Bipolar disorder (also known as “manic depression”) is a disorder characterized by mood swings from feelings of great highs to those of great lows. Because it has both highs and lows, bipolar can sometimes be misdiagnosed as simply depression by the patient, relatives, friends, and even physicians. An early sign of bipolar disorder may be hypomania — a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior for at least 4 days. The symptoms associated with hypomania tend to feel good. Therefore, even when family and friends learn to recognize the mood swings, the individual often may deny that anything is wrong.

In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.

Bipolar disorder in children is different and has a different set of symptoms. In children, bipolar disorder is known as disruptive mood dysregulation disorder.

If left untreated, bipolar disorder tends to worsen, and the person will often experience full-fledged manic episodes and depressive episodes.

One of the usual differential diagnoses for bipolar disorder is that the symptoms (listed below) are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or other Psychotic Spectrum Disorders.

And as with nearly all mental disorder diagnoses, the symptoms of manic depression must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.

What’s the Difference Between Bipolar (Manic Depression) and Depression?

Specific symptoms of the various types of bipolar disorder:

Bipolar I Disorder

  • Essential feature of Bipolar I is that the person experiences one full manic episode (though the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes).
    • manic episode is a distinct period during which there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least one week (or any duration if hospitalization is necessary), accompanied by at least three additional symptoms of mania.
  • The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Bipolar II Disorder

In both Bipolar I and II disorders, a person can have a mood episode (i.e., primarily manic or depressed) with mixed features, wherein a manic/hypomanic episode there are significant depressive symptoms, and in a depressive episode there are some manic/hypomanic symptoms.

Additionally, both bipolar and unipolar depression (i.e., in major depressive disorder) can occur with anxious distress, with a seasonal pattern, with psychotic features, with peripartum onset, with melancholia, and with atypical features. See additional information on these DSM-5 specifiers here.

Quick List of Symptoms in Bipolar Disorder

During a manic phase, symptoms include:

  • heightened sense of self-importance
  • exaggerated positive outlook
  • significantly decreased need for sleep
  • poor appetite and weight loss
  • racing speech, flight of ideas, impulsiveness
  • ideas that move quickly from one subject to the next
  • poor concentration, easy distractibility
  • increased activity level
  • excessive involvement in pleasurable activities
  • poor financial choices, rash spending sprees
  • excessive irritability, aggressive behavior

During a depressed phase, symptoms include:

  • feelings of sadness or hopelessness
  • loss of interest in pleasurable or usual activities
  • difficulty sleeping; early-morning awakening
  • loss of energy and constant lethargy
  • sense of guilt or low self-esteem
  • difficulty concentrating
  • negative thoughts about the future
  • weight gain or weight loss
  • talk of suicide or death

The main method used to diagnose bipolar disorder is a thorough interview with a psychiatrist, psychologist or other mental health professional. Although there are written methods for documenting the severity and number of symptoms, those tests only complement a complete interview. They do not substitute for a face-to-face evaluation by a professional. There are not yet any blood tests or other biological tests that can be used to diagnose bipolar disorder.

This post has been updated for DSM-5 criteria.

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