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Why is bipolar disorder difficult to diagnose?

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. Over time, though, by carefully documenting the changes in your symptoms and noting whether you respond well to the medications that work best for this disorder, they can be relatively sure of the diagnosis.

Bipolar disorder is difficult to diagnose for two main reasons.

  1. There is no simple blood test or x-ray that indicates definitively one way or another if you have bipolar disorder.
  2. The symptoms tend to vary from person to person and can mimic other illnesses. When mood swings do not occur often, they can be mistaken for other conditions like schizophrenia, alcohol or substance abuse, thyroid disease, anxiety, and heart disease. In addition, symptoms like depression can be treated by itself if you do not experience or report other symptoms.

So if you are concerned about your own or your loved one’s mood and behavior, talk to your doctor about all of your symptoms, even if you don’t think they are related. In this case, the more information, the better.

Dr. Ruth White, MPH
Social Work Specialist

Because the symptoms of bipolar disorder are so varied and there is no blood test or brain scan to diagnose the disease, it can appear to be something else. Some people think that the mood changes experienced by people living with bipolar disorder happen suddenly, without warning, but in reality, these changes can be very gradual and almost unnoticeable unless you or your loved ones learn to see subtle changes and track triggers that often precede mood changes. Sometimes, because of these subtleties, bipolar disorder goes undiagnosed, especially when substance abuse or other co-occurring disorders exist.

Other times, bipolar disorder can be misdiagnosed, especially as unipolar depression, because people often seek help when depressed and, unless they’re asked about possible manic symptoms, that aspect of the illness might go untreated. Similarly, someone experiencing a manic episode may seek treatment and be diagnosed with attention-deficit disorder or attention-deficit/ hyperactivity disorder. Some people with bipolar disorder attempt to self-medicate by using alcohol or drugs and may seek help for symptoms related to substance addiction. Poor work or school performance may also be signs of an undiagnosed mood disorder. Because there's still no biological or medical test for the presence of bipolar disorder, diagnosis is best made by a mental health professional who makes a diagnosis using a thorough case history that includes the occurrence and history of symptoms, along with family history (if available).

Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More

More About this Book

Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More

After receiving a bipolar diagnosis, you need clear answers. Bipolar 101 is a straightforward guide to understanding bipolar disorder. It includes all the information you need to control your...
Ms. Julie A. Fast
Mental Health Specialist

I think it's quite easy to diagnose bipolar disorder once you know the basics of the illness. Bipolar Disorder doesn't change much in terms of symptoms—what changes is the severity and frequency of the symptoms.

There are four basic mood swing categories I write about in my bipolar disorder work: Depression, Mania, Psychosis and Anxiety. Of course there are more symptoms, but once you understand these four categories, it's a lot easier to see what's going on in yourself and others.

People get manic in the same way. They get depressed in the same way and they get anxious and psychotic in the same way. The symptoms can mix and match- some may never have psychosis, while others have psychosis each time they get ill. Some may have more anxiety when they are depressed, while others are more lethargic. But the four core mood swing categories stay the same.

If a health care professional knows what questions to ask, the diagnosis is quite simple... I don't think it's even that hard to diagnose the two main types of bipolar disorder: bipolar I and bipolar II.

The main goal is to find a very qualified health care professional who can ask the right questions to get the right diagnosis.

It DOES get complicated if a person deals with a lot of psychosis that isn't a part of the mania or depression. This leads to a possible diagnosis of schizo affective disorder which is basically bipolar with a separate psychotic disorder.

Although doctors have developed a set of well established criteria to help distinguish between bipolar disorder and straight depression, different doctors may interpret your symptoms in different ways. As always, if you are uncomfortable with a diagnosis or need additional reassurance it makes sense to get a second opinion. Regardless of the diagnosis, though, be sure to tell your doctor if your new medications make you feel differently—whether it's in a good way or in a bad way. This is important information that could really help your treatment plan.

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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.