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How do I know if a bipolar disorder diagnosis is accurate?

Ms. Julie A. Fast
Mental Health
Have you been manic? It’s that easy.

If you have not had an obvious manic episode, you can’t have bipolar disorder.

It’s possible to be moody and anxious, excitable and agitated, but that’s not mania. You may have had days where sleeping is difficult, but if you woke up tired, grumpy and your eyes felt like they were filled with gravel, that is insomnia and not mania.

Mania is very specific. It can be full blown or hypomanic, positive/expansive (euphoric) or negative (agitation with depression symptoms.) Mania must exist hand in hand with depression for the bipolar disorder diagnosis to be correct.

Here are some mania questions you can answer if you doubt the accuracy of a bipolar diagnosis:
  1. Have you ever suddenly felt amazingly good, spontaneous, creative, powerful, fearless, sexy and so fantastic that you don't need to sleep and don’t get tired? (Euphoric mania)
  2. Have you ever been depressed and then your mood shifted to a highly positive mood that you considered the ‘real you’?
  3. Have the people in your life commented on very obvious changes in your energy and mood as compared to your depression.
  4. Has your mood suddenly and inexplicably turned angry, depressed, anxious, restless and negative while not sleeping or being tired the next day? (Dysphoric mania)
It’s especially important to ask these questions if a person has been depressed. Many people see a health care professional for depression symptoms and are not asked the essential mania questions- as a result, a bipolar disorder diagnosis may be missed.
What's Next?

The final step needed in order to assure yourself that a bipolar diagnosis is correct is to examine if your moods disrupt your life in terms of:
  • Relationships (including family, friends and romantic relationships)
  • Work
  • Money
  • Sexuality and
  • Personal safety
These are the areas most affected by bipolar disorder.
If you have depression and have experienced mania, you most likely have bipolar disorder.

Welcome to the club!
 
Sheri Van Dijk
Psychiatry

Bipolar disorder is a complex illness that presents differently from person to person, and can even change in an individual from episode to episode. As a result, it's often fairly difficult to diagnose. There is a screening form for bipolar disorder that is widely used called the Mood Disorder Questionnaire (you can complete this form online at www.dbtforbipolar.com), and while this questionnaire screens for the illness, it doesn't diagnose.

Diagnosis requires that a mental health professional such as a psychiatrist or psychologist carefully assesses your symptoms; this includes taking a comprehensive history, and it's helpful if a family member or someone else who has been a large part of your life is there to contribute to this assessment. One of the biggest problems in diagnosing bipolar disorder is that people don't tend to seek help when they're feeling good in the "high" episodes of bipolar, unless symptoms escalate to the point that the person's functioning is impacted. This is why people are often mis-diagnosed with unipolar depression. As well, while we think of hypomanic or manic episodes as "highs" they often involve irritability and anger, rather than the positive feelings we associate with them.

It's also important to remember that some medical conditions, such as thyroid problems, can cause mood instability and anxiety.

If a thorough assessment has been conducted, physical conditions ruled out, and your doctor believes you have bipolar disorder, it's okay to disagree - often it takes time for people to recognize the symptoms in themselves (if they are in fact there), and then to accept this as a new part of their lives. It can also help to do some reading once you've received the diagnosis, to see if what you read makes sense in terms of your own experience; or to attend a support group for people with bipolar disorder to see if you relate to what you hear.

I think the biggest thing to remember in this is that bipolar disorder is an unpredictable illness, and rarely do two people with the illness experience it in the same way. Don't think of bipolar as the stereotype - it's not just highs and lows, the illness consists of many other symptoms as well.

Over time, doctors can be relatively sure of your diagnosis by carefully documenting the changes in your symptoms and noting whether you respond well to the medications that work best for this disorder. Bipolar disorder is difficult to diagnose because many other conditions have similar symptoms. It may take some time for your doctors to know for sure that you have this disorder.
Keith Star
Psychology
Certain conditions can mimic bipolar symptoms. Common ones are:
  •   Thyroid conditions
  •   Neurological diseases
  •   Infections of the brain
  •   Deficiencies of certain vitamins, such as vitamin B-12
  •   Corticosteroid use, especially in high doses
  •   Medicine used for diseases like tuberculosis and AIDS
Talking to a doctor about your medical history and the medications that you are currently taking can help her determine the cause of your condition.
Answer the following questions:

1. Have you ever had a distinct period of consistently elevated, expansive, or irritable mood lasting throughout at least four days that is clearly different from your usual non-depressed mood?

2. If yes, during the period of mood disturbance have you had at least three or more of the following symptoms to a significant degree, and throughout the entire period?
  • Inflated self esteem or grandiosity
  • Decreased need for sleep (e.g., 3 hours sleep and not tired the next day)
  • You were more talkative than usual, or felt a pressure to talk
  • Your thoughts were racing quickly
  • You were very distractible
  • You had an increase in goal directed activities (either at home, work/school, or sexually), or felt agitation
  • You had excessive involvement in pleasurable activities that have a high potential for painful consequences (such as unrestrained buying, sexual indiscretions, foolish business investments)
Scoring: If your answer to question #1 is yes, and you answer yes to three of questions a-g, and were not on any substances known to cause mood disturbances (e.g., stimulants, other drugs of abuse, steroids), then it is likely that you have some degree of bipolar disorder-either mild (cyclothymic, bipolar II) or more severe (Bipolar type I).


Deborah Davis
OBGYN (Obstetrics & Gynecology)
Bipolar disorder, sometimes called manic-depressive disorder, causes mood swings that range from the lows of depression to the highs of mania.  It is diagnosed by a number of tests and exams. These can help rule out other problems and pinpoint a diagnosis and also check for any related complications.  An accurate diagnosis is made by performing a physical examination, laboratory tests, psychological evaluations and mood charting.  In order to be diagnosed with bipolar disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders. This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.  Diagnostic criteria for bipolar disorder are based on the specific type of bipolar disorder. 
Mona A. Schulz, MD
Psychiatry
When you have problems with mood, it is best to enlist support in the form of an entire team who will work together to analyze your symptoms, help characterize the disorder, and support you through a treatment program. By looking for the help from a psychiatrist, psychologist, neuropsychologist, nurse practitioner with special training in mental health, or a LISW social worker counselor, your team will help you approach the treatment of your mood disorder from multiple treatment modalities.

However, to best understand your mental health problem, and before continuing on long-term medical and psychological treatment for a bipolar diagnosis, it is preferable for you to get a second and third opinion from a psychiatrist, a psychologist, and a neuro-psychologist at a major teaching hospital.

What you must realize is, unlike any other medical specialty, psychiatry is the only branch of medicine that diagnoses patients based on questionnaires and checklists. All the other medical specialties, surgery, neurology, internal medicine, OB/GYN and others treat patients based on objective finding on x-rays, CT-scans, MRIs, blood tests, microbiology, pathology and tissue examination. Psychiatry, diagnosis, and treatment though often effective is still in its infancy even though major inroads are being made every day in potential diagnosis in functional neuro-imaging and neuro-psychological testing.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.