Bipolar Disorder Symptoms and Diagnosis

The symptoms of bipolar disorder depend on which type of the condition a person has, though all forms of bipolar disorder consist of periods of a level mood between episodes.

Bipolar 1 is characterized by at least one manic episode. Someone with this condition is also likely to experience symptoms of depression at times. Many people who have bipolar 1 also have depressive episodes, according to the National Institute of Mental Health.

With bipolar 2, you must have experienced a major depressive episode as well as an episode of hypomania (which is less severe than full mania), with periods of a level mood between episodes.

Finally, in cyclothymia, a milder form of bipolar disorder, people experience less severe manic and depressive episodes that alternate for at least two years; these episodes don’t meet the full criteria for either hypomania or major depression.

So, what constitutes a manic, hypomanic, or depressive episode?

Manic and Hypomanic Episodes: What Is the Difference?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, which doctors use to guide diagnosis, describes a manic episode as a period of abnormally and persistently elevated mood characterized by increased goal-directed activity or energy that lasts for at least a week. A manic episode can also consist of a period of irritable mood. Both elevated and irritable manic episodes are accompanied by some of the following symptoms:

  • You're easily distracted
  • You feel as though your thoughts are racing
  • You experience an exaggerated level of self-confidence and self-importance
  • Your need for sleep is reduced
  • You're unusually or excessively talkative
  • You engage in impulsive, reckless behavior with no consideration of the consequences (such as shopping sprees or unprotected, risky, or excessive sexual activity)

In manic episodes with both elevated and irritable moods, symptoms are present most of the day, every day.

A hypomanic episode has similar daily symptoms, but they are less intense and severe. The episode is also shorter in duration, lasting at least four days.

For a behavior change to be considered a manic episode, it must meet the following criteria:

  • Be a distinct and noticeable change in mood and functioning
  • Include noticeable problems in your day-to-day activities or require hospitalization to prevent harm to yourself or others
  • Not be the result of alcohol or drug use, a medication you're taking, or another medical condition
A manic episode may also trigger a break from reality (psychosis) and may cause hallucinations or false but strongly held beliefs (delusions). These psychotic symptoms can sometimes wrongly lead to a diagnosis of schizophrenia.

For a behavior change to be considered a hypomanic episode, it must meet these standards:

  • Involve a distinct and noticeable change in mood and functioning
  • Not be significant enough to disrupt daily activities or require hospitalization
  • Not be the result of alcohol or drug use, a medication you're taking, or another medical condition
  • Not have any associated psychotic symptoms (these would indicate a full-blown manic episode)

The Symptoms of Depressive Episodes

A major depressive episode includes the following signs and symptoms:

  • Depressed mood
  • Lack of interest in, or pleasure from, normal daily activities
  • Significant weight loss or gain, or changes in appetite
  • Insomnia or excessive need for sleep
  • Restlessness or slowed behavior
  • Fatigue or loss of energy
  • Feelings of guilt or worthlessness
  • Inability to think or concentrate
  • Thoughts of death or suicide
To be considered a major depressive episode, you must experience five or more of these symptoms daily or nearly every day — for most of the day — over a two-week period. At least one of the symptoms must be a depressed mood or loss of interest or pleasure in activities.

Your symptoms must also cause disruption in your day-to-day activities, as well as social activities or relationships.

As with manic episodes, depressive episodes must not be the result of alcohol or drug use, a medication you’re taking, or another medical condition.

Other Symptoms and Patterns of Bipolar Disorder

Other potential signs and symptoms of bipolar 1 and 2:

  • Anxiety
  • A manic episode with some symptoms of a depressive episode, or a depressive episode with some symptoms of a manic or hypomanic episode
  • Feeling empty or hopeless yet also highly energized
  • Loss of pleasure in all or most activities
  • Catatonia (a state of limited or abnormal movement)
  • Psychosis (detachment from reality, often with hallucinations or delusions)
People with catatonia don't react to their environment normally, and they may hold their body in an unusual position. Often, they don't speak.

People with psychosis experience a severe episode of either mania or depression that causes them to become detached from reality.

Both bipolar 1 and bipolar 2 may occur after a woman becomes pregnant or within a month of giving birth (also known as peripartum onset).

The disorders may also follow a so-called seasonal pattern, in which episodes change with the seasons.

Finally, there is a form of the disorder called rapid cycling, in which you may experience four or more mood episodes within a single year, with full or partial disappearance of symptoms between episodes.

Diagnosis: Is There a Bipolar Disorder Test?

Because of the unresolved questions surrounding the causes of bipolar disorder, the condition remains a challenge to diagnose. If you or your doctor suspect that you may have a form of bipolar disorder, you will most likely undergo these tests:

  • A physical exam, including blood tests, to rule out other potential causes of your symptoms
  • An MRI, PET scan, or CT scan to identify potential abnormalities or changes in your brain structure or chemistry that are linked to bipolar disorder, or to rule out other disease
  • A psychological exam in which your doctor will ask you about your thoughts, feelings, and behaviors (family and friends may also be consulted, with your permission)
  • Daily tracking of your moods and behaviors to confirm diagnosis

There are also multiple questionnaires that health professionals use to help make a diagnosis. These formal, researched, and clinically tested questionnaires are designed to identify and clarify your symptoms and assist in diagnosis. Your doctor may or may not use such a questionnaire.

Because bipolar symptoms can be similar to those of other disorders, the condition can be a challenge to distinguish and properly diagnose. Additionally, many people with bipolar disorder also have another concurrent condition, such as an anxiety disorder, attention deficit hyperactivity disorder, substance abuse, or an eating disorder.

Bipolar Disorder in Children and Teenagers

Although bipolar disorder has the same symptoms in children and teenagers as it does in adults, these symptoms may be more challenging to identify in younger people. This is because they are often difficult to distinguish from normal mood changes that can occur as a result of stress or trauma. As a result, children with bipolar disorder are frequently misdiagnosed with other mental health conditions.

If your child shows signs of severe mood swings that appear different from previous or normal mood swings, talk to your doctor or pediatrician.

Additional reporting by Deborah Shapiro and Leona Vaughn.

Leave a comment

Your email address will not be published. Required fields are marked *