Symptoms and Diagnosis of Bipolar Disorder An Overview

Symptoms and Diagnosis of Bipolar Disorder An Overview Bipolar Disorder Symptoms Print Symptoms and Diagnosis of Bipolar Disorder By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on May 28, 2018 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on August 02, 2019 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights In This Article Table of Contents Expand Assessing Symptoms Bipolar Mania  Symptoms Bipolar Depression  Symptoms Differential Diagnosis Diagnostic Challenges View All Bipolar disorder isnt just about having mood swings. Its a serious mental health condition that used to be referred to as manic depression. According to the DSM-5, the guide used to diagnose mental illnesses, there are two main types of bipolar disorder that can be diagnosed based on the severity and nature of their symptoms:?? Bipolar I â€"  Individuals  with bipolar I experience at least one manic  episode in their lives. Although not required for the formal diagnosis, the vast majority will also experience major depressive episodes during the course of their lives.Bipolar II  â€" Individuals  with bipolar II have at least one hypomanic episode (a less serious form of mania) and at least one major depressive episode. Assessing Symptoms Illustration by Hugo Lin. © Verywell, 2018.   Being a mental health condition, blood draws or imaging exams wont help with diagnosing bipolar disorder but may sometimes be ordered to help rule out medical conditions that may be contributing to the symptoms. To confirm a diagnosis, a person must meet the criteria outlined above (symptoms and frequency), which will be assessed through a psychiatric assessment.?? Note that  symptoms of bipolar disorder are the same in women and men, but societal and gender roles can affect how they manifest or how others perceive them. Bipolar Mania  Symptoms Manic episodes last at least seven days. Hypomanic episodes involve the same symptoms, but the individuals functioning isnt markedly impaired and psychotic symptoms cannot be present. Symptoms of a manic or hypomanic episode include:?? Decreased need for sleepTalking excessivelyRacing thoughtsBeing easily distractedPhysical agitation and relentless movementIncreased sexual desireImpulsive risk behaviors (including gambling and lavish spending)Grandiosity or inappropriate behaviorIrritability, hostility, or aggressionDelusions or hallucinations Bipolar Depression  Symptoms During a depressive episode, an individual may experience the following symptoms:?? Crying for no reason or prolonged periods of sadnessFeelings of guilt or hopelessnessLoss of interest in activities that usually give you pleasureExtreme fatigue, including the inability to get out of bedLoss of interest in your health, nutrition, or physical appearanceDifficulty concentrating or remembering thingsSleeping excessively or difficulty sleepingSuicidal thoughts or an impulse to self-harm Problems with cognitive skills, such as  short-term memory trouble, difficulty concentrating, and indecision, may be the first things noticed by others when someone has bipolar depression. It can interfere with an individuals performance and make it difficult to complete tasks. Physical Symptoms Associated With Depressive Episodes During depressive episodes, individuals may experience a variety of physical symptoms, including unexplained aches and pains.?? Changes in weight are also common. While some people struggle to eat when theyre feeling down, others turn to food for comfort.  Thus, both weight loss and weight gain can be symptoms of a depressive episode.?? Psychomotor agitation, an increase in activity caused by mental rather than physical tension or psychomotor retardation, slowing of both thought and physical activities, may also occur.?? Differential Diagnosis There are distinct diagnostic criteria that have been proposed for bipolar disorder, but even with these criteria, the diagnosis is far from easy. Psychiatric conditions that can manifest symptoms similar to bipolar disorder include: Attention Deficit Hyperactivity Disorder (ADHD) Hyperactivity and distractibility are two of the hallmark symptoms of  attention deficit hyperactivity disorder  (ADHD). However, they are also quite predominant in bipolar disorder, especially as it relates to children. To further complicate things, these conditions can often co-occur.?? Alcohol/Substance Abuse It is very common for those with bipolar disorder to struggle with alcohol and substance abuse issues.?? This is often an attempt, even on an unconscious level, to  self-medicate. Additionally, the effects of certain substance use (which may cause hallucinations or the inability to sleep) can be confused with the symptoms of bipolar disorder. In addition to these concerns,  alcohol may interact  with the medications used to treat bipolar disorder. Borderline Personality Disorder   The diagnostic criteria for  borderline personality disorder  include  impulsivity, suicidal behavior, reactivity of mood,  inappropriate anger, and transient paranoia. All of these are also associated with bipolar disorder. It is possible for an individual to be diagnosed with both of these disorders as well. (Learn more about the similarities and  differences between bipolar disorder and borderline personality disorder.)?? Delusional Disorder The hallmark of delusional disorder is non-bizarre delusions, meaning the situation may be possible.  Mood episodes can be present but they are brief in duration relative to the delusion.?? Depression The one thing that distinguishes depressive disorders (unipolar depression) from bipolar disorder is  mania/hypomania.?? If a patient with depression swings into an episode of mania, the diagnosis becomes bipolar disorder. Many people who have undiagnosed bipolar disorder are found to have the disorder when medications such as some antidepressants are started and precipitate mania.?? Eating Disorders It is not uncommon for those with bipolar disorder to experience  eating disorders.?? Moreover, depression, anxiety and irritability often result  from eating disorders. Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight or getting fat. Those with this disorder often have a body weight of less than 85 percent of that which is considered normal.?? Bulimia nervosa is typified by periods of binge eating followed by purging (purposely vomiting). Panic Disorder Panic disorder  is characterized by recurrent, spontaneous  panic attacks. Panic disorder is often comorbid (occurs together) with mood and other psychiatric disorders. Furthermore, panic attacks are also common in those with bipolar disorder.?? Schizophrenia Schizophrenia is a mental disorder that causes intense disturbances in cognition (thinking), behaviors, and emotions. It consists of two classifications of  Symptomsâ€"positive and negative.  Positive symptoms  include delusions,  hallucinations, disorganized speech and thinking, disorganized behavior,  catatonic behavior, and inappropriate moods.  Negative symptoms  are flattened emotions, lack of speech and a reduction in goal-directed behavior. The  symptoms of schizophrenia are easily confused with those of bipolar disorder.?? Schizoaffective Disorder A diagnosis of schizoaffective disorder is given when there are symptoms of major depression or mania, along with certain symptoms of schizophrenia. However, the delusions or hallucinations must persist for periods when the mood symptoms aren’t present. As you might expect, there is a great deal of confusion and controversy surrounding differentiating this disorder from bipolar disorder.?? Diagnostic Challenges While specific, the assessment of bipolar criteria is also highly subjective. As such, cases are often missed. According to a study published in 2018, 60% of patients seeking care for recurring depression actually have bipolar disorder.?? On the other hand, over-diagnosis of bipolar disorder is also a concern. A 2013 review of clinical studies demonstrated that bipolar disorder was incorrectly diagnosed in:?? 42.9 percent of substance abuse treatment centers40 percent of patients with borderline personality disorder37 percent of cases where a clinician inexperienced in bipolar disorder made the call A study released in 2010 showed that, of 528 people receiving Social Security disability for a bipolar disorder, only 47.6 percent met the strict diagnostic criteria. Caveats When Diagnosing the Type There are two important caveats that may further complicate the process of distinguishing the two types of bipolar disorder. One is that although present psychotic symptoms are one of the things that differentiate  bipolar I mania from bipolar II hypomania, someone with bipolar II  may  experience hallucinations or delusions during  depressive episodes  without the diagnosis changing to bipolar I.?? The second is that someone with bipolar I disorder may also have hypomanic episodes. In fact, they commonly do. But, someone with bipolar II does not ever have  a manic episode. If a manic episode occurs in someone with bipolar II, the diagnosis will be changed.?? A Word From Verywell If you or someone you know is experiencing symptoms of bipolar disorder, its important to talk to your physician. Your physician may want to rule out any potential physical health issues that could be contributing to your symptoms. Your physician may refer you to a mental health professional for an evaluation. The treatment provider can assess your symptoms and, once a proper diagnosis is made, can assist with developing a treatment plan. Theories About the Causes of Bipolar Disorder