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:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g., feeling rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- 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)
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.