Bipolar Disorder Symptoms and Diagnosis

Understanding the signs of bipolar disorder can be challenging, particularly in children and teens.

In general, the symptoms of bipolar disorder depend on which type of the condition a person has.

Bipolar I, for example, is characterized by extreme manic or mixed episodes and at least one major depressive episode.

With bipolar II, you may experience a major depressive episode as well as an episode of hypomania (less severe than full mania), with periods of level mood between episodes.

Finally, in cyclothymia — a milder form of bipolar disorder — people experience less severe manic and depressive episodes that alternate for at least two years.

So what constitutes a manic, hypomanic, or depressive episode?

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Manic and Hypomanic Episodes

The Diagnostic and Statistical Manual of Mental Disorders — which doctors use to guide diagnosis — describes a manic episode as a period of abnormally and persistently elevated mood, characterized by increased goal-directed activity or energy, that lasts for at least a week, with symptoms present most of the day, everyday.

A hypomanic episode has similar daily symptoms but is shorter in duration — at least four days.

During a manic or hypomanic episode, you may experience the following symptoms or changes in behavior:

You’re easily distracted.
You feel as though your thoughts are racing.
You experience high levels of self-esteem.
Your need for sleep is reduced.
You’re unusually, or excessively, talkative.
You engage in reckless behavior (such as shopping sprees or sexual activity).
For your behavior change to be considered a manic episode, it must:

Involve a distinct and noticeable change in mood and functioning
Be severe enough to cause noticeable problems in your day-to-day activities or require hospitalization to prevent harm to yourself or others
Not be the result of alcohol or drug use, a medication you’re taking, or another medical condition
A manic episode may also trigger a break from reality (psychosis).

For your behavior change to be considered a hypomanic episode, it must:

Involve a distinct and noticeable change in mood and functioning
Not be significant enough to disrupt daily activities or require hospitalization
Not be the result of alcohol or drug use, a medication you’re taking, or another medical condition
Depressive Episodes

Signs and symptoms of a major depressive episode include:

Depressed mood
Lack of interest in, or pleasure from, normal daily activities
Significant weight loss or gain and/or changes in appetite
Insomnia or excessive need for sleep
Restlessness or slowed behavior
Fatigue or loss of energy
Feelings of worthlessness or guilt
Inability to think or concentrate
Thoughts of death or suicide
To be considered a major depressive episode, you must experience five or more of these symptoms daily or nearly every day — for most of the day — over a two-week period, with at least one of the symptoms being a depressed mood or loss of interest or pleasure in activities.
Your symptoms must also cause disruption in your day-to-day activities, as well as social activities or relationships.

As with manic episodes, they must also not be the result of alcohol or drug use, a medication you’re taking, or another medical condition, or be caused by grieving (such as after the loss of a loved one).

Other Symptoms and Patterns

Other potential signs and symptoms of bipolar I and II include:

Mixed episodes (experiencing some of the symptoms of manic or hypomanic and major depressive episodes simultaneously)
Loss of pleasure in all or most activities
Catatonia (state of limited or abnormal movement)
Psychosis (detachment from reality, often with hallucinations or delusions)
People with catatonia don’t react to their environment normally, and they may hold their body in an unusual position. Often they don’t speak.

People with psychosis experience a severe episode of either mania or depression that causes them to become detached from reality. They may develop false — but strongly held — beliefs (delusions) and have hallucinations.

Both bipolar I and bipolar II may occur after a woman becomes pregnant or within a month of giving birth (peripartum onset).

The disorders may also follow a so-called seasonal pattern, in which episodes change with the seasons.

Finally, there is a form of the disorder called rapid cycling in which you may experience four or more mood-swing episodes within a single year, with full or partial disappearance of symptoms between episodes.

Bipolar Tests and Diagnosis

Because of the unresolved questions surrounding the causes of bipolar disorder, the condition remains a challenge to diagnose.

If you or your doctor suspect that you may have a form of bipolar disorder, you will most likely undergo:

A physical exam — including blood tests — to rule out other causes of your symptoms
An MRI, PET, or CT scan to identify potential abnormalities or changes in your brain structure or chemistry that are linked to bipolar disorder or to rule out other disease
A psychological exam, in which your doctor will ask you about your thoughts, feelings, and behaviors (family and friends may also be consulted, with your permission)
Daily tracking of your moods and behaviors to confirm diagnosis
There are also multiple bipolar tests, or formal, clinically tested questionnaires designed to identify and clarify your symptoms and assist in diagnosis. Your doctor may or may not use such a questionnaire.

Bipolar Disorder in Children and Teens

Although bipolar disorder has the same symptoms in children and teenagers as it does in adults, these symptoms may be more challenging to identify in younger people.
This is because they are often difficult to distinguish from normal mood changes that can occur as a result of stress or trauma.

As a result, children with bipolar disorder are frequently misdiagnosed with other mental health conditions.

If your child shows signs of severe mood swings that appear different from previous or normal mood swings, talk to your doctor or pediatrician.


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