Diagnosing Bipolar Disorder

Physicians rely on the following to make a diagnosis of bipolar disorder:

  • Diagnostic criteria established for bipolar disorder established by the American Psychiatric Association
  • Family members' observations of the patient's behavior
  • Patient's description of moods
  • Physician's observations of the patient during examination
  • Thorough medical and psychiatric history

Diagnosis can be difficult because the first episode of mania may go undetected, and an episode of depression does not necessarily predict a subsequent manic episode. Generally, however, there is a history of depression before the first manic episode.

Diagnostic Criteria for Mania

  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration, if hospitalization is necessary). *According to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., this criterion also includes an emphasis on changes in activity and energy level, as well as mood.
  • During the period of mood disturbance, three (or more) of the following symptoms have persisted (four, if the mood is only irritable) and have been present to a significant degree:
    1. inflated self-esteem or grandiosity
    2. decreased need for sleep (e.g., feeling rested after only 3 hours of sleep)
    3. more talkative than usual or pressure to keep talking
    4. flight of ideas or subjective experience that thoughts are racing
    5. distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
    7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
  • The symptoms do not meet criteria for a Mixed Episode. *A new specifier, "with mixed features" has been added in the DSM-V.
  • The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
  • The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

From the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1996. Washington, DC: American Psychiatric Association (APA); Updated per DSM-V.

The diagnostic criteria for major depressive disorder apply to the diagnosis of bipolar disorder (see symptoms of depression).

Bipolar Disorder Differential Diagnosis

When the patient is suffering symptoms of a mixed episode, the direct physiological effects of a substance (e.g., a drug of abuse, antidepressant medication, ECT, light therapy) or a general medical condition (e.g., hyperthyroidism) must be ruled out.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Jan 2001

Last Modified: 02 Sep 2015