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Diagnosing Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) is a common mental health condition that often goes undiagnosed or misdiagnosed for years. This is because its symptoms may be confused with other mental health conditions such as substance use disorder, schizophrenia, or borderline personality disorder. Bipolar symptoms also may be caused by other health conditions, such as hypothyroidism.1,2

Your doctor will diagnose you with BPD after ruling out other conditions and looking for specific behavioral symptoms. This process includes a physical exam, a series of tests, and talking to you and your loved ones.1,2

Symptoms of bipolar disorder

Doctors use a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose BPD and other mental health issues. To be diagnosed with bipolar disorder, a person must have the following symptom patterns. The pattern determines what type of BPD they are diagnosed with:2

  • Bipolar 1 (BD-I) – At least 1 episode of mania and 1 episode of depression
  • Bipolar 2 (BD-II) – At least 1 episode of depression and 1 episode of hypomania, but not mania
  • Cyclothymic disorder, or cyclothymia – Episodes of hypomania and mild depression for 2 years in adults (1 year in children) with no major depression or mania

Mania

The DSM lists these specific symptoms of mania:2

  • An inflated sense of self or grandiosity
  • Going for several days with little to no sleep
  • Loud, rapid talking, or inability to stop talking
  • Hostile or angry tirades, especially if interrupted
  • Speech that is disorganized or difficult to understand
  • Racing thoughts
  • Being easily distracted by unimportant things
  • Starting multiple, unrealistic projects, often with no expertise in those areas
  • Restlessness or pacing
  • Increased sex drive, sociability, or religious activities
  • Reckless behavior
  • Psychosis (being unable to tell what is real, such as having hallucinations and delusions)

Hypomania

Hypomania is a milder form of mania. Someone with hypomania may be more energetic and distracted, need less sleep, and be more talkative than usual. But they will not have psychosis or need a hospital stay. Hypomania is not severe enough to disrupt a person’s personal connections, work, or school.2

Depression

The DSM criteria for bipolar depression include:2

  • Low mood and loss of interest or pleasure
  • Feeling sad, hopeless, empty, or tearful most of the day, nearly every day
  • Weight loss or weight gain, or loss or increase in appetite
  • Sleeping too much (hypersomnia) or not enough (insomnia)
  • Other people saying the person seems restless or “slowed down”
  • Extreme tiredness (fatigue)
  • Feelings of worthlessness or guilt
  • Trouble concentrating or making decisions
  • Thoughts of death and dying

Physical exam and medical history

Before diagnosing BPD, your doctor will need to rule out other health conditions that may cause similar symptoms. They begin this process by asking about your medical history and conducting a physical exam.1,3

Your doctor will ask you a variety of questions about your health and your family’s health. Questions may focus on:3

  • Your past symptoms of mania, hypomania, and depression
  • How much your symptoms affect your life
  • Your exercise and eating habits
  • What kinds of prescription and over-the-counter drugs and supplements you take
  • Whether you drink, smoke, or use illegal drugs, and how much
  • Any family history of BPD and other mental health conditions
  • Any history of allergies or seizures
  • Vaccine history
  • Past surgeries, accidents, and illnesses as well as past treatments
  • If you have experienced trauma or hardships that may be triggers
  • Your socio-economic status throughout your life as it relates to history of hardships

During the physical exam, the doctor will check your height, weight, heart rate, and blood pressure. They will look at your eyes, ears, and skin. And they will listen to you breathe and press on your belly.3

Blood and urine tests

Your doctor will run a series of blood and urine tests to check for other health conditions. A complete blood count (CBC) is a common test that measures red blood cells, white blood cells, platelets, and hemoglobin. A blood chemistry test, or metabolic panel, measures things like how well your liver and kidneys are working. Other tests may be included based on symptoms and family history.4

A urine test (urinalysis) can check for infections, asses your kidney health, and help your doctor know whether you have diabetes.5

Mental health evaluation

Your doctor may conduct a mental health evaluation or refer you to a psychiatrist or psychologist for one. This exam is sometimes called a psychological evaluation.6

During this mental health exam, a specialist will ask you whether you have a family history of BPD, depression, or anxiety. This is because people with BPD often have family members with one of these mental health conditions.1,6

Also, the specialist may ask you:1,6

  • When your symptoms started
  • How long your symptoms last
  • How often your symptoms appear
  • How your symptoms impact your life
  • Whether you use alcohol or drugs
  • If you have thoughts about death or suicide

The specialist may ask to talk to a loved one or support person. People do not always remember their actions during a manic episode.1,6

People with BPD are more likely than the average person to have additional mental health conditions. So, the specialist will also screen you for symptoms of:1

  • Anxiety
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorders

After ruling out other conditions and reviewing your mental health evaluation, your doctor may diagnose you with bipolar disorder. Your treatment options will depend on what type you have and how severe your symptoms are.2

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