but by foreclosing understanding.