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Diagnosis Guide 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’s no single test to confirm the condition. Often, a combination of methods is used to make a diagnosis.

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Recognizing symptoms

What to do before diagnosis

Before your diagnosis, you may experience rapidly changing moods and confusing emotions. It can be hard to describe exactly how you feel, but you may know that something isn’t right.

Bouts of sadness and hopelessness can become intense. It can feel as if you're drowning in despair one moment, and then later on, you’re optimistic and full of energy.

Low emotional periods aren’t uncommon from time to time. Many people deal with these periods due to everyday stresses. However, emotional highs and lows associated with bipolar disorder can be more extreme. You may notice a change in your behavior, yet you’re powerless to help yourself. Friends and family may also notice changes. If you’re experiencing manic symptoms, you may not see the need to get help from a doctor. You may feel great and not understand the concerns of those around you until your mood shifts again.

Don’t ignore how you feel. See a doctor if extreme moods interfere with daily life or if you feel suicidal.

Medical tests

Ruling out other conditions

If you experience extreme shifts in your mood that disrupt your daily routine, you should see your doctor. There are no specific blood tests or brain scans to diagnose bipolar disorder. Even so, your doctor may perform a physical exam and order lab tests, including a thyroid function test and urine analyses. These tests can help determine if other conditions or factors could be causing your symptoms.

A thyroid function test is a blood test that measures how well your thyroid gland functions. The thyroid produces and secretes hormones that help regulate many bodily functions. If your body doesn't receive enough of the thyroid hormone, known as hypothyroidism, your brain may not function properly. As a result, you may have problems with depressive symptoms or develop a mood disorder.

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

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Mental health evaluation

Mental health evaluation

A psychiatrist or psychologist will ask you 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’s known for its periods of both mania and depression. The diagnosis for bipolar disorder 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’ll 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’ve 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.

Mania

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
  • getting 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

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, 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 prevention

If 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, or you are, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Bipolar I disorder

Bipolar I disorder

Bipolar I disorder involves one or more manic episodes or mixed (manic and depressive) episodes and may include a major depressive episode. The episodes aren’t due to a medical condition or substance use.

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Bipolar II disorder

Bipolar II disorder

Bipolar II disorder has one or more severe major depressive episodes with at least one hypomanic episode. Hypomania is a lesser form of mania. There are no manic episodes, but the individual may experience a mixed episode.

Bipolar II doesn’t disrupt your ability to function as much as bipolar I disorder. The symptoms must still 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 hypomanic episodes.

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Cyclothymia

Cyclothymia

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.

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Rapid-cycling bipolar disorder

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)

Not otherwise specified (NOS)

This category is for bipolar symptoms that don’t 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.

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In children

Diagnosing bipolar disorder in children

Bipolar isn’t only an adult problem, it can also occur in children. Diagnosing bipolar disorder in children can be difficult because the symptoms of this disorder can sometimes mimic those of attention-deficit hyperactivity disorder (ADHD).

If your child is being treated for ADHD and their symptoms haven’t improved, talk to your doctor about the possibility of bipolar disorder. Symptoms of bipolar in children can include:

  • impulsiveness
  • irritability
  • aggression (mania)
  • hyperactivity
  • emotional outbursts
  • periods of sadness

The criteria for diagnosing bipolar disorder in children is similar to diagnosing the condition in adults. There’s no particular diagnostic test, so your doctor may ask a series of questions about your child's mood, sleep pattern, and behavior.

For example, how often does your child have emotional outbursts? How many hours does your child sleep a day? How often does your child have periods of aggression and irritability? If your child's behavior and attitude are episodic, your doctor may make a bipolar diagnosis.

The doctor may also ask about your family history of depression or bipolar disorder, as well as check your child’s thyroid function to rule out an underactive thyroid.

Misdiagnosis

Misdiagnosis

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 aren’t properly diagnosed for 10 years or more.

The condition shares many of the symptoms associated with other mental disorders. Bipolar disorder is often misdiagnosed as unipolar (major) depression, anxiety, OCD, ADHD, an eating disorder, or a personality disorder. 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.

Talk to your doctor if you believe you may be experiencing any symptoms of bipolar disorder or another mental health condition.

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