Diagnosis guide to bipolar disorder

Part 1 of 4
Testing for bipolar disorder
People with bipolar disorder go through intense emotional changes that are very different from their usual mood and behavior. These changes affect their lives on a day-to-day basis.

Testing for bipolar disorder isn’t as simple as taking a multiple choice test or sending blood to the lab. While bipolar disorder does show distinct symptoms, there is no single test to confirm the condition. Often, a combination of methods is used to make a diagnosis. 

Part 2 of 4
Medical tests
If you experience extreme shifts in mood that disrupt your daily routine, you should see your doctor. They will perform a physical exam and may also order lab tests, including blood and urine analyses. These tests can help determine if other conditions or factors could be causing your symptoms.

Sometimes, certain thyroid issues cause symptoms that are similar to those of bipolar disorder. Symptoms may also be a side effect of other medications. After other possible causes are ruled out, your doctor will likely refer you to a mental health specialist.

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Part 3 of 4

Mental health evaluation
A psychiatrist or psychologist will ask questions to assess your overall mental health. Testing for bipolar disorder involves questions about symptoms, how long they’ve occurred, and how they may disrupt your life. The specialist will also ask you about certain risk factors for bipolar. This includes questions about family medical history and any history of drug abuse.

Bipolar disorder is a mental health condition that is known for its periods of both mania and depression. The diagnosis for bipolar requires at least one depressive and one manic or hypomanic episode. Your mental health specialist will ask about your thoughts and feelings during and after these episodes. They will want to know if you feel in control during the mania and how long the episodes last. They might ask your permission to ask friends and family about your behavior. Any diagnosis will take into account other aspects of your medical history and medications you have taken.

To be exact with a diagnosis, doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a technical and detailed description of bipolar disorder. Here’s a breakdown of some of the terms and symptoms used to diagnose the condition.

The DSM defines mania as a “distinct period of abnormally and persistently elevated, expansive, or irritable mood.” The episode must last at least a week. The mood must have at least three of the following symptoms:

high self-esteem
little need for sleep
increased rate of speech (talking fast)
flight of ideas
easily distracted
an increased interest in goals or activities
psychomotor agitation (pacing, hand wringing, etc.)
increased pursuit of activities with a high risk of danger

The DSM states that a major depressive episode must have at least four of the following symptoms. They should be new or suddenly worse, and must last for at least two weeks:

changes in appetite or weight, sleep, or psychomotor activity
decreased energy
feelings of worthlessness or guilt
trouble thinking, concentrating, or making decisions
thoughts of death or suicidal plans or attempts
Suicide preventionIf you think someone is at immediate risk of self-harm or hurting another person:
Call 911 or your local emergency number.
Stay with the person until help arrives.
Remove any guns, knives, medications, or other things that may cause harm.
Listen, but don’t judge, argue, threaten, or yell.
If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Sources: National Suicide Prevention Lifeline • Substance Abuse and Mental Health Services Administration

Bipolar I disorder
Bipolar I disorder involves one or more manic episodes or mixed (mania and depression) episodes and at least one major depressive episode. The episodes are not due to a medical condition or substance use.

Bipolar II disorder
Bipolar II disorder has one or more severe major depressive episodes with at least one hypomanic episode. There are no manic or mixed episodes. Hypomania is a lesser form of mania. It doesn’t disrupt your ability to function as much as bipolar I disorder. The symptoms must cause a lot of distress or problems at work, school, or with relationships. It’s common for those with bipolar II disorder to not remember their manic episodes.

Cyclothymia is characterized by changing low-level depression along with periods of hypomania. The symptoms must be present for at least two years in adults or one year in children before a diagnosis can be made. Adults have symptom-free periods that last no longer than two months. Children and teens have symptom-free periods that last only about a month.

Rapid-cycling bipolar disorder
This category is a severe form of bipolar disorder. It occurs when a person has at least four episodes of major depression, mania, hypomania, or mixed states within a year. Rapid cycling affects more women than men.

Not otherwise specified (NOS)
This category is for bipolar symptoms that do not clearly fit into other types. NOS is diagnosed when multiple bipolar symptoms are present but not enough to meet the label for any of the other subtypes. This category can also include rapid mood changes that don’t last long enough to be true manic or depressive episodes. Bipolar disorder NOS includes multiple hypomanic episodes without a major depressive episode.

Part 4 of 4
Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it’s diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided. Other factors of a misdiagnosis are inconsistency in the timeline of episodes and behavior. Most people don’t seek treatment until they experience a depressive episode.

According to a 2006 study published in Psychiatry, around 69 percent of all cases are misdiagnosed. One-third of those are not being properly diagnosed for 10 years or more.

Bipolar disorder is often misdiagnosed as unipolar depression, anxiety, OCD, ADHD, an eating disorder, or a personality disorder. The condition shares many of the symptoms associated with other mental disorders. Some things that may help doctors in getting it right are a strong knowledge of family history, fast recurring episodes of depression, and a mood disorder questionnaire.

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