Bipolar disorder is a complex mental health condition that involves moods that shift between mania and depression. This serious mental health disorder poses significant challenges to the individual living with it, including difficulty in maintaining employment and meaningful relationships.
Bipolar disorder is often hard to diagnose initially. Someone may seek mental health support while in the midst of a depressive episode, which can lead to a diagnosis of depression, instead of bipolar disorder. Continue reading to learn more about bipolar disorder and why it can be so difficult to diagnose.
What is bipolar disorder?
Bipolar disorder is a mental illness that features extreme and often unpredictable shifts in mood and energy. Changes in sleep patterns, eating habits, emotions, and behaviors can also accompany these mood shifts, disrupting a person’s ability to live a happy and healthy life. The periodic shifts from manic to depressive episodes can feature the following symptoms:
Symptoms of a manic episode:
- Abundance of energy
- Increased activity levels
- Euphoric mood
- Insomnia
- Rapid and talkative speech patterns
- Irritability
- Jitters or an otherwise agitated state
- Racing thoughts
- High-risk behaviors
- Sudden initiation of multiple tasks
Symptoms of a depressive episode:
- Experiencing sad, hopeless, or empty feelings
- Difficulty concentrating
- Loss of interest in usual activities
- Decreased activity level
- Slowed movements
- Forgetfulness
- Low energy
- Changes in eating habits
- Disrupted sleep patterns
- Excessive fatigue
- Thoughts of suicide
Bipolar disorder has no identifiable single cause. Symptoms usually manifest at some point in childhood into late teen years. Some of the risk factors include genetics, family history, trauma, and brain structure or functioning anomalies.
There are four subtypes of bipolar disorder:
Bipolar I Disorder: Characterized by at least one manic episode that is followed or preceded by a depressive episode.
Bipolar II Disorder: Characterized by at least one depressive episode and at least one hypomanic episode.
Cyclothymic Disorder: Characterized by less extreme episodes of depression with episodes of hypomania that persist for at least two years.
Other Specified Bipolar and Related Disorders: Disorders that feature bipolar-like symptoms but do not fulfill diagnostic criteria for the above three subtypes.
What are the complications of diagnosing bipolar disorder?
Bipolar disorder, especially subtypes I and II, are difficult to diagnose. In fact, during the first year of seeking treatment, only 20% of patients are correctly diagnosed. The usual time span between a misdiagnosis and an accurate diagnosis of bipolar disorder is 5-10 years.
The difficulty of arriving at an accurate diagnosis is mostly due to the prevalence of an initial misdiagnosis of major depressive disorder. This happens when the patient is assessed while experiencing a depressive event, and has possibly not acknowledged or recalled a prior manic episode, or has not yet experienced a manic episode.
There are other confounding factors at play as well, such as a co-occurring substance use disorder. In cases where this is also present, the diagnosing professional may assume that the mood swings are directly related to the effects of the substance. Also, bipolar disorder may be misdiagnosed as schizophrenia because many symptoms are included in the diagnostic criteria for both disorders.
It’s important to accurately diagnose bipolar disorder
Undiagnosed or misdiagnosed bipolar disorder can result in a patient receiving the wrong medication for their mental illness. For this reason, clinicians are tasked with the challenge of conducting a very thorough psychological evaluation that considers the individual’s entire mental health history. This might reveal the bipolar symptoms were present prior to the advent of a substance use disorder, so that can be ruled out. Also, conducting a thorough review of the mental health history may help the patient recall a manic episode in the past they might have forgotten about.
Since the DSM-5 was published in 2013, a bipolar diagnosis may be based on extreme changes in energy levels, instead of just mood behavior patterns. As providers become more aware of the problems of diagnosing patients with bipolar disorder, improvements can be made to the diagnostic process, providing appropriate interventions much sooner.
Ashley Addiction Treatment, formerly Father Martin’s Ashley, is a nationally recognized nonprofit leader in integrated, evidence-based treatment for substance use disorders. Our programs are accredited by The Joint Commission, and result in frequent publications of ongoing research into effective treatment methodologies. We offer holistic care that encompasses the mind, body and spirit through inpatient and outpatient treatment, provide drug detox, relapse prevention plans, family wellness programs and a variety of other services tailored to each patient’s unique needs. Our driving principle — “everything for recovery” — reinforces our mission to transform and save lives through the science of medicine, the art of therapy and the compassion of spirituality, and is complemented by our philosophy of healing with respect and dignity. For information about our comprehensive programs, please call (866) 313-6307.