Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Anne Fish


Roxanne Vandermause

Kuei-Hsiang Hsueh

Azfar Malik


Bipolar disorder is a complex illness that is difficult to correctly diagnosis and treat. Experts estimate that a correct diagnosis and treatment for bipolar disorder may be delayed for up to 7-10 years after symptoms become problematic. The primary purpose of this study was to identify the complexity of diagnosing bipolar disorder, including diagnostic patterns, recommended treatment, and patient response. A focused ethnography, including in-depth interviews and a retrospective chart review, were completed to answer the research questions: 1) What is the nature of the experience of receiving a diagnosis of bipolar disorder? 2) What are the diagnostic and treatment patterns for patients switched from depressive disorder to bipolar disorder during a psychiatric hospitalization? For the in-depth interviews, adults, 18-65 years of age and newly diagnosed with bipolar disorder during psychiatric hospitalization (n=10), were interviewed. Transcripts of audio recorded interviews were analyzed using thematic analysis. Two patterns and five themes were identified. The first pattern, Living with undiagnosed bipolar disorder included three themes: Distinguishing impulsive moods and behavior, Suffering life challenges, and Seeking relief. The second pattern, Receiving a new diagnosis of bipolar disorder, included two themes: Understanding the diagnosis and Reconciling the diagnosis. For the retrospective chart review, inclusion criteria were: adults age 18-65, diagnosis of major depression disorder upon admission and switched to bipolar disorder by discharge, and had complete data. The results showed that out of 3,092 patients admitted to the psychiatric hospital over a 1.5-year time frame, 16.9% (525) had their diagnosis switched from major depression disorder to bipolar disorder. Out of 525 patients, only 5.2% (n=100) were screened for bipolar disorder on admission. The interview data corroborated what was identified in the retrospective chart review, indicating that appropriate diagnosis and subsequent treatment opportunities are frequently missed in bipolar disorder. These findings offer clinicians and researchers a new way to think about the condition of bipolar disorder, including understanding barriers to proper diagnosis and using the diagnostic event to instigate meaningful life change.

OCLC Number


Included in

Nursing Commons