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Diagnosis Guide for Bipolar Disorder
Key takeaways
Diagnosis of bipolar disorder involves assessing mood episodes, which include manic and depressive states, and understanding that these experiences vary among individuals.
The diagnostic process includes a comprehensive mental health evaluation, potentially involving family input, and aims to differentiate bipolar disorder from conditions with overlapping symptoms like ADHD or depression.
Receiving a timely and accurate diagnosis, though it may evoke mixed emotions, is crucial for accessing effective, long-term treatment options, including therapy and medication, to improve overall well-being.
People with bipolar disorder experience intense emotional changes that are very different from their usual moods and behaviors. These changes affect their lives on a day-to-day basis.
Testing for bipolar disorder is not as simple as taking a multiple-choice test or sending blood to a lab. While bipolar disorder does show distinct symptoms, there's no single test to confirm the condition. Often, doctors use a combination of methods to make a diagnosis.
Who is a candidate for diagnosis?
Mood episodes are the main symptom of bipolar disorder, and everyone with the condition experiences these a little differently. Most people who live with bipolar disorder experience manic episodes (highs) and depressive episodes (lows).
These episodes can last for several days, weeks, or more. People with bipolar disorder tend to fluctuate rapidly between mania and depression. Some people with bipolar disorder have long periods with neutral moods as well.
The way people experience manic episodes varies from one person to another, but the episodes usually involve:
feeling high, elated, or tense
having little appetite
having little need for sleep
having racing thoughts
possibly making harmful decisions
sometimes feeling 'all powerful'
During a depressive episode, your symptoms will likely be at the other end of the spectrum. You may:
feel extreme sadness, hopelessness, or emptiness
sleep more
eat more
have trouble concentrating and completing tasks
have less interest in activities you usually enjoy
have feelings of self-hatred or suicidal thoughts
Getting help
If you're having thoughts of suicide, help is out there. There is a thriving community of people living with and supporting each other through bipolar disorder every day.
For free, confidential 24/7 help:
988 Suicide & Crisis Lifeline: call or text 988 or use the chat feature at
Crisis Text Line: text HOME to 741-741
Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: call 800-662-HELP (4357)
Trans Lifeline: call 877-565-8860 in the United States, or call 877-330-6366 in Canada
If you or a loved one is in immediate danger, please call 911 or go to the nearest emergency room.
Preparing for an adult bipolar disorder diagnosis
If you think you may have bipolar disorder, you can start by visiting a healthcare professional. They will likely do a physical examination, discuss your medical history, and ask you some basic questions about your symptoms, family history, and life experiences.
If your healthcare professional believes you may have bipolar disorder, they will probably refer you to a psychiatrist who will do a more detailed mental health evaluation. Some of the questions a psychiatrist may ask include:
What symptoms are you experiencing?
What are your thoughts and feelings like during a manic or depressive episode?
Do you feel in control of your mania or how long an episode lasts?
When did you first start experiencing these symptoms?
Do you ever have suicidal thoughts or thoughts of self-harm?
Do you have a history of substance misuse?
Did anyone in your family have similar symptoms or a diagnosis of bipolar disorder?
They might also ask your permission to ask friends and family about your behavior.
The diagnosis of bipolar disorder requires at least one depressive and one manic or hypomanic episode. Any diagnosis will take into account other aspects of your medical history and the medications you've taken.
Diagnosing bipolar disorder in children
Bipolar disorder is not only an adult condition — it can also occur in children. Diagnosing bipolar disorder in children can be difficult because its symptoms can sometimes mimic those of:
attention deficit hyperactivity disorder (ADHD)
anxiety disorders
depression
conduct disorders
disruptive mood dysregulation disorder (DMDD)
Symptoms of bipolar disorder in children can include:
impulsiveness
irritability
aggression (mania)
hyperactivity
emotional outbursts
periods of sadness
The criteria for diagnosing bipolar disorder in children are similar to those for adults. While there is no single definitive test, psychologists can administer test batteries to help determine whether bipolar disorder is present.
Diagnosis typically involves a comprehensive evaluation, including questions about your child's mood, sleeping patterns, and behavior.
Because symptoms such as impulsiveness, irritability, hyperactivity, and emotional outbursts can also be associated with conditions like ADHD, distinguishing between them can be challenging.
However, a doctor may ask specific questions to gather more insight, such as:
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?
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.
Ruling out other conditions
There are no specific blood tests or brain scans to diagnose bipolar disorder. Even so, a doctor may perform a physical exam and order lab tests, including a thyroid function test and urine analysis. These tests can help determine whether 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 does not receive enough of the thyroid hormone, which is known as hypothyroidism, your brain may not function as expected. 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.
Other similar conditions
One reason bipolar disorder can be difficult to diagnose is that it can have similar symptoms to other mental health conditions. Additionally, you can have other mental health conditions along with bipolar disorder.
For example, during a manic episode of bipolar disorder, you may experience symptoms of psychosis, such as hallucinations, hearing voices, and other delusions. Sometimes people with these symptoms receive a diagnosis of schizophrenia but actually have bipolar disorder.
It's also possible to experience other mental health conditions at the same time as bipolar disorder. People who have bipolar disorder often experience:
anxiety disorders
substance use disorders
eating disorders
ADHD
Gender and race discrepancies in bipolar disorder diagnosis
Bipolar disorder affects approximately 4.4% of U.S. adults. It affects all people at similar rates, but there are differences in how certain people experience symptoms and receive diagnoses:
Men are more likely to show signs of mania and substance misuse.
Women are more likely to experience major depressive disorder.
Men are less likely to receive a proper diagnosis of bipolar disorder than women.
A 2019 study show a higher prevalence of bipolar disorder diagnoses in the transgender community.
There are discrepancies in terms of diagnosis based on race as well. For example, Black people in the United States tend to be misdiagnosed with schizophrenia and are more likely to receive subpar treatment for their bipolar disorder.
Hispanic people in the United States are more likely to be misdiagnosed with schizophrenia and, thus, are more likely to receive inadequate treatment for bipolar disorder.
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 do not seek treatment until they experience a depressive episode.
According to a 2018 study, bipolar disorder has a misdiagnosis rate as high as 76.8%.
The condition shares many of the symptoms associated with other mental health conditions. Bipolar disorder is often misdiagnosed as:
depression
anxiety
obsessive-compulsive disorder (OCD)
schizophrenia
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 with a doctor if you believe you may be experiencing any symptoms of bipolar disorder or another mental health condition.
What happens after a bipolar disorder diagnosis?
You may experience a mix of emotions if you receive a bipolar disorder diagnosis, including shock and sadness, but also relief and hope. Bipolar disorder is considered a long-term condition, but there are effective treatments available for you to live a full life.
Treatments for bipolar disorder include a combination of therapy and medication. Therapy options for bipolar disorder include:
cognitive behavioral therapy (CBT)
psychotherapy, or 'talk therapy'
interpersonal therapy
family-focused therapy
Medications commonly prescribed for bipolar disorder are:
lithium
anticonvulsants
second-generation antipsychotics
antidepressants
Other frequently asked questions
What are the different types of bipolar disorders you can receive a diagnosis for?
A bipolar disorder diagnosis will most likely fit into one of these categories:
Bipolar I disorder involves one or more manic episodes or mixed (manic and depressive) episodes, and it may include a major depressive episode. The episodes are not due to a medical condition or substance use.
Bipolar II disorder has one or more severe major depressive episodes with at least one hypomanic ('lesser mania') episode. There are no manic episodes, but you may experience a mixed episode.
Rapid-cycling bipolar disorder is a severe form of bipolar disorder. It occurs when you have at least four episodes of major depression, mania, hypomania, or mixed states within a year.
Not otherwise specified (NOS) is a category for symptoms of bipolar disorder that do not clearly fit into other types. NOS is diagnosed when multiple symptoms of bipolar disorder are present but not enough to meet the criteria for any of the other subtypes. This category can also include rapid mood changes that do not last long enough to be clinical manic or depressive episodes. NOS includes multiple hypomanic episodes without a major depressive episode.
Should you get a second opinion on a bipolar disorder diagnosis?
It never hurts to get a second opinion on a diagnosis, but if you receive a diagnosis from a trusted psychiatrist and you believe it's accurate, you do not need to get one. One diagnosis from a qualified healthcare professional should be enough for any insurance or disability claims.
Can you get a bipolar disorder diagnosis removed or reversed?
A diagnosis of bipolar disorder usually is not removed because it's a lifelong disorder.
But if you feel that your condition has been misdiagnosed, do not hesitate to advocate for yourself and seek a second medical opinion. Additional healthcare professionals may be able to reverse or amend a misdiagnosis of bipolar disorder.
How long does the bipolar disorder diagnosis process take?
Because bipolar disorder may be misdiagnosed, it can sometimes take years to get a proper diagnosis. However, once you find a healthcare professional who is willing to evaluate you for bipolar disorder, the process should only take a few weeks.
When can you receive a diagnosis of bipolar disorder?
You can receive a diagnosis of bipolar disorder at any time in your life. Children, teens, and adults can receive a diagnosis of bipolar disorder.
Who can you see for a bipolar disorder diagnosis?
If you think you may have bipolar disorder, make an appointment with a healthcare professional, like a primary care doctor. They will examine you to rule out any possible medical reasons for your symptoms.
If they suspect you have bipolar disorder, they will refer you to a psychiatrist for evaluation.
Can bipolar disorder run in the family?
Yes, a family history of bipolar disorder is the most influential risk factor for bipolar disorder. If you're concerned about your mental health symptoms, make sure to ask your parents, grandparents, or older family members if they remember anyone else in the family facing similar struggles.
Your doctor will ask about your family's history of mental health during your diagnosis.
Does a bipolar disorder diagnosis qualify for disability?
Yes, bipolar disorder is considered a disability under the Americans with Disabilities Act (ADA), and your employer must offer reasonable accommodations to you.
How do I accept my bipolar disorder diagnosis?
Bipolar disorder is not something to be ashamed of. You can work with a therapist on ways to make peace with your diagnosis, as many people do. Joining a bipolar disorder support group can help you feel less alone as well.
