Bipolar Diagnosis Challenges

Bipolar disorder, formerly known as manic-depressive disorder, is a complex mental health condition characterized by intense, often unpredictable, mood swings that alternate between depression and mania. Episodes can last anywhere from a few hours to a few days to several weeks or longer, seriously disrupting normal patterns of daily life such as sleeping, eating, and being able to maintain employment or meaningful relationships.

Spotting the early warning signs

Everyone experiences emotional ups and downs at one time or another, but with bipolar the mood swings are extreme.

Early warning signs of a depressive episode include fatigue, lethargy, low mood, a loss of interest in hobbies or activities usually enjoyed, finding it hard to do even little things, unexplained aches, and pains, sleeping too much or having trouble sleeping, changes in eating patterns, persistent sadness for no distinguishable reason, irritability, trouble focusing or making decisions, slowed thinking, and/or suicidal thoughts.

The biggest red flag for bipolar mania is having little need for sleep. Other early warning signs include increased energy, extremely high mood, rapid speech, trouble concentrating, impulsive behavior, euphoria, engaging in risky activities, overspending, racing thoughts, excitability, inflated self-esteem, being overly ambitious and taking on many new projects, a feeling of invincibility, and/or having delusions and grandiose ideas.

DSM-5-TR^* criteria for a bipolar diagnosis

Bipolar I

For a diagnosis of Bipolar I, there needs to be at least one episode of mania that lasts for a minimum of one week, affects daily function, and does not take place on top of an already existing psychotic disorder diagnosis such as schizophrenia or delusional disorder. The manic episode may or may not be followed or preceded by hypomanic^** or depressive episodes but these are not necessary for Bipolar I diagnosis.

Bipolar II

For a diagnosis of Bipolar II, there needs to be at least one hypomanic episode that lasts four days or longer and one major depressive episode, that is not attributed to a schizoaffective disorder^*** or take place on top of an already existing diagnosis of schizophrenia or other psychotic disorder, or be attributable to the physiological effects of a substance.

Cyclothymia

Cyclothymia is a mild form of bipolar disorder characterized by shorter, less extreme episodes of depression and hypomania. To be diagnosed with it requires that these episodes persist for two years or longer.

Bipolar diagnosis challenges

Bipolar disorder is often hard to diagnose at first because it shares common symptoms with other mental health conditions and may be misdiagnosed as something else. Someone assessed while suffering from a depressive episode, for instance, may mistakenly be diagnosed with depression instead of bipolar disorder.

Since bipolar is a mood disorder, common diagnostic tools such as blood work, brain scans, or other laboratory tests used to determine the state of one’s physical health are not useful in diagnosing it. The most important diagnostic tool is talking openly with a trained mental health professional about your mood swings, behaviors, and lifestyle habits, who is qualified to use specific criteria from the DSM-5-TR to evaluate your symptoms.

Although bipolar disorder is considered a lifelong condition, there are effective treatments available to enable you to live a full life.

If you have questions or think you may have bipolar disorder and would like to set up an appointment to meet with one of the faith-based counselors in Orange County to see how we can help you manage the challenges you are facing, please give us a call at Orange County Christian Counseling in California.