Diagnosis for Bipolar Disorder

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 are used to make a diagnosis. 

Medical tests

If your symptoms disrupt your daily routine, see a doctor. Your doctor will do a physical exam and may perform lab tests. These may include blood and urine analyses. This helps decide if other conditions or factors could be causing symptoms. Sometimes certain thyroid issues cause symptoms that are similar to those of bipolar disorder.

Symptoms may also be a side effect of other medication.

After other possible causes are ruled out, the doctor will likely refer you to a mental health specialist.

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. You will also be asked 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 (depending on the type of bipolar disorder that you have). 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 ask your 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 is a breakdown of some of the terms and symptoms used for this condition.


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:

  • 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. 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 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 before a diagnosis can be made (one year in children). Adults have symptom-free periods that last no longer than two months. Kids 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. It appears to be more common in those who have their first bipolar episode at a young age.

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 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. 


Growing up, everyone thought I was some jerk kid who lashed out with this enormous anger all the time. My parents were confused and my teachers thought I was a troublemaker with impulse issues. Doctors thought I could not control my anger and sadness due to learning disabilities and depression. That is until one day, a doctor finally told me I had bipolar disorder.
– Jessica McNeil, living with bipolar disorder

Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it is 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 study done by the National Depressive and Manic-Depressive Association (DMDA), 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 taking a mood disorder questionnaire.