How Is Bipolar Disorder Diagnosed?

How Is Bipolar Disorder Diagnosed?

Bipolar disorder is a complex condition, which can make diagnosis a difficult and lengthy process that can require a multidisciplinary team. Assessment typically begins by comparing one’s lived experience with the DSM-5’s classified bipolar symptoms. Additionally, the doctor will ask for a medical history, family history and may conduct a physical exam and order lab tests to rule out any other conditions.

A person should seek a medical exam if they are experiencing three or more of the following DSM-5 criteria for mania:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity)
• Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)⁶

A person should also monitor themselves to see if they are experiencing five or more of the following DSM-5 criteria for depression in bipolar disorder:

• Intense sadness or despair
• Loss of interest in activities the person once enjoyed
• Feelings of worthlessness or guilt
• Fatigue
• Increased or decreased sleep, including insomnia
• Increased or decreased appetite
• Restlessness (e.g., pacing) or slowed speech or movement
• Difficulty concentrating
• Frequent thoughts of suicide⁷

Why Is Bipolar So Often Misdiagnosed?

The diagnostic process for bipolar disorder is complex because there is a lot of overlap between bipolar symptoms and symptoms of other mental health disorders. For example, an individual with bipolar II diagnosis only requires one manic episode to occur throughout the duration of one’s life, it may be easily misdiagnosed as a type of major depressive disorder.

There is also a lot of misinformation surrounding bipolar disorder. If an individual does not understand facts vs. myths about bipolar disorder, they may not seek the proper help. If an individual receives the wrong diagnosis, they won’t get effective treatment.

Fortunately, advances in technology, research, and understanding of the condition have helped doctors and researchers come a long way in understanding mood disorders.

Bipolar Diagnosis in Children

Diagnosing a child with bipolar disorder can be challenging due to the overlap of symptoms with other conditions, such as attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. Children may normally experience rapid mood swings, which can make it difficult to distinguish between typical childhood behaviors and symptoms of bipolar disorder.

In order to receive a proper diagnosis, parents/guardians should start by keeping a daily log of their child’s behaviors, including mood swings, sleep changes, irritability, and hyperactivity. It is also helpful to track any triggers that may contribute to changes in behavior, such as stressors at school or home. Additionally, parents should observe their child’s interactions with peers and family members. This information can provide valuable insight for a mental health professional toward making an accurate diagnosis and developing an effective treatment plan.

Children tend to have less emotional regulation than adults, so it can be hard to identify bipolar behaviors, but the most common symptoms of bipolar in children include:

• Serious mood swings: These should differ from their usual mood swings, can last a long time, and greatly affect the way a child acts.
• Changes in energy: Being very hyperactive and aggressive, which affects how a child acts socially.
• Racing thoughts: Racing thoughts are sometimes shown by quickly and often changing subjects when talking.
• Difficulties with sleep: Being unable to sleep or greatly decreased need for sleep.
• Depression and/or irritability: Depressed or irritable mood most of the day, nearly every day, during a depressive bout.
• Inflated sense of self: An inflated view of capabilities that are not based on reality and not appropriate for their age
• Suicidal thoughts or behaviors: These symptoms occur more often in older children than in younger children.
• Loss of contact with reality: This includes seeing things that aren’t there or believing that someone is trying to hurt them.⁸

Information Your Doctor Will Need for a Bipolar Diagnosis

Because bipolar can be difficult to diagnose, a doctor will ask a lot of in-depth questions regarding mood, sleep patterns, energy levels, appetite, and any medications taken. If someone is considering seeking a bipolar diagnosis, they should start thinking about and monitoring their symptoms. This can help provide valuable information to the doctor and assist in making the most accurate diagnosis, contributing toward a comprehensive treatment plan.

Insofar as tracking bipolar cycles, individuals may want to use a mood chart or tracker, which can help identify patterns in mood and behavior. By monitoring symptoms and tracking cycles, individuals can play an active role in their mental health care while working to improve overall well-being.

Questions an adult can expect their MD, psychiatrist, or therapist to ask include:

• What are your typical moods and behaviors like? How have they changed recently?
• Have you experienced any intense mood swings that are different from your typical moods or behaviors?
• Are there any triggers that seem to contribute to changes in your mood or behavior?
• Have you ever experienced symptoms of depression, such as feelings of sadness, loss of interest, or changes in sleep or appetite?
• Have you ever experienced symptoms of mania or hypomania, such as unusually elevated mood, increased energy, or racing thoughts?
• Have you ever experienced psychotic symptoms, such as delusions or hallucinations?
• When did you start feeling this way?
• Are there any family members with a history of bipolar disorder or other mental health conditions?
• Have you received treatment for any mental health conditions in the past?

Questions a parent/guardian can expect their child’s MD, psychiatrist, or therapist to ask include:

• What are the child’s typical moods and behaviors like? How have they changed in recent months?
• Does the child have a family history of bipolar disorder or other mental health conditions?
• Are there any triggers that seem to contribute to changes in the child’s mood or behavior?
• How is the child functioning in various settings, such as at home, school, or in social situations?
• Have there been any incidents of aggressive or violent behavior?
• How often are outbursts?
• Is the child experiencing any symptoms of depression, such as feelings of sadness, loss of interest, or changes in sleep or appetite?
• Have there been any instances of risky or impulsive behavior, such as substance abuse or reckless driving?
• Have there been any instances of self-harm or suicidal thoughts or behaviors?

It’s important to note that these are just a few examples of questions a healthcare professional may ask, as a comprehensive evaluation is typically needed to make an accurate diagnosis.

What Tests Are Used to Diagnose Bipolar Disorder?

Healthcare professionals may begin with a range of diagnostic tools and assessments to gather information and assist in making a diagnosis. One commonly used tool is the Mood Disorder Questionnaire (MDQ), which is a screening tool designed to identify symptoms of bipolar disorder. The MDQ includes questions about mood changes, energy levels, and other symptoms commonly associated with bipolar disorder. The Bipolar Spectrum Diagnostic Scale (BSDS) is another commonly used assessment.

It’s important to note that there is no singular biological marker for bipolar disorder.⁹ Accordingly, there are no specific lab tests or imaging studies that can diagnose the condition. Healthcare professionals routinely perform physical exams and/or order lab tests to rule out any underlying medical conditions that may be contributing to symptoms. Blood tests, thyroid function tests, and drug screens may be ordered to help rule out other conditions that may present with similar symptoms.

Brain Scans & Bipolar Diagnosis

Brain imaging studies, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have been used to study the brains of individuals with bipolar disorder. These studies have identified differences in brain structure and function between individuals with bipolar disorder and those without the condition.

The changes identified in research studies are not consistent, and therefore imaging tests are not helpful in diagnosing bipolar disorder, but they might be used to rule out other conditions that can present with similar symptoms, such as meningitis or a stroke.

Challenges of Diagnosing Bipolar Disorder

Much of the diagnostic protocol for bipolar disorder revolves around ruling out other conditions because many psychiatric and medical conditions can present similar symptoms (e.g., mood swings, fatigue, sleep disturbances). This can make it challenging to differentiate between bipolar disorder and other conditions, such as depression, anxiety disorders, or thyroid disorders.

Determining a bipolar diagnosis can take several months to years, as individuals may experience different symptoms at different times and may not report all their symptoms during a single visit. Moreover, gender discrepancies, age-specific concerns, societal influences, and barriers to access can influence the diagnosis of bipolar disorder.¹⁰

For example, younger patients may be misdiagnosed with ADHD or conduct disorder, while older patients may be misdiagnosed with dementia or Parkinson’s disease. Socioeconomic factors, such as poverty and lack of access to healthcare, can also affect the diagnosis and treatment of bipolar disorder.

Other conditions that could be causing bipolar disorder symptoms include:

• Major depressive disorder (MDD): MDD is similar to bipolar disorder because both involve symptoms of depressed mood, loss of interest in activities, and changes in appetite and sleep patterns. However, it does not include manic or hypomanic episodes.
• Substance abuse/addiction: Addiction and bipolar can be confused because addiction can lead to mood swings, irritability, and impulsivity, which can mimic symptoms of bipolar disorder. However, these symptoms typically disappear once the substance is no longer being abused.
• Thyroid disorders: Hypothyroidism and hyperthyroidism can cause mood swings, fatigue, and changes in appetite and sleep patterns that can be mistaken for bipolar disorder.
• Attention-deficit/hyperactivity disorder (ADHD): ADHD and bipolar both present symptoms of impulsivity, hyperactivity, and poor concentration, which can cause an individual to be misdiagnosed as bipolar disorder.
• Borderline personality disorder (BPD): BPD can be mistaken for bipolar because they both can cause mood swings, impulsivity, and unstable relationships.
• Schizophrenia: Schizophrenia can present with hallucinations, delusions, and disorganized thinking, which can be misinterpreted as symptoms of bipolar disorder.
• Traumatic brain injury (TBI): TBI can cause mood swings, irritability, and impulsivity, which can mimic symptoms of bipolar disorder.
• Sleep disorders: Sleep disorders, such as sleep apnea and restless leg syndrome, can cause fatigue, disrupted sleep, and irritability, which can be mistaken for bipolar disorder. However, bipolar disorder is characterized by distinct episodes of mania or hypomania.
• Post-traumatic stress disorder (PTSD): Bipolar disorder and PTSD have many overlapping symptoms, including rapid mood cycling, less satisfaction with life, and increased suicide attempts. Individuals with bipolar II are especially at risk of being misdiagnosed with PTSD because their predominant symptoms are depressive and, therefore, are more easily mistaken for PTSD.

What Happens After Bipolar Disorder Diagnosis?

Bipolar disorder is a lifelong condition and managing it requires ongoing care and attention. With the right treatment and support, however, many people with bipolar disorder can lead full and productive lives. After someone has received a bipolar diagnosis, their next step involves working with their healthcare team to develop a bipolar disorder treatment plan that meets their individual needs.

Bipolar treatment typically includes medication management, psychotherapy, and lifestyle changes. This can involve:

• Medication for bipolar: Medication for bipolar disorder may include mood stabilizers, antipsychotics, and antidepressants, which can help manage mood swings and other symptoms.
• Psychotherapy: Psychotherapy can be particularly helpful in developing coping strategies and improving communication with family and friends. Cognitive behavioral therapy (CBT) for bipolar is an evidence-based treatment that is a particularly effective form of therapy.
• Lifestyle changes: Lifestyle changes are often needed to manage their symptoms better. These may include getting enough sleep, healthy eating, exercise, and others. It is also highly recommended to avoid alcohol and drugs, as they can exacerbate symptoms.
• Building a support system: Bringing family and loved ones into their support network can also be an important part of managing bipolar disorder. This can involve educating them about the condition and how it affects the person’s life, as well as working together to identify triggers and develop coping strategies.
• Support groups: Support groups can also be a valuable resource for people with bipolar disorder and their loved ones.

Can a Bipolar Diagnosis Be Reversed?

Bipolar is a treatable but incurable condition. A bipolar diagnosis can only be “reversed” if the individual was misdiagnosed. According to research, up to 69% of people with bipolar disorder are initially misdiagnosed with another condition.¹⁰ If a diagnosis of bipolar disorder is “reversed,” it is because another condition better explains the individual’s symptoms.

Should I Get a Second Opinion?

Given that bipolar disorder can be misdiagnosed, a second opinion from a mental health professional can confirm whether the initial diagnosis was accurate while helping ensure that one receives appropriate treatment for their specific condition. It can also provide an individual with peace of mind and a sense of control over their healthcare. Further, a second opinion can offer additional insights and alternative treatment options that may not have been considered initially.

Can I Qualify for Disability?

For some, managing bipolar disorder can be a long and challenging process that may require taking time off work, school, or otherwise. In such cases, disability coverage may be available to help provide financial and medical support. Disability coverage for bipolar disorder is typically provided through employer-provided disability insurance or through government programs such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

To qualify for disability coverage for bipolar disorder, the individual must meet specific criteria established by the insurer or government agency. These criteria typically include:

• Having a documented history of bipolar disorder
• Demonstrating that the condition prevents the individual from working
• Providing appropriate medical documentation to support the claim.

It’s important to note that qualifying for disability coverage for bipolar disorder can be a complex process, and it may be helpful to seek guidance from a mental health professional or disability specialist.

How Do I Accept My Bipolar Diagnosis?

Accepting that bipolar disorder is a lifelong condition and not curable can be difficult, but it’s an important step in moving forward and developing coping strategies. it’s important to remember that the condition is manageable with appropriate treatment and support. It’s also important to remember that the condition does not define the person and that they can still lead a fulfilling and meaningful life with the right support and treatment.

Finding a therapist who specializes in bipolar disorder is an important step toward managing symptoms. Therapy can provide individuals with coping strategies and support. It can also help improve communication with family and friends and provide a safe and non-judgmental space to discuss related challenges and concerns. With the right treatment and support, individuals with bipolar disorder can and do lead fulfilling and meaningful lives.

I Am Worried About the Genetic Implications

Despite bipolar’s genetic component, one is discouraged from worrying about this too much. Having a family history of bipolar disorder does not necessarily mean that one’s offspring will develop the condition, too. Being aware of the risk factors and having open and honest communication with family members about the condition can be helpful in managing the condition as well as reducing such worry.

In My Experience

Diagnosing bipolar disorder can be a complex process that requires ruling out other conditions that can cause similar symptoms. Misdiagnosis is not uncommon, which is why it’s important to work with a mental health professional in a multidisciplinary team to develop an accurate diagnosis and treatment plan.

While early diagnosis and intervention is best, it is especially important if the condition has become debilitating. Common treatments for bipolar disorder include medication management and psychotherapy. People with bipolar disorder may need to make lifestyle changes to better manage their symptoms and bring family and loved ones into their support network. When properly treated, people with bipolar disorder lead fulfilling and meaningful lives, and this can be true for anyone who has read this article as well. Hang in there and remember that help is out there.