How Is bipolar disorder diagnosed?
People who have bipolar disorder experience a range of symptoms depending on their mood state. These emotional or mood states include manic or hypomanic episodes, depressive episodes, and periods of regulated (normal) moods. Because people cycle between these moods — and can have weeks or months when they aren’t manic or depressed — getting an accurate diagnosis of bipolar disorder can be challenging.
From the community: “I have been diagnosed with bp 2 by 2 psychiatrists even though never having had a major depression. If I've ever had depression it was mild at best. I've favored cyclothymia but they wouldn't buy it…I used to doubt the whole thing in diagnosing me with bp. But I can't deny I develop many strong fixations/hobbies periodically and I justify many inappropriate behaviors. And my son has been diagnosed with it. And my family history has one distant relative documented with it who committed suicide and many others I think suspicious for it...” – Inspire member
What is bipolar disorder?
Bipolar disorder is a type of mood disorder that causes fluctuations in your energy levels and emotional state. During a manic episode, you may feel energized, happy, and display an overinflated ego. Depressive episodes are marked by low energy levels and feelings of hopelessness, worthlessness, and sadness.
It’s estimated that more than 3 million Americans have bipolar disorder. Symptoms of bipolar disorder typically appear during adolescence or early adulthood. But the condition can also appear in older adults and young children. Even with the onset of manic or depressive symptoms, it can take a while to determine whether you truly have bipolar disorder.
Why is it difficult to diagnose bipolar disorder?
Some studies suggest that it can take as long as 5 to 10 years to receive a bipolar disorder diagnosis after the initial onset of symptoms. There are many reasons for this delay, such as:
Other mental health disorders like depression and borderline personality disorder (BDP) cause similar symptoms.
People in the manic phase of bipolar disorder can experience psychosis (hallucinations and delusions). They may be misdiagnosed as having a psychotic disorder like schizophrenia or schizoaffective disorder.
Who diagnoses bipolar disorder?
Psychiatrists typically diagnose bipolar disorder. These medical doctors specialize in diagnosing and treating all types of mental disorders. A mental health professional like a psychologist or licensed clinical social worker may suspect bipolar disorder based on your symptoms. These specialists may refer you to a psychiatrist for a psychiatric evaluation. Occasionally, a primary care physician (PCP) may make a diagnosis.
From the community: “I fought my diagnosis for years. I agree - get a 2nd opinion. That helped me come to terms with it. When a spouse cares about you, which hopefully your wife does, her input about your behavior is alot better than you think regarding assessing your behavior and whether it might be manic or not. I agree with couples counseling too. Consider having your wife go for separate counseling as well because she may have some issues to work through too. And you should have a counselor for you in addition to your psychiatrist. It's a lot of therapists, at least initially, but it's worth it…” – Inspire member
What tests do doctors use to diagnose bipolar disorder?
Your doctor may use different tests to determine whether you have bipolar disorder. These tests include:
Physical examination: You may get blood tests and a physical exam to rule out other conditions that cause similar symptoms. For instance, an overactive thyroid (hyperthyroidism) can cause mood swings, fatigue, sleep issues, and irritability.
Medical history: As part of the physical exam, your doctor will ask about your family history of mental illness and other health conditions. Having a close relative like a parent or sibling with bipolar disorder is a risk factor for the condition.
Mood charting: You may need to keep a daily journal of your emotional states, sleep patterns, and other symptoms to share with your doctor.
Mental health assessment: A psychiatrist or other mental health expert can evaluate your symptoms, including their severity, frequency, and impact on your life. You may complete a questionnaire. This specialist may also ask to speak to your loved ones to learn more about your symptoms and behaviors.
How do doctors make a bipolar disorder diagnosis?
In order to make a bipolar disorder diagnosis, your doctor evaluates your symptoms to see if they match criteria established by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). There are different types of bipolar disorder, so symptoms and their duration can vary.
According to the most recent edition of the DSM (DSM-5-TR), you must meet these criteria to receive a diagnosis of some type of bipolar disorder:
depressive episode that lasts for two weeks with five or more depressive symptoms present throughout most of each day
manic episode that lasts for at least one week with a minimum of three manic symptoms present throughout most of each day
hypomanic episode that lasts for four consecutive days, with at least three hypomanic symptoms present throughout each day
cyclothymic episodes that cause milder mood swings that persist for a period of two years with no more than a two-month break between symptoms
What other conditions can occur with bipolar disorder?
People with bipolar disorder are more likely to have other mental health disorders. The same tests used to diagnose bipolar disorder can help identify these issues. Proper diagnosis of all mental health disorders is key to getting the appropriate treatments and improving quality of life.
Someone with bipolar disorder may also have:
anxiety disorder and panic attacks
eating disorders like binge eating or bulimia
substance use disorders
What happens after a bipolar disorder diagnosis?
Bipolar disorder is a lifelong condition that requires treatment. There are different types of medications and psychotherapies that can help. Your doctor will work with you to find the best combination of therapies to help you manage symptoms and enjoy life.
Sources
Expert Q&A: Bipolar disorder. American Psychiatric Association.
What are bipolar disorders? American Psychiatric Association. January 2021.
Bipolar disorder. Cleveland Clinic. April 2022.
Hypomania. Cleveland Clinic. September 2021.
Bipolar disorder: Diagnosis. Mayo Clinic. February 2021.
Bipolar disorder. MedlinePlus. September 2021.
Bipolar disorder. Mental Health America.
Bipolar disorder. National Alliance on Mental Illness. August 2017.
Any mood disorder. National Institute of Mental Health.
Bipolar disorder. National Institute of Mental Health. October 2018.
Diagnosing bipolar disorder in adults. NYU Langone Health.
Cha B, et al. Polarity of the first episode and time to diagnosis of bipolar 1 disorder. Psychiatry Investigation. June 2009.
Disclaimer
Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.
This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
