Diagnosing Bipolar Disorder

The clinical interview

A mental health provider will conduct a detailed interview to assess the patient’s mood patterns, behavior, and cognitive function. The clinician will ask about:

• Episodes of mania, hypomania, and depression
• Sleep patterns
• Energy levels
• Impulsivity and decision-making
• Family history of mental illness
• Any history of psychotic symptoms (e.g., hallucinations or delusions)
• Substance use, which can mimic or exacerbate symptoms of bipolar disorder

2. Diagnostic Criteria (DSM-5)

To confirm a diagnosis, the clinician checks whether the symptoms align with the DSM-5 criteria for Bipolar I Disorder (characterized by at least one manic episode, which may be followed by depressive episodes) or Bipolar II Disorder (characterized by at least one hypomanic episode and one major depressive episode).

• Manic Episode: A period of elevated or irritable mood lasting at least one week, with symptoms such as increased energy, racing thoughts, decreased need for sleep, impulsivity, or grandiosity.
• Hypomanic Episode: A less severe form of mania lasting at least four days.
  Major Depressive Episode: A period of at least two weeks of persistent sadness, low energy, loss of interest, changes in appetite or sleep, and possible suicidal thoughts.

3. Mood Charting

Patients may be asked to track their mood, sleep, and behaviors over time to help the clinician identify patterns that suggest bipolar disorder.

4. Psychological and Cognitive Testing

Structured psychological assessments or screening tools, such as the Mood Disorder Questionnaire (MDQ), can help differentiate bipolar disorder from other mood disorders.

5. Medical Evaluation

A medical workup, including blood tests and neurological examinations, may be performed to rule out other medical conditions that could cause similar symptoms, such as:

• Thyroid disorders
• Neurological conditions
• Substance use disorders
• Medication side effects

6. Differential Diagnosis

Bipolar disorder shares symptoms with other psychiatric conditions, such as major depressive disorder, borderline personality disorder, schizophrenia, and ADHD. A thorough evaluation ensures the correct diagnosis.

• Misdiagnosis: Bipolar disorder is often mistaken for major depression, especially if manic or hypomanic episodes are not reported.
• Delayed Diagnosis: Many patients experience depressive episodes before their first manic or hypomanic episode, delaying the correct diagnosis for years.
• Comorbid Conditions: Anxiety disorders, substance use disorders, and personality disorders can complicate the diagnostic process.