How Is Bipolar Disorder Diagnosed?

To diagnose bipolar disorder accurately, a mental health professional will use a combo of physical and mental health screenings. This will help them figure out the details or type of your disorder, or if you have a related condition.

Common screening tools for bipolar disorder include:

• General Behavior Inventory (GBI)
• Mood Disorder Questionnaire (MDQ)

While these screening tools are helpful, a detailed clinical interview is essential to confirm a diagnosis.

These clinical interviews (also called the Structured Clinical Interview for DSM-5, or SCID) provide a fuller, more accurate picture of potential mental health conditions.

Overall, the goals of a clinical interview include talking about:

• past or current mood episodes of mania, depression, or hypomania
• how often mood episodes arise and their severity, including whether you experienced suicidal thoughts or intent
• the effects of mood episodes on work, relationships, and other important areas of your life
• the presence of other conditions, such as substance use and anxiety disorders
• your response to past treatments (for example, people with bipolar disorder may not tolerate certain antidepressants, which can trigger episodes of mania or hypomania)
• any family history of mental health conditions

With your permission, your doctor may also speak with your loved ones. Family and close friends can often provide helpful insights into symptoms and mood episodes.

Lab tests may also be done as part of diagnosis to detect medical conditions that mimic psychiatric disorders, such as:

• a thyroid condition like hypothyroidism or hyperthyroidism
• anemia
• vitamin deficiencies

Additional tests can detect chronic diseases, such as diabetes, that may further alter your mental health.

A toxicology test can also show whether someone is using substances, which can impact symptoms or worsen bipolar disorder.

Many medical and mental health professionals follow criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose bipolar disorder.

The DSM-5 features detailed descriptions of the symptoms that make up the types of bipolar disorder.

Bipolar I disorder

Bipolar I disorder is defined by having at least one episode of mania in your lifetime. You may or may not experience depressive episodes.

Mania includes an elevated, expansive, or agitated mood that lasts at least 1 week and involves additional symptoms, such as:

• high self-esteem (elevated mood or feelings of grandiosity)
• very little or no need for sleep, yet still feeling well rested
• nonstop or fast talking (pressured or disorganized speech)
• racing thoughts
• inability to pay attention to one thing or feeling easily distracted
• doing many activities at once, like writing for hours or starting several new projects
• engaging in activities which might be considered impulsive or harmful, such as overspending, heavy substance use, or driving dangerously

An episode of mania may also be diagnosed if it lasts less than 1 week but leads to hospitalization.

While not everyone with bipolar I disorder experiences depressive episodes, those that do will have symptoms for at least 2 weeks or more. This will involve feelings of sadness, loss of interest or pleasure in things you normally enjoy, along with 4 or more of the following:

• deep exhaustion or loss of energy
• weight, sleep, or appetite changes
• trouble thinking, concentrating, or making decisions
• feelings of worthlessness or guilt
• thoughts of death, or suicidal thoughts or intent

Bipolar II disorder

Bipolar II disorder is diagnosed when you experience one or more depressive episodes, along with one or more episodes of hypomania.

Hypomania has the same symptoms as mania, but they’re less severe, so they don’t affect your functioning as much as mania does.

An episode also only needs to last at least 4 days to be diagnosed, rather than the full week for mania.

Cyclothymic disorder

Cyclothymic disorder, aka cyclothymia, is a type of bipolar disorder that involves symptoms of depression and hypomania that last at least 2 years in adults.

With cyclothymic disorder, the symptoms you experience aren’t enough to fit the criteria for a full mood episode. Symptoms are also less severe and shorter than those in bipolar I and II — but the condition can still significantly affect your life.

Rapid cycling bipolar disorder

Rapid cycling is an additional specifier for diagnosing bipolar disorder, not another type.

If you experience rapid cycling, you’ll have at least 4 episodes of major depression, mania, hypomania, or mixed states in 1 year.

Unspecified bipolar disorder

This “catch-all” category is given when someone has symptoms of bipolar disorder that cause significant distress or impairment, but these symptoms don’t meet the full criteria for any of the above diagnoses.

Read more about the symptoms of bipolar disorder here.

Getting diagnosed with bipolar disorder can take time. One reason? Many people are less likely to reach out to a doctor when they’re experiencing mania or hypomania, since some of the symptoms often make them feel good.

This is especially true for people with bipolar II disorder. After an exhausting bout of depression, hypomania can feel like “a period of wellness,” or a welcome reprieve from the depression.

Instead, many people with bipolar disorder seek help when they’re feeling depressed, which can lead to a misdiagnosis.

Bipolar disorder can sometimes be misdiagnosed for several conditions due to similar symptoms:

• major depressive disorder
• substance use disorders
• attention deficit hyperactivity disorder (ADHD)
• borderline personality disorder

It can also get complicated if — like many people with bipolar disorder — you also have another mental health condition, such as:

• panic disorder
• obsessive compulsive disorder (OCD)
• an eating disorder

While it can feel overwhelming to deal with several conditions at once, there are treatments available for each condition — so it won’t feel overwhelming or unmanageable forever.

Before your first doctor’s appointment to discuss diagnosis, you can prepare in a number of ways:

Reflect on your symptoms

To help better understand your symptoms and pinpoint patterns in your behavior and mood, consider these questions:

• When do you first remember experiencing intense mood changes?
• How long do these changes typically last?
• What happens when you feel this way?
• How do you behave during an episode?
• What does your daily life look like during these times?
• What symptoms are you currently experiencing? When did they start?
• When do your symptoms tend to worsen?

Keep a mood journal

Recording different symptoms and events throughout the day can be informative — whether you’re doing this for a week or month.

To track your mood, try writing down:

• how you feel
• energy levels
• current thoughts
• sleep patterns
• stressful events

You can also use an app to help you track your symptoms. Check out this list from our sister site Healthline.

Talk to family and close friends about your symptoms

Sometimes it’s easier for those around you to notice changes, especially when you’re experiencing mania.

You might start by simply asking your loved ones:

• Do you recall any specific incidents throughout the years when I wasn’t acting like myself?
• How would you describe my behavior?

Talk to family about their mental health

Because mental health conditions tend to run in families, it’s helpful to know your relatives’ mental health experiences.

In fact, an estimated 80–90% of people with bipolar disorder have a relative with depression or bipolar disorder.

You might ask family:

• Have you experienced extreme mood shifts in your life?
• Have you felt down a lot? Or not like yourself?
• Have other relatives struggled with their mental health?

Note down your medical background

Bring along a list of medical conditions and medications that you’re currently taking (or have taken), including:

• prescription medicines
• over-the-counter drugs
• vitamins
• herbal supplements

Make a list of questions for your doctor

This could be anything from Why do you think I have bipolar disorder? to How can I access effective treatments?

It also can help to ask your loved ones for suggestions. Or, if you feel like it, bring a trusted relative or close friend with you to your appointment.

If you receive a bipolar disorder diagnosis, know that it can be managed with a combo of medication, therapy, and coping strategies.

Want to learn more about bipolar disorder treatment? Check out our detailed guide.

To learn more about life with bipolar disorder, check out this course on living successfully with a mood disorder from the Depression and Bipolar Support Alliance.

They also offer a wellness workbook that lets you record your symptoms, triggers, and wellness strategies to use going forward.

The International Bipolar Foundation, a bipolar disorder support organization, also offers an array of helpful resources.