Symptoms and diagnosis of bipolar disorder

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Bipolar disorder is more than mood swings. This is a serious mental health condition that used to be called manic depression.

According to the guideline DSM-5 for diagnosing mental illness, there are two main types of bipolar disorder that can be diagnosed based on the severity and nature of the symptoms:

  • Biphasic I-People with biphasic I have experienced at least one manic episode in their lives. Although not required for a formal diagnosis, most people will experience major depressive episodes in their lifetime.
  • Bipolar II-Patients with bipolar II have at least one hypomanic episode (a less severe mania) and at least one major depressive episode.

Assess symptoms

As a mental health condition, blood draws or imaging tests are not helpful in diagnosing bipolar disorder, but sometimes you may be asked to help rule out medical conditions that may cause symptoms. To confirm the diagnosis, a person must meet the criteria, which will be evaluated through a psychiatric evaluation.

Please note that the symptoms of bipolar disorder are the same in women and men, but social and gender roles can affect how they behave or how others think about them.

Symptoms of bipolar mania

The manic episode lasts at least 7 days. Hypomanic episodes involve the same symptoms, but the individual’s function is not significantly impaired, and no symptoms of psychosis occur.

Symptoms of a manic or hypomanic episode include:

Bipolar depression symptoms

During a depressive episode, individuals may experience the following symptoms:

  • Crying for no reason or long periods of sadness
  • Feelings of guilt or despair
  • Lose interest in activities that usually bring you happiness
  • Extreme fatigue, including the inability to get up
  • Loss of interest in your health, nutrition or appearance
  • Difficulty concentrating or indecision
  • Excessive sleep or difficulty sleeping
  • Suicidal thoughts or self-harm impulse
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When someone has bipolar depression, cognitive skills problems, such as subjective memory impairment, inattention, and indecision, may be the first things others notice. It interferes with personal performance and makes it difficult to complete tasks.

Physical symptoms associated with depressive episodes

During a depressive episode, individuals may experience various physical symptoms, including unexplained pain.

Changes in weight are also common. Some people find it difficult to eat when they are depressed, while others turn to food for comfort. Therefore, both weight loss and weight gain may be symptoms of a depressive episode.

Psychomotor agitation, that is, increased activity caused by mental tension rather than physical tension, or mental retardation, slowing down of thinking and physical activity, may also occur.

Differential diagnosis

Different diagnostic criteria have been proposed for bipolar disorder, but even with these criteria, diagnosis is far from easy. Mental illnesses that can show symptoms similar to bipolar disorder include:

Attention deficit hyperactivity disorder (ADHD)

Hyperactivity and distraction are two hallmarks of attention deficit hyperactivity disorder (ADHD). However, they also predominate in bipolar disorder, especially when it comes to children. To complicate matters, these situations usually happen at the same time.

Alcohol/Drug Abuse

It is common for people with bipolar disorder to fight alcohol and drug abuse problems. This is usually an attempt to self-heal, even on an unconscious level. In addition, the effects of certain substance use (which may cause hallucinations or inability to fall asleep) may be confused with symptoms of bipolar disorder. In addition to these concerns, alcohol may interact with drugs used to treat bipolar disorder.

Borderline Personality Disorder

The diagnostic criteria for borderline personality disorder include impulsivity, suicidal behavior, emotional reactivity, inappropriate anger, and transient paranoia. All of these are also related to bipolar disorder. A person may also be diagnosed with these two diseases. (Learn more about the similarities and differences between bipolar disorder and borderline personality disorder.)

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The hallmark of delusions is non-singular delusions. Emotional episodes may exist, but their duration is short compared to delusions.


One thing that distinguishes depression (unipolar depression) from bipolar disorder is mania/hypomania. If a person with depression enters a manic phase, the diagnosis is bipolar disorder. Many people with undiagnosed bipolar disorder develop mania when they start taking certain antidepressants and other medications.

Eating disorder

It is not uncommon for patients with bipolar disorder to have eating disorders. In addition, depression, anxiety, and irritability are usually caused by eating disorders. Anorexia nervosa is an eating disorder characterized by extreme fear of gaining weight or becoming obese.

People with anorexia usually weigh less than 85% of their normal body weight. The typical feature of bulimia nervosa is defecation after overeating (intentional vomiting).

Panic Disorder

Panic disorder is characterized by recurrent, spontaneous panic attacks. Panic disorder usually coexists (occurs at the same time) with mood and other mental disorders. In addition, panic attacks are also common in patients with bipolar disorder.


Schizophrenia is a mental disorder that can cause severe disturbances in cognition (thinking), behavior, and mood. It consists of two types of symptoms-positive and negative. Positive symptoms include delusions, hallucinations, speech and thinking disturbances, behavioral disturbances, catatonic behaviors, and inappropriate emotions. Negative symptoms are calming mood, lack of speech, and a decrease in goal-oriented behavior. The symptoms of schizophrenia can easily be confused with the symptoms of bipolar disorder.

Schizoaffective disorder

Schizoaffective disorder is diagnosed when there are symptoms of major depression or mania, as well as some symptoms of schizophrenia. However, when the emotional symptoms are not present, the delusions or hallucinations must continue for a period of time. As you might expect, there is a lot of confusion and controversy surrounding the distinction between this disease and bipolar disorder.

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Diagnosis challenges

Although there are specific diagnostic criteria for the diagnosis of bipolar disorder, the evaluation of these criteria may be variable and subjective. Therefore, cases are often missed. According to a study published in 2018, 60% of patients seeking treatment for recurrent depression actually suffer from bipolar disorder.

On the other hand, overdiagnosis of bipolar disorder is also a problem.

A review of clinical studies in 2013 showed that bipolar disorder was misdiagnosed in the following areas:

  • 42.9% of drug abuse treatment centers
  • 40% of people with borderline personality disorder
  • 37% of cases were called by clinicians who lack experience in bipolar disorder

Precautions when diagnosing types

There are two important caveats that may further complicate the process of distinguishing between the two types of bipolar disorder.

One is that although the presence of psychotic symptoms is one of the factors that distinguish bipolar type I mania from bipolar type II hypomania, patients with bipolar type II may experience hallucinations or delusions during a depressive episode without being diagnosed It is bipolar type I mania.

The second is that patients with bipolar I disorder may also have hypomanic episodes. In fact, they usually do this. However, people with bipolar disorder II have never had a manic episode. If a person with bipolar disorder II has a manic episode, the diagnosis will change.

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If you or someone you know has symptoms of bipolar disorder, be sure to consult your doctor. Your doctor may want to rule out any underlying physical health problems that may cause you to develop symptoms.

Your doctor may refer you to a mental health professional for evaluation. The treatment provider can evaluate your symptoms and, after making the correct diagnosis, can assist in the development of a treatment plan.