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What to Expect During a Bipolar Disorder Diagnosis

Learning about the process can make it less scary.
Illustration representing someone feeling depressed and anxious.
Knowing the symptoms of bipolar disorder can help you pursue a diagnosis. Ponomariova_Maria / Getty Images

Receiving or pursuing a bipolar disorder diagnosis is a brave step. No matter the specifics of what you’re experiencing, reaching out for help probably feels scary, and it may be even harder to know where to start or how to process if you’re experiencing emotional ups and downs that interfere with your normal activities. Understanding what you may be experiencing is the first step to finding the support you need to feel like yourself again. The first thing to know: You’re not alone. An estimated 4.4% of American adults experience bipolar disorder at some point in their lives, according to the National Institute of Health1. While people who have bipolar disorder can experience periods of severe depression, it has some other distinct features. Bipolar disorder, also called manic-depressive disorder, is a mood disorder that can cause emotional and energetic lows (depressive episodes) and highs (manic or hypomanic episodes). It can also cause mood episodes with mixed features, meaning both emotional highs and lows2.

According to Po Wang3, M.D., director of the Stanford Bipolar Disorders Clinic, these periods of elevated mood (and resulting behaviors) are what distinguish bipolar from, say, major depressive disorder. Like many other mental health conditions, bipolar disorder doesn’t just affect a person’s emotions. It can also change people’s behavior and result in significant impairment in other areas of life1.

Bipolar disorder is considered a lifelong condition, so treatment is focused on managing symptoms. The good news is there are plenty of effective and safe treatment options available to stabilize mood. If your doctor diagnoses you with bipolar disorder, they’ll work with you to find the best treatment possible, which ultimately depends on what type of bipolar disorder you have, your lifestyle and personality, and other factors.

Wondering if you may have bipolar disorder, and what next steps you should take? Kudos for taking a step forward in caring for your mental health. Here’s what you need to know about the condition, from risk factors and symptoms to bipolar disorder diagnosis and treatment.

Risk factors | Signs and symptoms | Depression | Mania | Hypomania | Mixed | Diagnosis | Types | Bipolar I | Bipolar II | Cyclothymic disorder | Unclassified | Getting help

Risk factors of bipolar disorder

Francis Mondimore4, M.D., director of the Johns Hopkins Mood Disorders Clinic and associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says genetics are likely a primary risk factor for bipolar disorder. A person who has a parent or sibling with bipolar disorder is at an elevated risk for developing the condition.

That said, even if you don’t know of someone in your family with a bipolar disorder diagnosis, genetics could be at play. “People can get bipolar disorder if they don’t have a family history, but it is highly genetic, so those people may have a family history that’s not complete,” says Dr. Wang.

While genetics are an important potential factor in developing bipolar disorder, there are others as well. For example, stressful circumstances, traumatic events, or drug or alcohol abuse could incite a bipolar episode. Studies show difficult events during childhood, such as maltreatment and emotional abuse by parents, may also increase a person’s risk for developing bipolar disorder later on in life5.

Bipolar disorder symptoms can appear at any time, but the average age of onset of bipolar disorder is early adulthood, between 18-20 years of age, according to the Cleveland Clinic6. In some cases, bipolar disorder symptoms can appear during pregnancy or following childbirth, and sometimes, children exhibit bipolar symptoms. Bipolar disorder also co-occurs in people who have seasonal depression and anxiety disorders (such as post-traumatic stress disorder, or PTSD).

While bipolar disorder can occur in people of any gender, women are more likely to meet the diagnostic criteria for bipolar II disorder, which causes depression and less severe manic episodes (hypomania), according to the Cleveland Clinic6. Women with bipolar disorder may also experience faster shifts in mood, which is called “rapid cycling,” potentially due to shifting hormone levels, however, men can experience this too.

Signs and symptoms of bipolar disorder

In general, bipolar disorder is characterized by a pattern of dramatic swings involving periods of low mood and energy (depression) and elevated mood and energy (mania or hypomania). But a person’s experience with bipolar disorder is as unique as they are. Not everyone with bipolar disorder shares the same symptoms or experiences those symptoms with the same severity. Bipolar disorder symptoms typically depend on the type of bipolar disorder someone has, and what type of bipolar episode they’re experiencing.

Read on for some of the most common symptoms of the main types of bipolar episodes.

Depression signs and symptoms

Depressive episodes in bipolar disorder are a lot like any other type of depression. Symptoms of a depressive episode may include persistent sadness, hopelessness, pessimism, difficulty concentrating, irritability, loss of interest in normal activities, and changes in a person’s appetite or sleeping habits6. If the depression is severe, Dr. Mondimore says it may cause suicidal ideation, which is one reason it’s so important to diagnose and treat.

Mania symptoms

According to Dr. Mondimore, mania is the exact opposite of depression. Rather than feeling sluggish and down, people experiencing mania have high energy levels and racing thoughts2. This may result in out-of-character, risky behavior, such as drug use, spending excessive amounts of money, or going on unplanned trips, says Dr. Wang. Generally, mania lasts for at least one week, according to the Cleveland Clinic8.

Signs of hypomania

When it comes to hypomania, picture a less severe version of mania. You may experience things like a markedly good mood and increased productivity, but not to the level of a manic episode, according to the NIMH. Typically, hypomania doesn’t affect your ability to work, and episodes last about four days, according to the Cleveland Clinic8. This can sound like a strictly good thing, but untreated hypomania can make you more susceptible to mania and depression down the line.

Bipolar mixed episodes

Manic and depressive episodes don’t always occur separately. Some people with bipolar disorder have mixed episodes, which include both symptoms of depression and mania. According to Dr. Wang, people may feel depressed and engage in risky activities at the same time, or they may feel hopeless and down but still have a lot of energy. Usually, says Dr. Wang, mixed episodes occur later in the course of a person’s bipolar disorder, between ages 30 and 50. Using illicit substances can also trigger mixed bipolar episodes.

Intense mania and depression can lead to psychosis, which can cause issues like hallucinations and delusions, according to the Mayo Clinic9.

While everybody experiences ups and downs from time to time, bipolar disorder is typically more persistent and severe. If you have any of these signs and symptoms, it’s important to reach out to a health care provider, who can help you identify what’s going on, educate you about the condition, and find the best treatment plan to improve your well-being.

How is bipolar disorder usually diagnosed?

Getting diagnosed with bipolar disorder can be a complicated process. According to Dr. Mondimore, some people go years without getting a proper diagnosis and treatment. Understanding the risk factors, signs, and symptoms are the first steps in supporting your mental health. “There are some features which people can recognize, and if they recognize some of them in themselves or family members, the next step is to get an expert to help them make a treatment decision,” he says.

Because bipolar disorder can be complicated to treat, Dr. Wang recommends starting out with a therapist or psychiatrist who specializes in diagnosing and treating mental health disorders if you can. If you can’t access this type of mental health provider, then Dr. Mondimore says a primary care provider can also help (or refer you to someone who can).

There aren’t any blood tests or imaging to diagnose bipolar disorder; instead, doctors rely on a person’s symptoms and family history to land on a bipolar disorder diagnosis. Along with asking you about your symptoms and how they affect your life, your health care provider will ask about your family history of mental illness. If you’re not sure about your family’s medical or mental health history, you can ask a knowledgeable family member to help. But, if necessary, your doctor can still diagnose you without that information.

Because everyone experiences mood swings from time to time, doctors look for distinct symptoms when they’re considering a bipolar disorder diagnosis. Dr. Wang says he looks for a “constellation” of symptoms when he’s working with a patient who may have bipolar disorder. For example, say you experience racing thoughts from time to time. A doctor would want to see a consistent pattern of that bipolar symptom along with other mania symptoms, such as irritability and engaging in risky behaviors.

To be formally diagnosed with bipolar disorder, you’ll need to meet specific criteria. Depending on the symptoms you display, your doctor may diagnose you with one of four types of bipolar disorder and then treat you accordingly. While there are many types of treatments that can improve bipolar disorder symptoms, Dr. Wang says the most effective method is a combination of medication and psychotherapy; according to Dr. Monidmore, psychoeducation, or learning about the condition, can also help stabilize a person’s mood over time. “Psychoeducation has been tested in research studies10, and it helps people do better,” he says.

Types of bipolar disorder

All forms of bipolar disorder include mood swings, but the disorder can manifest differently, ultimately depending on the type a person has. Here are the four types of bipolar disorder a doctor may diagnose, along with their unique diagnostic criteria:

Bipolar I

Because bipolar I includes more intense, longer-lasting symptoms, it’s considered the most severe type of bipolar disorder, says Paula Zimbrean11, M.D., associate professor of psychiatry at Yale University School of Medicine. People with bipolar I experience distinct depression episodes for at least two weeks along with episodes of mania that last for at least a week1. (Or the mania can last for less time than that but be severe enough to result in psychiatric hospitalization. According to Dr. Mondimore, people with bipolar I are also more likely to develop delusions and hallucinations.

Bipolar II

Rather than a less-severe version of bipolar I, bipolar II is a completely separate diagnosis. According to Dr. Wang, this form of bipolar disorder includes depression and hypomania. In order to be diagnosed with bipolar II, Dr. Zimbrean says people have to have at least one episode of hypomania and one episode of major depressive disorder.

It’s also worth noting that while it’s seen as less severe than bipolar I, bipolar II still requires treatment. People with bipolar II may not experience extreme mania or engage in risky behaviors, but they can be depressed for longer periods of time, which may interfere with their ability to function in daily life8.

Cyclothymic disorder

Cyclothymic disorder is a condition on the bipolar spectrum characterized by milder mood swings. People with this disorder may constantly fluctuate between mild depression and elevated mood, but it may not result in full-blown mania or significant depression. Generally, Dr. Mondimore says, cyclothymic disorder is very responsive to medication.

Like other types of bipolar disorder, a cyclothymic disorder diagnosis requires specific criteria. Typically, doctors look for hypomanic episodes and depressive episodes that occur frequently within a two-year period, with alternating highs and lows that occur during at least half that period of time12.

Unclassified bipolar disorder

If a person displays symptoms of bipolar disorder but doesn’t meet the criteria to be diagnosed with one of the above types, then this is labeled as unclassified bipolar disorder, according to Dr. Wang. Sometimes this happens when people use substances that can result in mood swings and doctors may not know whether the mood changes stem from a disorder, drug use, or both.

Taking steps toward a bipolar disorder diagnosis

Facing a mental health condition such as bipolar disorder can be difficult, and putting a label on what you’re experiencing may be overwhelming. You may understandably hope the symptoms go away on their own, or that you can manage them on your own without medical treatment.

But according to Dr. Wang, seeking medical care for your symptoms and receiving a diagnosis are important ways to keep your mood stable. Taking steps to pursue medical care can definitely feel like a big step, and understanding what’s involved with diagnosis—and all the potential treatments available to help you feel better—can empower you during a scary time. “Diagnosis can help us choose the best treatment,” says Dr. Wang. “We just want to help our patients with the symptoms they’re living with.”

Sources:
1. National Institute of Mental Health, Bipolar Disorder Definition
2. National Institute of Mental Health, Bipolar Disorder
3. Stanford, Po Wang, M.D.
4. Johns Hopkins Medicine, Our Expert Team
5. Therapeutic Advances in Psychopharmacology, Epidemiology and Risk Factors for Bipolar Disorder
6. Cleveland Clinic, Bipolar Disorder
7. National Institute of Mental Health, Depression
8. Cleveland Clinic, Hypomania
9. Mayo Clinic, Bipolar Disorder
10. Bipolar Disorder, Psychosis in Bipolar Disorder: Does It Represent a More ‘Severe’ Illness?
11. Yale School of Medicine, Paula Zimbrean, M.D. 
12. Mayo Clinic, Cyclothymia

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