How Bipolar Disorder Is Diagnosed

The diagnosis of bipolar disorder is based on a history of symptoms of mania and depression, a medical history, and consideration of other conditions that could be causing the symptoms. 

This mood disorder is defined by diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the guide that mental health professionals use. The diagnosis of this mood disorder can take several years as you begin to recognize a pattern of episodes of depression and mania over time.

Professional Screenings

Although bipolar disorders are usually diagnosed through a clinical interview with a mental health professional, screening tests are sometimes used in the diagnostic assessment. These include the Mood Disorders Questionnaire (MDQ) and the Structured Clinical Interview for DSM (SCID).

These screenings can help identify whether you could have a mood disorder, and the DSM-5 criteria are used to categorize which disorder you could specifically have.

Labs and Tests  

It is important that you seek medical attention for any distressing mood symptoms. Your healthcare provider will do a physical examination, including a neurological examination and mental status examination.

Signs of bipolar disorder can include diminished facial and voice expression, disengagement, sadness, crying, extreme excitation, jitteriness, rapid or pressured speech, and agitation. Bipolar disorder should not cause physical changes. For example, it does not affect physical strength or mobility.

The signs seen in bipolar disorder can be present in various other conditions, such as dementia, post-concussive syndrome, and thyroid disease. During your physical examination, your healthcare provider will be looking for signs of other conditions that could be causing your symptoms, such as skin changes, impaired movement, or neck swelling.

Laboratory Tests  

You may have blood tests or a urine test during the evaluation of your symptoms. There are no laboratory tests that are diagnostic of bipolar disorder.

Your healthcare provider would consider blood or urine tests if your symptom history, medical history, and physical examination point to a possible medical contribution to your symptoms besides bipolar disorder.

Many drugs of abuse can cause emotions and behaviors similar to those of bipolar disorder. You might not consider your drug use to be abuse, but the presence of substances in the blood or urine can help identify a contribution of drug use to your symptoms.

Blood tests can identify problems such as thyroid disease or an adrenal disorder. Sometimes, a genetic test, such as a test for the gene that causes Huntington’s disease, could be considered if you are at risk of having this condition.

Imaging 

There are no consistent changes in the structure of the brain that are diagnostic of bipolar disorder. However, changes to certain parts of the brain can cause altered behavior and emotions.

Brain imaging studies might be ordered if you have a history of head trauma or if you had a deficit on your physical examination that points to the possibility of a structural cause of your symptoms—such as a stroke or a brain tumor.  

Determining Subtypes

There are three main subtypes of bipolar disorder. These include bipolar 1 disorder, bipolar 2 disorder, and cyclothymia.

Bipolar 1 Disorder

To meet the criteria for bipolar 1 disorder, you must have a manic episode lasting for at least seven days. Sometimes manic episodes are associated with psychosis and might involve hospitalization.

It is common also to have episodes of depression and/or mixed episodes in which you have depression and mania at the same time, but these are not a necessary criterion for a diagnosis of bipolar 1 disorder.

Bipolar 2 Disorder

To meet the criteria for bipolar 2 disorder, you would have episodes of depression and episodes of hypomania.

Cyclothymic Disorder

Cyclothymic disorder is characterized by persistent, often cyclic, depressive and hypomanic symptoms that do not meet the full criteria for major depression or hypomania.

Self/At-Home Testing

If you or the people who are close to you are concerned about your mood, you can help facilitate your diagnosis by keeping track of your mood and behavior over time. You could consider keeping a diary or a calendar to record how you are feeling.

It is a good idea to discuss this preliminary diagnostic step with your healthcare provider and to make an appointment for an evaluation when you can go over the results of your self-checks together.

Record your symptoms of mania, which can include:

• Extreme excitement
• Irritability
• Agitation
• Overestimating your own abilities
• Difficulty focusing, being easily distracted
• Having many new ideas that can’t realistically be carried out
• Decreased need for sleep
• Risky behavior

Manic episodes often involve neglecting responsibilities, altered interactions with other people, and/or placing yourself in danger. For example, you might not show up to your job, working on a highly ambitious project instead. Or you could spend more money than you have.

Hypomania can also be a component of certain types of bipolar disorder. The same features characterize hypomania as mania, but the symptoms are not as disruptive. Psychosis is not a feature of hypomania.

Record your symptoms of depression, which can include:

• Feeling sad
• Feeling hopeless, worthless, or guilty
• Excessive fatigue
• Trouble sleeping, or sleeping excessively
• Diminished appetite or weight loss
• Loss of interest in activities and a lack of motivation
• Slow-paced movement
• Indecisiveness
• Thoughts of suicide or self-harm

You might experience features of depression along with features of mania. It is also common to have phases of euthymia (stable mood) in between phases of altered mood.

Differential Diagnosis 

Several medical and psychiatric conditions can cause symptoms that resemble the symptoms of bipolar disorder. If you have signs of any of these conditions, your healthcare provider might order tests to rule them out:

• Post-traumatic stress disorder (PTSD): PTSD can manifest in various ways, with emotional lability (frequent mood changes) among the effects. Therapy is often needed as a treatment for the effects of PTSD.
• Chronic traumatic encephalopathy (CTE) and post-concussive syndrome: Emotional and behavioral changes can develop after a brain injury due to head trauma, so your healthcare provider will consider this if you have such a history. This might be seen in brain imaging, but imaging is often normal. Mood stabilizers and therapy can help reduce the effects.
• Schizoaffective disorder: This condition is characterized by features of schizophrenia and depression and/or mania. When bipolar disorder is associated with psychosis, it can be difficult to distinguish schizoaffective disorder from bipolar disorder. The treatments can be similar when psychosis is a major component of bipolar disorder.
• Drug use: Drugs of abuse, such as alcohol, cocaine, and others, can cause mood swings and behavioral changes. Some medications, such as high doses of steroids, can cause similar effects. Often, stopping the drugs requires a period of gradual tapering with medical supervision. The effects should resolve when the drug is no longer active in your body.
• Endocrine (hormone) condition: Thyroid disease and adrenal disease can cause depression and/or features that resemble mania. Generally, blood tests will show the hormone abnormalities, and treatment for the endocrine disorder should reduce the symptoms.
• Dementia: Many different types of dementia can cause emotional and behavioral changes. Depression is characterized by a gradual deterioration of memory and self-care abilities, while these skills are not usually severely affected in bipolar disorder.
• Stroke: Strokes in certain areas of the brain can cause changes in behavior. Generally, strokes cause changes that can be seen with brain imaging. Treatment often involves rehabilitation.
• Brain tumor: Brain tumors in certain areas of the brain can cause emotional changes. These symptoms should improve with removal of the tumor or with treatment used to shrink the tumor.

A Word From Verywell

If you are diagnosed with bipolar disorder, it can be a relief to put a name on the feelings and behaviors you have been having. This condition can be treated with medication and therapy.

The prognosis of this condition varies. You might have many episodes, or you could have very few. Either way, your treatment may be adjusted by your healthcare provider as your need for treatment changes over time.