Diagnosing bipolar disorder is difficult, as no single test can tell whether a person has bipolar disorder.
Doctors use a combination of physical examinations and laboratory testing to ensure that a physical condition is not causing the symptoms. They may then use psychiatric testing to diagnose the condition.
Just as there is no single test for bipolar disorder, there is no single way that its symptoms manifest.
A person must meet certain criteria before their doctor issues a diagnosis. This article discusses those criteria.
Mania and depression
People with bipolar disorder tend to experience intense emotional states along with other changes, which come on in episodes.
There are two main types of episode: manic episodes and depressive episodes.
A person with bipolar disorder may have episodes of mania and depression.
Manic episodes may cause symptoms that include:
- feeling euphoric, high, or extremely happy
- having increased activity levels
- having excess energy
- having difficulty sleeping or staying asleep
- feeling energized all the time
- feeling as if the mind is racing
- talking very fast and jumping between topics
- trying to take on many tasks at once
- displaying irritation or aggressiveness
- engaging in impulsive behaviors, such as spending too much money or engaging in unsafe sexual practices
Symptoms of a depressive episode may include:
- feeling very sad or hopeless
- having severely decreased activity levels
- having very little energy throughout the day or feeling tired all day
- having sleep issues, such as sleeping too much or having difficulty sleeping
- feeling worried or anxious regularly
- feeling as if it will not be possible find joy in things that used to be enjoyable
- having difficulty concentrating on anything
- having difficulty remembering things
- experiencing eating issues, such as binge eating or not eating
- idealizing death or having suicidal thoughts
Importantly, it is normal for a person to feel some of these symptoms occasionally. This does not necessarily mean that they have bipolar disorder.
Symptoms of bipolar disorder disrupt a person's life and can be difficult to manage. The symptoms may last for days or weeks.
There are four main subtypes of bipolar disorder, and the criteria for diagnosis is slightly different for each. The common symptom in all types is an unusual change in mood.
Bipolar I disorder
For a bipolar I diagnosis, a person needs to have a manic episode. The manic episode must last for at least 7 days, or any duration if the symptoms are so severe that hospitalization is necessary.
Some people also experience depressive episodes that also include symptoms of mania.
Bipolar II disorder
A person with bipolar II disorder has depressive episodes that precede or follow an episode of hypomania.
Hypomania is a less severe form of mania. It may still cause the person to feel very euphoric or have a lot of energy, but the person may not feel that there is anything imbalanced or wrong.
A person with cyclothymia or cyclothymic disorder may experience many symptoms of hypomania and many symptoms of depression for over 2 years, or 1 year in children.
However, these symptoms are not strong enough or do not otherwise meet the diagnostic criteria for hypomania or a major depressive disorder.
Unspecified bipolar disorder
A person with unspecified bipolar disorder may experience bipolar symptoms that do not fit into a pattern as the other three types do.
Writing a mood journal can help with monitoring bipolar disorder symptoms.
Testing for bipolar disorder can be a long process, as it requires doctors to monitor a person carefully and note any symptoms, as well as how long they last.
Doctors will often ask the person to keep a mood journal, in which they can write about their general mood and any noticeable symptoms each day.
Often, the doctor will obtain permission to interview family members to learn about mood and behavioral symptoms that the person themselves may not be aware of.
They will combine these data with their own observations about the person's symptoms and asses their full range of symptoms using the Diagnostic and Statistical Manual of Mental Disorders.
Testing for other disorders
Doctors need to take time with the testing process, as other mental health conditions may cause similar symptoms. Monitoring and testing helps ensure that the person receives the correct treatment for their condition.
Doctors will often perform a physical examination when the person first visits them. This may not help with a bipolar diagnosis, but it may help rule out physical issues that can cause similar symptoms.
For instance, issues with the thyroid gland may cause similar symptoms to those of manic or depressive episodes.
Some symptoms that may seem similar to symptoms of bipolar disorder may also appear in a few different mental health conditions.
For instance, symptoms such as impulsive behavior and mood swings may appear in conditions such as:
- attention deficit hyperactivity disorder (ADHD)
- some anxiety disorders
- substance abuse disorders
- borderline personality disorder
- impulse control disorders
Also, people with bipolar disorder may be more likely to experience other conditions, such as anxiety, ADHD, and substance abuse.
During the testing process, doctors may also ask about or check for other risk factors for bipolar disorder.
- Brain structure: According to the National Institute of Mental Health (NIMH), some research suggests that the brain of a person with bipolar disorder may be different from the brain of a person without it, or that of someone with a different mental health condition. However, it is unknown if these changes occur before or after the symptoms of bipolar develop.
- Family history: People with a close relative who has bipolar disorder are more likely to develop the condition. A study in The Primary Care Companion for CNS Disorders notes that 80–90 percent of people with bipolar describe family members who have had mood disorders.
Genes: Some genes may play a role in bipolar disorder.
A doctor or psychiatrist can diagnose bipolar disorder.
Properly diagnosing bipolar disorder is crucial to get the person medical treatment and help them live a balanced life.
Anyone who feels that they may have bipolar disorder should talk to a doctor or mental health professional first and foremost.
A doctor may perform a physical exam to help them rule out other conditions or deficiencies. After checking for other conditions, doctors will typically refer the person to a mental health specialist for an evaluation.
Specialists such as psychiatrists or psychologists perform these evaluations, as they have more experience in diagnosing and treating these types of conditions.
Once the mental health specialist has tested the person and finds that they meet the criteria for bipolar disorder, treatment can begin.
Diagnosis in children
As the NIMH note, people with bipolar disorder tend to develop the condition in their "late teen or early adult years."
That said, bipolar disorder can also affect children. It can be difficult to diagnose, as some of the symptoms may appear similar to those of other conditions, such as ADHD.
Symptoms in children may include:
- experiencing hyperactivity
- acting overly silly in a way that is out of character
- displaying aggressiveness
- having emotional outbursts or difficulty controlling emotions
- experiencing intense mood changes
- being impulsive
- displaying sadness or depression
Due to the similarities between the two conditions, doctors may begin treating ADHD first in many cases. If the child's symptoms are not responding to ADHD medications, talk to a doctor about other possible conditions, such as bipolar disorder.
Bipolar disorder can disrupt a person's life. A thorough diagnosis is important in each case to ensure that the person is getting the correct treatment.
Misdiagnosis is possible. Anyone who is not responding to their treatment should discuss this with their doctor.
Bipolar disorder is a lifelong condition. However, treatment helps many people with bipolar disorder, even those with more severe symptoms. Treatment commonly consists of a combination of medication and psychotherapy.
Anyone who thinks that they have bipolar disorder, or any other mental health condition, should talk to a doctor for a full diagnosis.