Diagnosing Bipolar Disorder
Doctors have come a long way in fully understanding different moods in bipolar disorder and in making an accurate diagnosis. It wasn’t that long ago when bipolar disorder was confused with other disorders such as unipolar depression or with schizophrenia (a serious mental illness with symptoms of incoherent speech, delusions, and hallucinations). With the greater understanding of mental disorders today, doctors can identify the signs and symptoms of bipolar depression, hypomania, and mania, and in most cases, treat the disorder effectively and safely with bipolar medications.
Most of us have become used to specialized blood tests or other laboratory measures to help our doctors make an accurate diagnosis. However, most lab tests or imaging tests are not useful in diagnosing bipolar disorder. In fact, the most important diagnostic tool may be talking openly with the doctor about your mood swings, behaviors, and lifestyle habits.
While a physical examination can reveal a patient’s overall state of health, the doctor must hear about the bipolar signs and symptoms from the patient in order to effectively diagnose and treat bipolar disorder.
What does a doctor need to know to diagnose bipolar disorder?
A bipolar disorder diagnosis is made only by taking careful note of symptoms, including their severity, length, and frequency. "Mood swings" from day to day or moment to moment do not necessarily indicate a diagnosis of bipolar disorder. Rather, the diagnosis hinges on having periods of unusual elevation or irritability in mood that are coupled with increases in energy, sleeplessness, and fast thinking or speech. The patient’s symptoms are fully assessed using specific criteria from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders or DSM-5.
In making the diagnosis of bipolar disorder, the psychiatrist or other mental health expert will ask you questions about your personal and family history of mental illness and bipolar disorder or other mood disorders. Because bipolar disorder sometimes has a genetic component, family history can be helpful in making a diagnosis. (Most people with bipolar disorder, however, do not have a family history of bipolar disorder.)
Also, the doctor will ask detailed questions about your bipolar symptoms. Other questions may focus on reasoning, memory, ability to express yourself, and ability to maintain relationships.
Do other illnesses mimic symptoms of bipolar disorder?
Mood swings and impulsive behavior can sometimes reflect psychiatric problems other than bipolar disorder, including:
- Substance use disorders
- Borderline personality disorder
- Conduct disorders
- Impulse control disorders
- Developmental disorders
- Attention deficit hyperactivity disorder
- Certain anxiety disorders such as post-traumatic stress disorder
Psychosis (delusions and hallucinations) can occur not only in bipolar disorder but other conditions such as schizophrenia or schizoaffective disorder. In addition, people with bipolar disorder often have additional psychiatric problems such as anxiety disorders (including panic disorder, generalized anxiety disorder (GAD), and social anxiety disorder), substance use disorders, or personality disorders that may complicate an illness presentation and require independent treatment.
Some non-psychiatric illnesses, such as thyroid disease, lupus, HIV, syphilis, and other infections, may have signs and symptoms that mimic those of bipolar disorder. This can pose further challenges in making a diagnosis and determining the treatment.
Other problems often resemble mania but reflect causes other than bipolar disorder. An example is mood or behavior changes caused by steroid medications like prednisone (used to treat inflammatory diseases such as rheumatoid arthritis and asthma, musculoskeletal injuries, or other medical problems). .
What should I do before I see the doctor about bipolar disorder?
Before meeting with your doctor to clarify a diagnosis, it’s helpful to write down the symptoms you notice that may reflect depression, hypomania, or mania. Particular attention should focus not just on mood but also changes in sleep, energy, thinking, speech, and behavior. It is also useful to get an in-depth family history from relatives before meeting with your doctor. A family history can be very helpful in supporting a suspected diagnosis and prescribing appropriate treatments.
In addition, consider bringing your spouse (or other family member) or a close friend with you to the doctor’s visit. Oftentimes, a family member or friend may be more aware of a person’s unusual behaviors and be able to describe these in detail to the doctor. Before your visit, think about and record the following:
- Your mental and physical health concerns
- Symptoms you’ve noticed
- Unusual behaviors you’ve had
- Past illnesses
- Your family history of mental illness (bipolar disorder, depression, mania, seasonal affective disorder or SAD, or others)
- Medications you are taking now and in the past (bring all medications to your doctor’s appointment)
- Natural dietary supplements you are taking (bring your supplements to your doctor's appointment)
- Your lifestyle habits (exercise, diet, smoking, alcohol consumption, recreational drug use)
- Your sleep habits
- Causes of stress in your life (marriage, work, relationships)
- Questions you may have about bipolar disorder
What tests will the doctor use to make a bipolar diagnosis?
Your doctor may have you fill out a mood questionnaire or checklist to help guide the clinical interview when they assess mood symptoms. In addition, your doctor may order blood and urine tests to rule out other causes of your symptoms. In a toxicology screening, blood, urine, or hair are examined for the presence of drugs. Blood tests also include a check of thyroid stimulating hormone (TSH) level, since depression is sometimes linked to thyroid function.
Can brain scans or imaging tests help with the bipolar diagnosis?
While doctors don’t rely on brain scans or imaging tests for making a bipolar diagnosis, some high-tech neuroimaging tests may help doctors make specific neurologic diagnoses that can account for psychiatric symptoms. An MRI or CT scan is therefore sometimes ordered in patients who have had a sudden change in thinking, mood, or behavior to assure that a neurological disease is not the underlying cause.
According to the National Institute of Mental Health, studies are underway to examine whether electroencephalograms (EEGs) and magnetic resonance imaging (MRI) studies of the brain can reveal differences between bipolar disorder and related behavioral syndromes. But bipolar disorder remains a clinical diagnosis, and no imaging study or other lab test has yet been established to confirm its diagnosis or guide its treatment.
What can I do if I think a loved one has bipolar disorder?
If you suspect that a loved one has bipolar disorder, talk with the person about your concerns. Ask if you can make a doctor’s appointment for the person and offer to accompany the person to the visit. Here are some tips:
- Alert the doctor that this is a new problem and the doctor will need to allow sufficient time for the exam.
- Have your concerns written down on a sheet of paper to make sure you cover all areas.
- Be specific as to the problems of bipolar depression, hypomania, or mania.
- Give specific details of mood symptoms and behaviors to the doctor.
- Describe any severe mood changes, especially anger, depression, and aggressiveness.
- Describe personality changes, especially instances of elation, paranoia, illusions, and hallucinations.
- Be sure to discuss any use of alcohol or other drugs (like marijuana, cocaine or amphetamines) that the person may be using since they can often cause changes in mood, which may be mistaken for the symptoms of bipolar disorder.
- Bring with you a summary of all medications (both psychiatric and nonpsychiatric) that you are taking. Some medicines can have negative effects on mood and could play a part in understanding your symptoms.