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This paper argues that the overdiagnosis of  bipolar disorder (BD) 
is an urgent and underrecognized problem within the U.S., threatening 
to expose vulnerable Americans to heightened stigma and harmful drug 
effects while disguising the environmental and traumagenic roots of  their 
distress. The paper traces BD overdiagnosis to biomedical assumptions 
about mental illness and to the decline of  social welfare policies over 
the past twenty-five years. It calls on policymakers to address BD 
overdiagnosis by revising criteria in the DSM 5, developing psychosocial 
models of  mental illness, and reintroducing protective social welfare 
programs. Finally, the paper urges social workers to educate themselves 
about the harms of  BD overdiagnosis as well as to recognize their own 
role in medicalizing their clients’ distress.

The Overdiagnosis of Bipolar 
Disorder Within Marginalized 
Communities: A Call to Action

PAUL DOYEN
HE, HIM

THE OVERDIAGNOSIS OF BIPOLAR DISORDER WITHIN MARGINALIZED COMMUNITIES

THE OVERDIAGNOSIS OF BIPOLAR DISORDER WITHIN 
MARGINALIZED COMMUNITIES: A CALL TO ACTION

Researchers have been sounding the alarm about the overdiagnosis 
of  bipolar disorder (BD) for more than a decade (Ghouse et al., 2013). 
For example, in 2008, Goldberg et al. found that only 33% of  a cohort 
diagnosed with BD actually met clinical conditions, and in 2010, Ruggero 
et al. discovered that 60% of  patients studied had been misdiagnosed 
as having BD. A meta-analysis by Mitchell (2012) reported rampant 
overdiagnosis of  BD driven by flawed screening tools and studies inflating 
the prevalence of  BD. One year later, another literature review found BD 
misdiagnoses reaching rates of  67% (Ghouse et al., 2013). 

The scope of  the problem is vast, with some researchers pressing 
for even greater rates of  diagnosis and setting BD prevalence as high as 
27% (Mitchell, 2012). While anyone can be subject to misdiagnosis, those 
who suffer from other mental health conditions, such as major depressive 
disorder (MDD) and substance use disorder (SUD), are especially at 
risk (Mitchell, 2012). BD diagnoses are also disproportionately applied 
to people with limited social support, low socioeconomic status, and a 
history of  traumatic experiences (Fusar-Poli et al., 2017). Given that BD 
is thought to be a lifelong affliction, the consequences of  overdiagnosis 
extend far into each individual’s future. 

Some of  the most serious consequences of  misdiagnosing BD are 
pharmacological. Lithium, a prescription mood stabilizer medication 
and first-line treatment for BD, has been shown to increase risks of  
hypothyroidism and chronic kidney disease (Littrell, 2012; Livingstone 
& Rampes, 2006; Presne et al., 2003). A 2012 systematic review 
discovered renal, cardio-vascular, and neurotoxicity in older adults 
using lithium (Sun, Hermann & Shulman, 2017). Huxley & Baldessarini 
(2007) report that lithium’s neurotoxic effects can lead to greater 
impairment and disability among those diagnosed with BD, such as 
memory loss and decreased executive functioning. Severe risks associated 
with antipsychotics, another common treatment for BD, include 
cardiovascular disease, osteoporosis, and significant reductions in brain 



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tissue over time (Voineskos et al., 2020; Littrell, 2012; Dorph-Petersen et 
al., 2005). 

Another harmful consequence of  BD overdiagnosis is the risk of  
exposure to social and internalized stigma, which can lead to social 
exclusion, occupational failure, and reduced functioning (Hawke et al., 
2013). Researchers suggest that the stigma imparted by BD diagnosis, 
similar to that of  schizophrenia, may reflect the condition’s longevity 
and genetic roots (Hawke et al., 2013). Unfortunately, the harms of  BD 
stigma appear to be highest for those most at risk of  misdiagnosis: those 
who lack support systems and carry stigma brought on by other diagnoses 
(Fusar-Poli et al., 2017).  

Perhaps the most insidious result of  inflating BD diagnoses, and the 
one which may be of  most concern to social workers, is the masking 
of  oppressive social conditions. Like all disorders involving psychosis, 
BD and its symptoms have been linked to childhood abuse, perceived 
stress, and poor physical health, all of  which disproportionately 
affect poor communities and communities of  color (Fusar-Poli et al., 
2017). Environmental stressors including poverty, crime, and racial 
discrimination are correlated with depressive symptoms, psychosis, and 
the dysregulation of  the limbic system; research suggests that they may 
also be erroneously attributed to BD (Cogan et al., 2020; Gómez, 2015; 
Jackson et al., 2010). As a result, there are serious concerns that the 
rise in BD diagnoses, with their biological underpinnings, is concealing 
increasing social and environmental distress among marginalized 
Americans. 

POLICY RESPONSE
According to critics, the biggest drivers of  BD overdiagnosis are 

its diagnostic criteria and estimates of  prevalence, both of  which have 
shifted dramatically over the past three decades (Ghouse et al., 2013; 
Mitchell, 2012; Littrell, 2012; Burrows, 2010). In 1994, the DSM IV 
introduced bipolar II by expanding mania, the central feature of  bipolar 
I disorder, into the less severe category of  hypomania, despite mania’s 

PAUL DOYENTHE OVERDIAGNOSIS OF BIPOLAR DISORDER WITHIN MARGINALIZED COMMUNITIES

high concordance and limited evidence for its expansion (Yutzy et al., 
2013; Singerman et al., 1981). Following the introduction of  bipolar 
II, a small group of  researchers developed the idea of  “subthreshold” 
or “subclinical” BD, which further expanded criteria and prevalence 
estimates (Mitchell, 2012). Between 1994 and 2007, BD diagnoses 
doubled in adults and multiplied by 40 in children, while estimates of  
BD’s prevalence rose from 1.6% to 24.2% of  the population (Burrows, 
2010; National Institute of  Mental Health, 2007).  

Critics regard the DSM IV’s changes to BD’s nosology as arbitrary 
and unsupported by evidence (Yutzy et al., 2013; Mitchell, 2012).  They 
reject that surges in BD diagnoses capture an increasing incidence of  the 
disorder, which, given BD’s biogenetic roots, should remain stable over 
time (Almeida et al., 2020).  Instead, these researchers argue that BD’s 
expanded diagnostic criteria and inflated prevalence estimates have led to 
an epidemic of  overdiagnosis (Ghouse et al., 2013; Mitchell, 2012).

Despite these criticisms and growing evidence of  overdiagnosis, 
researchers and policymakers have done little to address the problem. In 
2013, the newly released DSM 5 rebuffed warnings of  overdiagnosis by 
expanding subsyndromal criteria for BD, a change that may significantly 
increase the risk of  depressive patients being misdiagnosed with BD 
(Carta & Angst, 2016; Cerimele et al., 2014). Other issues related to 
BD’s overdiagnosis, such as diagnostic overlap with schizophrenia, 
schizoaffective and borderline personality disorders, comorbidity 
with anxiety and unipolar depression, and reliance on overly sensitive 
screening instruments were not addressed within the DSM 5, even 
though they were well-documented at the time of  its publication 
(Cosgrove & Suppes, 2013; Mitchell, 2012; Vieta & Philips, 2007). 

Of  the factors contributing to BD overdiagnosis, one of  the most 
serious is the DSM 5’s failure to clarify the relationship between BD 
and post-traumatic stress disorder (PTSD). The co-incidence of  PTSD 
in BD patients has been cited at 35%; the two disorders share multiple 
symptoms and affect similar regions of  the brain (Carmassi et al., 
2020; McCormack & Thompson, 2017; Rakofsky et al., 2011). Despite 



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calls from some researchers, the need to screen and control for trauma 
disorders in potential BD patients has been ignored, leaving marginalized 
communities, who experience disproportionate rates of  trauma and 
decreased access to trauma-informed care, at risk of  misdiagnosis 
(Etaine et al., 2008). Evidence suggests that misdiagnoses of  BD leave 
trauma survivors less likely to receive appropriate care, with BD patients 
on Medicaid being offered less therapy and more unsupervised drug 
treatments than other patients (Busch et al., 2007; Fontanella et al., 2015). 

UNDERLYING ASSUMPTIONS
Diagnostic psychology has been slow to recognize the problem 

of  BD overdiagnosis in part due to its underlying assumptions about 
individuals with BD. One such assumption is that BD and its symptoms 
are biogenetic in origin. This claim is supported by family studies of  
bipolar I, but has not been substantiated for the diagnostic labels critics 
believe are driving overdiagnosis: bipolar II and subclinical BD (or 
“bipolar not otherwise specified”)  (Almeida et al., 2020; Mitchell, 2012). 
In fact, inconclusive findings have led some researchers to question 
whether bipolar I and bipolar II are genetically related conditions 
(Littrell, 2012). Despite this lack of  evidence and a wealth of  literature 
identifying BD symptoms with over 51 unique environmental stressors, 
diagnostic psychology continues to regard bipolar II and sub-clinical BD 
as biogenetic disorders (Bortolato et al., 2017). 

Another assumption obscuring BD overdiagnosis is that people 
diagnosed with BD have little hope of  recovery. Once again, evidence 
of  poor prognosis is significant for bipolar I but is less clear for bipolar II 
and subclinical BD, both of  which have garnered less research (Almeida 
et al., 2020). One historically important variable in determining BD’s 
prognosis is unemployment, which involves social factors as much as it 
reflects individual impairment. For instance, data showing that around 
57-65% of  BD patients were unemployed in 2007 compared to only 15% 
in the 1970s is difficult to explain without recourse to other factors, such 
as deindustrialization and declining job security (Huxley & Baldessarini, 
2007). Indeed, opponents of  overdiagnosis argue that social distress due 

to rising work insecurity has been systematically mislabeled as mental 
illness over the past four decades, disguising the problem and worsening 
outcomes (Buffel et al., 2017; Wong, 2016). 

A third assumption about those diagnosed with BD is that their 
condition is universal and “colorblind.” In light of  this assumption, 
some researchers have taken the low prevalence of  BD among Black 
Americans as a sign of  underdiagnosis, dismissing findings that the 
prevalence of  mood disorders is consistently lower in Black communities 
than in white communities (Alvarez et al., 2018; Boyd et al., 2011; 
Breslau et al., 2008; Neighbors et al., 2003; Woodward et al., 2011). 
Calls for increased screening among Black Americans carry a notable 
threat of  overdiagnosis, given that actual prevalence appears to be 
low, and the depressive and trauma-related symptoms associated with 
anti-Black oppression are frequently mislabelled as mental illness 
(Jarvis, 2007; Stevenson et al., 1997). Meanwhile, the DSM’s colorblind 
approach to mental health treatment, which has failed to account for 
how psychological diagnoses impact racial groups differently, means that 
the risks of  BD overdiagnosis within communities of  color have not been 
monitored by mental health policymakers (Green et al., 2012). 

While these assumptions have all likely contributed to the failure to 
address BD overdiagnosis, diagnostic psychology’s neglect of  social and 
environmental problems is rooted in its assumption that mental illness 
represents discrete, biologically based diseases, a claim unsupported by 
evidence despite over 40 years of  influence (Jacob et al., 2014; Timimi, 
2014). Critics of  the “bio-medicalization” of  mental health, stemming 
from the publication of  the DSM III in 1980, complain that it has led to 
“tunnel vision” about mental illness, even as evidence has increasingly 
characterized mental illness not as distinct clusters of  biogenetic 
symptoms, but as transdiagnostic distress linked to trauma, deprivation, 
and social inequality (Pilgrim, 2014; Rimke, 2016; Timimi, 2014). 

One explanation for the persistence of  the biomedical model of  
mental illness, despite a lack of  evidence to support it, is its shared 
assumptions with neoliberalism, which holds that individuals are 

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responsible for their own health, have equal agency, and resolve their 
needs and problems through the consumption of  private goods (Rimke, 
2016). Detractors argue that neoliberal assumptions about mental distress 
have pathologized poor and minority groups, who have limited agency 
to address their problems, and have helped medicalize social welfare, 
with government support becoming increasingly contingent on diagnoses 
of  physical and mental disability (Wong, 2016). From this perspective, 
the medicalization of  social welfare and the overdiagnosis of  mental 
illness are mutually reinforcing, expressing the same neoliberal logic of  
privatization and growth that has dominated U.S. policy since the 1980s 
(Rimke, 2016). 

OVERDIAGNOSIS AND WELFARE REFORM
While few, if  any, peer-reviewed studies have explored the 

relationship between social welfare reform and the overdiagnosis of  
BD, evidence suggests that the two are closely related. Following the 
1996 Personal Responsibility and Work Opportunity Act’s (PRWORA) 
dismantling of  traditional welfare, BD diagnoses skyrocketed, along 
with enrollment in supplemental security income (SSI), which rose 
fourfold between 1996 and 1998 (Burrows, 2010; Jans et al., 2004). As 
impoverished Americans flocked to SSI as a source of  financial stability 
and Medicaid access, mood disorders became the largest and fastest-
growing drivers of  enrollment, with a 100% increase in children applying 
to SSI and Medicaid under BD diagnoses between 2001 to 2010 
(National Academies of  Science, Engineering & Medicine et al., 2015; 
Drake et al., 2013). 

Findings of  rampant BD overdiagnosis among SSI recipients 
indicate that these surges in SSI enrollment reflect welfare-related needs 
rather than shifts in BD’s true prevalence (Ghouse et al., 2013). Multiple 
studies have connected rising BD diagnoses to gaps in post-welfare 
services. For example,  a 2006 study found that impoverished Americans 
were pursuing BD diagnoses in order to receive substance-related 
treatment, which the PRWORA purged from coverage in 1996 (Stein 

et al., 2006). Meanwhile, multinational studies on the medicalization of  
unemployment suggest that increasing rates of  joblessness among SSI 
recipients with BD diagnoses reflect unmet needs for stable employment, 
with many frustrated SSI enrollees expressing a desire to work (Buffel et 
al., 2017; Frank, 2013; Holmqvist, 2009).  

As with most neoliberal policies, the PRWORA’s transfer of  poverty 
services from welfare to disability programs has benefitted private 
interests, including pharmaceutical companies and a growing industry 
of  mental health professionals, all of  which reap profits from psychiatric 
overdiagnosis, expanded categories of  mental illness, and reallocations 
of  government spending (Mitchell, 2012; Rimke, 2016). Vulnerable 
Americans, including those applying for disability under misapplied BD 
diagnoses, suffer the greatest losses as unmet needs for employment, 
housing support, healthcare access, neighborhood investment, and anti-
discrimination policies are met with irrelevant and often harmful mental 
health interventions (Shepherd & Wilson, 2018; Rimke, 2016; Mills, 
2015; Hansen et al., 2014). 

ADVOCACY ORGANIZATIONS
According to prominent psychiatrist and DSM 5 critic Allen J. 

Frances, American mental health advocacy groups have consistently 
failed to push back against the overdiagnosis of  psychiatric disorders 
(Frances, 2010). Instead, advocacy groups such as the American 
Psychological Association (APA), the National Alliance of  Mental Illness 
(NAMI), and the National Association of  Social Workers (NASW) 
have issued demands for heightened mental health screenings within 
marginalized communities, calls which have drawn frequent support from 
the pharmaceutical lobby (American Psychiatric Association, 2015; Davis 
& Williams, 2020; Frances, 2010). These campaigns, which express the 
influence and assumptions of  America’s powerful mental health industry, 
reflect that there are currently few, if  any, advocacy groups addressing 
the problem of  BD overdiagnosis within the U.S. The majority of  
organizations recognizing overdiagnosis now operate in other countries.

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One of  the most influential of  these organizations is Mental Health 
Europe (MHE), a pan-European, non-governmental organization 
(NGO), which has pushed for a demedicalized, psychosocial approach 
to mental health policy over the past decade. In 2012, MHE set up 
a task force to investigate the development of  the DSM 5, releasing 
a statement that denounced its biomedical assumptions, expanded 
diagnoses, and promotion of  “unnecessary and harmful” drug treatments 
(Mental Health Europe, 2014; Mental Health Europe, 2013). In a 
follow-up report, MHE called on the European Union and World 
Health Organization to ignore expanded DSM diagnoses unsupported 
by evidence, to offer diagnostic alternatives, and to cease promoting 
psychiatric medications as a first line response to distress (Mental Health 
Europe, 2015). MHE’s criticisms of  the DSM 5 have been influential 
across Europe, with the Superior Health Council of  Belgium declaring in 
2019 that the DSM would no longer be at the nation’s “center of  [mental 
health]care planning” (Simons, 2019). 

In addition to curtailing the influence of  the DSM 5, MHE has 
targeted several other drivers of  psychiatric overdiagnosis. Since 2013, 
MHE has called for legislation to expose the financial ties between mental 
health policymakers, professional organizations, and pharmaceutical 
companies (L’Ecluse, 2019). MHE has also launched an investigation 
into the influence of  chronic unemployment on rising “psychosocial 
disability,” a term MHE uses in place of  mental illness (Mental Health 
Europe, 2016). MHE’s proposal of  work programs for those labeled 
mentally ill was approved by the Council of  the European Union in 
2016, suggesting that Europe is moving away from the medicalization 
of  unemployment, as well as from biogenetic models of  mental illness 
in which disability is considered incurable (Finn, 2017; Mental Health 
Europe, 2016). Meanwhile, the ascendency of  MHE’s psychosocial 
approach to mental health was powerfully expressed in a 2017 report 
from the United Nation General Assembly, which declared that the 

“neurological paradigm [of  mental illness] causes more harm than 
good,” and called for a shift “from focusing on chemical imbalances to 
focusing on power imbalances and inequalities” (Kinderman, 2020). 

A CALL TO ACTION: POLICY AND PRACTICE
To address BD overdiagnosis within the U.S., policymakers must first 

study the hundreds of  thousands of  Americans receiving SSI benefits 
under BD diagnoses, a growing population at high risk of  childhood 
trauma, poverty, and homelessness (Cerimele et al., 2014; Etain et al., 
2008; Huxley & Baldessarini, 2007). New and focused research is needed 
to determine if  these are in fact “risk factors” for BD, as is usually 
assumed, or if  they are generating transdiagnostic symptoms which are 
driving overdiagnosis. There is also an urgent need for studies exploring 
the socioeconomic deprivation behind BD diagnoses, and the extent to 
which underemployment and poor access to healthcare are motivating 
Americans to seek SSI enrollment (Ghouse et al., 2013; Wong, 2016). 
Finally, researchers need to examine the impact of  BD diagnoses within 
communities of  color and the intersections of  racial stigma with those 
brought on by DSM diagnoses and disability status (Hawke et al., 2013). 

As researchers develop a clearer image of  BD overdiagnosis, the 
mental health community can begin taking steps to address it. One 
strategy is to demand that researchers stop using inflated figures to 
characterize BD and instead adhere to conventional, evidence-based 
estimates of  BD’s prevalence, which have ranged from 1% to 2% of  the 
population (Mitchell, 2012). Another step is to discourage or eliminate 
the use of  screening tools like the Mood Disorder Questionnaire (MDQ) 
and return to clinical interviews as the “gold standard” in BD diagnosis 
(Ghouse et al., 2013). The most direct path to reducing overdiagnosis 
is to revise expanded criteria for BD by removing the “bipolar not 
otherwise specified” category from the DSM 5, and by toughening 
criteria surrounding hypomanic episodes, the key symptom in bipolar II 
(Mitchell, 2012). Some researchers, citing findings that bipolar II has no 
clear genetic profile and is not phenotypically distinctive from unipolar 

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depression, have explored eliminating the bipolar II diagnosis altogether, 
which would lead to substantially fewer diagnoses of  BD (Gitlin & Malhi, 
2020; Parker & Fletcher, 2009). 

Others insist that addressing the roots of  BD overdiagnosis will 
require more dramatic changes to the DSM. BD’s high comorbidity, 
expanding criteria and subtypes, and failure to control for environmental 
distress point to a broader crisis in post-DSM III psychiatry, which has 
failed to successfully classify mental illness into distinct conditions, find 
biogenetic markers for core diagnoses, or curtail its own expansion 
(Ghaemi, 2014; Timimi, 2014). Thus, stemming the flow of  overdiagnosis 
may require the diagnostic system established with the DSM III, which 
has consistently prized reliability over external validity, to be abandoned 
(Dutta et al., 2007; Pilgrim, 2014; Vieta & Philips, 2007). In its place, 
researchers propose the DSM be reorganized into a dimensional system 
with less arbitrary divisions between symptoms and fewer pathologizing 
diagnoses (Dutta et al., 2007; Vieta & Philips, 2007). Others demand that 
the DSM adopt a “traumagenic” model of  mental illness that is based 
on shared experiences of  adversity and encourages environmental over 
drug-focused interventions (Pilgrim, 2014). 

MHE’s campaign for financial transparency and protective 
social policies provides a potential blueprint for curbing psychiatric 
overdiagnosis within the U.S. Legislation preventing researchers with 
drug industry ties from serving on DSM panels could reduce pressures 
to further widen diagnostic criteria, while housing and employment 
programs for those at risk of  being labelled mentally ill would likely 
lead to fewer diagnoses and less biogenetic pessimism about mental 
illness (Elinson et al., 2007; Huxley & Baldessarini, 2007). By following 
Belgium’s lead and decentering the DSM within its healthcare system, 
the U.S. could begin to explore diagnostic models that are more sensitive 
to the social, economic and racial determinants of  mental health. Finally, 
retiring the stigmatizing term “mental illness,” which locates the roots 
of  mental distress within dysfunctional individuals, may help cleanse 

U.S. mental healthcare of  neoliberal assumptions that are driving 
overdiagnosis and the privatization of  poverty (Mills, 2015; Rimke, 2016; 
Shepherd & Wilson, 2018). 

Social workers will need to think critically about how to respond to 
the problem of  BD overdiagnosis, both as clinicians and as advocates for 
change. As clinicians, social workers need to familiarize themselves with 
the harms that BD diagnoses can impose on clients, such as heightened 
stigma, adverse drug effects, and enrollment in disability programs 
that can further reduce functioning (Hawke et al., 2013; Huxley & 
Baldessarini, 2007; Littrell, 2012). Similarly, social workers should be 
aware of  the pressures they face to apply DSM diagnoses, including 
organizational needs for efficiency, growth, and specialization, directives 
which often benefit social workers and their status as health professionals 
(Rimke, 2016). Finally, clinical social workers need to look beyond 
biological theories and identify the environmental factors driving clients 
to seek BD diagnoses, such as childhood trauma, housing instability, 
underemployment, and a lack of  welfare related services. They must bear 
in mind that a BD diagnosis is a mark of  lifelong biogenetic dysfunction, 
one that may render clients less likely to receive the help that they need. 

As advocates, social workers must challenge calls to reduce 
mental health disparities through indiscriminate screening and warn 
policymakers about the differential impact of  BD overdiagnosis within 
minority communities. They must resist the increasing bio-medicalization 
of  mental health and be prepared to defy a system of  diagnostic 
psychology which many researchers say has lost its claim to scientific 
validity (Dutta et al., 2007; Ghaemi, 2014; Jacob et al., 2014; Pilgrim, 
2014; Timimi, 2014). Finally, social workers will need to join researchers 
in psychiatry and psychology to develop new systems of  diagnoses that 
link mental distress to environmental risk factors and harmful public 
policies (Rimke, 2016). Social workers will need to decide for themselves 
whether a public conception of  mental health is possible within the 
U.S.’s privatized healthcare system, and within an unregulated market 
economy that prioritizes innovation and profits over social protections. 

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Whatever they decide, social workers can no longer afford to ignore 
the overdiagnosis of  BD, which has mischaracterized distress, bolstered 
stigmas, and placed the burden of  change on those who are often least 
able to effect it. 

CONCLUSION
BD overdiagnosis is a growing problem within the U.S., especially 

among marginalized Americans seeking social support through 
SSI enrollment. Consequences of  misdiagnosis include heightened 
stigma, adverse drug effects, and the concealment of  environmental 
distress within poor communities and communities of  color. A new 
frontline in the medicalization of  poverty, the overdiagnosis of  BD has 
been poorly monitored by mental health organizations, which have 
launched uncritical campaigns for increased mental health screening 
amidst widespread reports of  invalid diagnoses (American Psychiatric 
Association, 2015). 

BD overdiagnosis is perpetuated by clinical assumptions that BD is 
undertreated, prone to subclinical presentations and underrecognized 
in communities of  color, claims which have failed to amass significant 
evidence (Littrell, 2012; Mitchell, 2012). Assumptions about BD’s poor 
prognosis and biogenetic origins are rooted in the unsubstantiated 
claim that mental illness involves discrete biologically based conditions, 
and from neoliberal assumptions about the sources of  and solutions to 
mental distress, which have helped to medicalize and dismantle social 
welfare programs over the past four decades (Timimi, 2014; Wong, 
2016). Policymakers are encouraged to follow Mental Health Europe’s 
example by passing financial transparency laws, decentering the DSM 
within mental healthcare, and introducing protective social programs that 
offer employment, stable housing, and expanded access to healthcare. 
Recommendations targeting BD overdiagnosis include narrowing 
diagnostic criteria in the DSM 5 and developing new traumagenic 
models of  mental distress that are sensitive to social inequalities. Social 

workers are called to educate themselves about the harms of  BD 
overdiagnosis, to press for a psychosocial and welfare-based approach 
to mental healthcare, and to maintain a healthy skepticism about DSM 
diagnoses and their status as evidence-based guides to practice.

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PAUL DOYENTHE OVERDIAGNOSIS OF BIPOLAR DISORDER WITHIN MARGINALIZED COMMUNITIES

PAUL DOYEN is a Masters of  Science in Social Work candidate 
at Columbia School of  Social Work in Advanced Clinical Practice 
concentrating in Health, Mental Health and Disabilities. He 
graduated from Tulane in 2019 with a Bachelor of  Science in 
Psychology. Paul is currently an intern at the Psychoanalytic 
Psychotherapy Study Center in Manhattan, where he is practicing 
psychodynamic therapy with clients throughout New York.


