Diagnosis Guide for Bipolar Disorder

Written by Brian Krans | Published on July 28, 2014
Medically Reviewed by Kenneth R. Hirsch, MD on July 28, 2014

Discover the diagnostic features of bipolar disorder, a mental condition where a person fluctuates between periods of mania and depression.

Testing for Bipolar Disorder

People with bipolar disorder experience intense emotional changes that are distinctly different from their usual mood and behavior, and these changes lead to problems in their daily lives.  However, testing for bipolar disorder isn’t as simple as taking a multiple-choice test or sending some blood to the lab. While bipolar disorder does show distinct symptoms, there is no single test to confirm the condition. Usually a combination of methods is needed for a doctor to make a diagnosis. 

Medical Tests

If your symptoms are disrupting your daily routine you should see your primary care doctor. Your doctor will conduct a physical examination and may perform lab tests, such as blood or urine analyses, to help determine if other conditions or factors could be causing your symptoms. For example, certain thyroid issues may cause symptoms similar to those of bipolar disorder. Perhaps your symptoms are a side effect of another medication. Additionally, if you have used any recreational drugs you must tell your doctor – frequent drug use could be the source of your symptoms.

After other possible causes are ruled out, your doctor will likely refer you to a mental health specialist for further evaluation.

Mental Health Evaluation

A psychiatrist or psychologist will ask a series of questions to assess your overall mental health. Testing for bipolar disorder primarily involves questions about symptoms, their duration, and how they are disrupting your life. You will also be asked about certain risk factors for bipolar, which may include questions about your family medical history and any history of substance abuse.

Bipolar disorder is a mental health condition that is characterized by periods of both mania and depression; the criteria for bipolar requires at least one depressive episode and one manic episode. There will be questions about your thoughts and feelings during and after these episodes. Your doctor will want to know if you feel in control during the mania and how long the episodes last. The doctor might also ask your friends and family about your behavior. Any diagnosis will take into account other aspects of your medical history and any medications you are currently taking.

To be exact with a diagnosis, mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a technical and detailed description of bipolar disorder. Here is a breakdown of some of the terms and symptoms used for this condition.

Mania

The DSM defines mania as a “distinct period during which there is an 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:

  • inflated self-esteem
  • little need for sleep
  • pressure of speech (talking constantly)
  • flight of ideas
  • easily distracted
  • excess pursuit of goal-directed activities or psychomotor agitation (pacing, hand wringing, etc.)
  • excess pursuit of pleasure with a high risk of danger

Depression

The DSM states that a major depressive episode must have at least four of the following symptoms. They should be new or suddenly worse. They 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

Bipolar I Disorder

Bipolar I disorder involves one or more manic episodes or mixed (mania and depression) episodes. The episodes are not due to another 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 milder form of mania that is never accompanied by delusions or hallucinations.  It doesn’t disrupt the patient’s ability to function as significantly as bipolar I disorder, but nevertheless the symptoms must cause significant distress or impairment at work, school, or with personal relationships. It’s common for those with bipolar II disorder to not recall their manic episodes. 

Cyclothymia

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

Rapid-Cycling Bipolar Disorder

This category is a severe form of bipolar disorder, occurring 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, and appears to be more persistent in those who have their first bipolar episode at a young age (National Institute of Mental Health, 2012).

Bipolar Disorder 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 sufficient to meet the diagnostic criteria for any of the bipolar subtypes described above.  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 repeated hypomanic episodes without a major depressive episode.

None of this information should be used to self-diagnose bipolar disorder. This is for educational purposes only. If you experience any of these symptoms, contact your doctor or a mental health professional to obtain a diagnosis. 

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