The defining symptom of bipolar disorder (also known as “manic depression”) is the presence of severe mood swings — episodes between feeling great highs to feeling great lows, including depression (American Psychiatric Association, 2013). When in the highs, a person with bipolar symptoms may feel like they are “on top of the world,” able to accomplish anything they set their mind to, with the desire to do a dozen things all at once (finishing none of them). Sometimes this high appears as greater irritability in the person, rather than an elevated mood.
In its early stages, the symptoms of bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor performance at school or work. Bipolar symptoms generally don’t come and go quickly — they are persistent and significantly impair the person’s life (Caponigro & Lee, 2012). This condition is sometimes prone to being misdiagnosed as depression, because the person experiences hypomanic, rather than manic, episodes. (Hypomania can be mistaken for normal, goal-directed activity if not carefully assessed by a mental health professional.)
Bipolar disorder in children is different, with a different set of symptoms. In children, bipolar disorder is known as disruptive mood dysregulation disorder.
According to the National Institute of Mental Health (2020), if left untreated, bipolar symptoms tends to worsen, and the person will often experience full-fledged manic episodes and depressive episodes. Treatment usually consists of a combination of psychiatric medications and psychotherapy, and some form of treatment is usually needed throughout most of a person’s adult life (Fink & Kraynak, 2015).
This condition is treated with a combination of medication and psychotherapy.
This condition is diagnosed according to the criteria listed in the diagnostic reference manual published by the American Psychiatric Association (2013):
Bipolar I Disorder
- The 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). Learn more about bipolar depression.
- A 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 (1) 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 episodes is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
DSM-5 Codes: Most recent episode manic — Mild, 296.41 (F31.11); Moderate, 296.42 (F31.12); Severe, 296.43 (F31.13) Most recent episode depressed — Mild, 296.51 (F31.31); Moderate, 296.52 (F31.32); Severe, 296.53 (F31.4)
Bipolar II Disorder
- Bipolar II requires occurrence (or history) of one or more major depressive episodes and at least one hypomanic episode. Additionally, there has never been a full manic episode. A hypomanic episode lasts for at least four (4) or more consecutive days, and shares the same symptoms as a full manic episode.
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.
Modifiers for a Bipolar Disorder Diagnosis
There are a number of modifiers to the diagnosis that can help a clinician communicate the exact type of bipolar disorder a person is experiencing. Additionally, both bipolar and 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.
People with this condition may either be rapid cycling through the different mood phases, or slow cycling. In slow cycling, the person may spend weeks or months experiencing one type of mood before cycling to the other. In rapid cycling, a person may experience mood changes in a matter of days or weeks. Effective treatment helps reduce or stop the cycling altogether (Fink & Kraynak, 2015).
DSM-5 Code: 296.89 (F31.81)
Quick List of Bipolar Disorder Symptoms
During a manic or hypomanic phase, bipolar 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, easily distracted
- increased activity level
- excessive involvement in pleasurable activities
- poor financial choices, rash spending sprees
- excessive irritability, aggressive behavior
During a depressed phase, bipolar 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 is a thorough clinical interview with a psychiatrist, psychologist, or other mental health specialist (Fink & Kraynak, 2015). 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. Like all mental disorders, there are not yet any blood tests or other biological tests that can be used to diagnose bipolar disorder.
An early bipolar symptom may be hypomania — an emotional state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior for at least four (4) consecutive days. The symptoms associated with hypomania tend to feel good, and so many times the person seeks to minimize the symptoms to others. Even when family and friends learn to recognize the mood swings, the individual may deny — or may not even realize — that anything is wrong.
One of the usual differential diagnoses for this condition is that the bipolar symptoms 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. Bipolar symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.
This post has been updated for DSM-5 criteria.
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