How is bipolar disorder identified?

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  A Sheri Van Dijk , Psychiatry, answered

  Bipolar disorder can be quite difficult to diagnose, and is often misdiagnosed as unipolar depression. On average, a person with bipolar disorder goes misdiagnosed for nine years! One reason for this is that there is no diagnostic test - no x-ray or blood test, for example - that can show us definitively that a person has bipolar disorder.

  So in order to diagnose any mental health problem accurately, a psychiatrist or psychologist must do an in-depth assessment and obtain as much history from the "patient" as possible. It's also really helpful if information can be obtained from family or other care-givers, since the person with the illness isn't always able to objectively identify or describe symptoms - for example, with bipolar disorder, a person experiencing a hypomanic or manic state might not identify it as a problem, since he or she likely has more energy, needs less sleep, experiences an elevated mood, etc. Why complain to your doctor about feeling GOOD?

  While there is no diagnostic test for bipolar disorder, there is a screening tool that is commonly used to assist in diagnosing: the Mood Disorder Questionnaire, or MDQ (available on-line at www.dbtforbipolar.com). This is NOT a diagnostic tool, but can help you and your doctor determine if you MAY have the illness - and if so, you need to be seen by a psychiatrist or psychologist to confirm the diagnosis.

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  A Dr. Russ Federman, PhD , Psychology, answered on behalf of International Bipolar Foundation

  Bipolar disorder is usually identified by a mental health professional that assesses an individual’s current symptoms in the broader context of long term patterns involving mood variability, physical energy, sleep patterns, thought processes, impulsivity, sexual energy, and self-perceptions. Bipolar disorder cannot accurately identified by assessing an individual's experience or behavior at any one point in time as the disorder truly involves long term mood and behavioral patterns.
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  A Dr. Ruth White, MPH , Social Work, answered

  Diagnosing bipolar disorder is very challenging because it depends on what is going on with the patient at the time that they seek help. Most people tend to seek help when they are depressed because one of the symptoms of mania is thinking that all is well even when it isn't. Depression is difficult and challenging and feels awful so when someone with bipolar seeks help when they are depressed then it is highly likely they may be diagnosed with 'unipolar' depression. Sometimes mania or hypomania presents like Attention Deficit Hyperactivity Disorder.

  To eliminate common misdiagnoses, doctors take a comprehensive history of the patient. It often includes work history, and sometimes consultations with loved ones. There are also paper and pencil questionnaires that are part of this history. It usually requires at least 2 - 3 visits before doctors make a tentative diagnosis.

  Sometimes the effectiveness of a drug like lithium to relieve symptoms is a final step because it would not work on other symptoms.

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  A World Federation For Mental Health (WFMH) answered

  It is now commonly acknowledged that there is a spectrum of bipolar illness which includes several types of Bipolar Disorder. These include the most common or classic form of the illness, Bipolar Disorder I, which is characterised by recurrent episodes of mania and depression, and Bipolar Disorder II, which involves milder episodes of mania that alternate with depression. In some people, the illness involves "rapid cycling", whereby four or more episodes (during the last 12 months) of this cycle occur. These episodes of mania and depression are often punctuated by periods of normal mood in between. When depression or mania recurs, this is known as a relapse.
  Episodes of mania and depression, as well as their signs and symptoms, occur differently in each person diagnosed with Bipolar Disorder. Many of these signs and symptoms can be missed, or misinterpreted as another disorder. Careful consideration should be given to the person's culture and context when diagnoses are made, as well as ruling out other medical problems. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the most commonly used tool to diagnose bipolar and other mental disorders.
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