Are You Bipolar? How To Get Evaluated For A Diagnosis

If you suspect you are bipolar, you might be wondering how to find out for sure. Bipolar disorder can be very disruptive to your life, including your personal relationships, finances, and overall health. Yet unfortunately, many people with bipolar disorder are not diagnosed correctly until later in life, after years of struggling, misdiagnoses, or even hospitalization. 

If you think you might have bipolar disorder, you should get evaluated by a mental health professional as soon as possible. They will be able to confirm your suspicions or ease your concerns. If they diagnose you with bipolar disorder, they will be able to suggest an effective treatment plan.

Let’s take a closer look at bipolar disorder and the signs and symptoms that may suggest you should get evaluated for a diagnosis. You will also find out what diagnosing bipolar disorder involves and the steps you can take from there.

What is bipolar disorder?

If you learn that you have bipolar disorder, you are not alone. You share your diagnosis with approximately 2.8% of the US population¹. That's roughly seven million people.

Bipolar disorder is a type of mood disorder. You might experience strong changes in your mood and energy levels, affecting your thoughts and behaviors.

There are two main types of bipolar disorder — neither is "better" nor "worse" than the other. There is no cure for the condition, but your symptoms may become more manageable with the right medication and support from loved ones and mental health professionals.

Here's a brief overview of bipolar I and II and the lesser-known cyclothymic disorder.

Bipolar I

Bipolar I is usually characterized by a history of manic episodes (feelings of euphoria, high energy, or extreme irritability). In some bipolar I cases, a hypomanic (milder and shorter than mania) episode will come before or after mania. Mania and hypomania can prompt risky and impulsive behavior, including thrill-seeking, overspending, and obsessive gambling.

Some people with bipolar I experience a period of psychosis, a break from reality that usually requires hospitalization.

If you are bipolar I, you will likely experience depressive episodes before or after mania, but this isn’t necessary to be diagnosed. This is one reason why the historical term "manic-depressive" is no longer used.

Bipolar II

With bipolar II, you are likely to experience significant periods of depression and shorter periods of hypomania. Unlike bipolar I, you won’t experience mania.

Type II bipolar was once thought to be “milder” than type I. However, it is now recognized that bipolar II’s low-mood episodes and mood changes can cause as much instability and disruption in your daily life, relationships, and general wellbeing as the manic episodes associated with type II.

Cyclothymic disorder

Cyclothymia is the rarest form of bipolar disorder². With this condition, you will experience distinct periods of high-mood and low-mood over two years or more. These episodes are not as severe as those you would experience with other types of bipolar disorder.

What kind of health professional can diagnose bipolar disorder?

Family physicians and psychologists may be the first health professionals you speak to about your symptoms, and they may be involved in assessing you for bipolar disorder. However, psychiatrists are typically best placed to diagnose mental health conditions.

Psychiatrists are trained to treat both medical and psychiatric issues, having completed four years of psychiatry residency after medical school and becoming licensed as a physician. They can also prescribe medication, an important tool in managing bipolar disorder.

How bipolar disorder is diagnosed

The medical professional who assesses you to provide a diagnosis will ask you questions and carry out checks. They will compare their findings against a set of criteria for diagnosing bipolar disorder.

Here are some of the areas your psychiatrist will want to find out about:

Your symptoms

To help diagnose bipolar disorder, you will be asked about the symptoms you have been experiencing.

You can expect to be asked these questions:

• What symptoms have you been experiencing?

• If you are having manic or depressive episodes, how long do they last?

• How many episodes have you had?

• How often do they happen?

• How do your symptoms affect your day-to-day life (including your general health and wellbeing, relationships, and finances)?

You might find these questions difficult to answer accurately. To reach a diagnosis, your doctor might ask you to keep a symptom diary.

Your physical health

No single medical test can diagnose bipolar disorder, but your care provider may recommend a complete physical examination and a blood test. This is to rule out other illnesses and determine which medications will be helpful for you.

Your personal history

A health professional will also ask you questions about your past experiences and how you behave and feel on a day-to-day basis.

Be prepared to answer questions relating to the following: 

• Thinking patterns and worries

• Reckless behavior

• Treatment received for mental illness in the past or hospitalization

• Suicide attempts or suicidal thoughts

• Substance abuse

• Work history, including frequent career changes

These conversations are often difficult, and it may take a few sessions before you feel comfortable opening up.

Your family history

Bipolar disorder has been linked to genetics³, so if you have a family member who has been diagnosed bipolar, that information may help confirm your own diagnosis.

Unfortunately, the condition can be missed (or misdiagnosed), so there is a chance that a family member is living with bipolar without knowing it. For this reason, your psychiatrist will likely ask you about your home life growing up, family dynamics, and any history of suicide, suicide attempts, severe mood swings, or depression within your close and extended family.

What your loved ones think

It might help your psychiatrist to learn about your background from the perspective of the people in your life. With your permission, they might ask to meet with your spouse, parents, adult children, and/or friends to get their insights into your behavior and moods.

Not only is this information helpful in diagnosing bipolar disorder, but it may also help your loved ones to understand the condition and your diagnosis. Your psychiatrist will be able to explain to the people in your support network how they can help you manage bipolar episodes going forward.

Criteria for diagnosing bipolar disorder

Once your psychiatrist has gathered all the information they need, they will compare their findings against official guidelines published by the American Psychiatric Association⁴ for the classification of mental disorders. You might hear or see these guidelines referred to as DSM-5.

Can self-tests be effective in diagnosing bipolar disorder?

Your healthcare professional might suggest you do a self-test as part of the diagnosis process.

With 13 "yes" or "no" questions, the simplest and quickest self-test that your psychiatrist may ask you to complete is the Mood Disorder Questionnaire.

The General Behavior Inventory (GBI) is another type of self-test, and it may help to determine if you are bipolar, cyclothymic, or suffering from major depression. It’s a 73-item questionnaire in which you’ll be asked about different situations, such as “have there been periods when you felt a persistent sense of gloom?”. You will need to rate how much the situation reflects your own on a scale of 0–3, with 0 being “Never/Hardly Ever” and 3 being “Very Often/Almost Constantly.”

Self-tests like these are typically used as a type of screening tool. Your results will help your psychiatrist assess whether you need further evaluation and whether you are likely to have bipolar disorder.

How long does it take to diagnose bipolar disorder?

There is no set amount of time or number of sessions needed to diagnose bipolar disorder. 

While some health professionals make a diagnosis in just one session, most will prefer to see you a few times to understand your condition better, rule out other problems, or determine if you have other mental health issues that coexist with bipolar.

Challenges to getting a correct diagnosis

Bipolar disorder isn't always easy to detect, which is why 69% of patients with bipolar disorder were previously misdiagnosed⁵, and more than a third of these were misdiagnosed for at least a decade.

Most of the time, people with bipolar only seek treatment when they are suffering from major depression, rather than hypomania or mania. This is one of the biggest challenges mental health professionals face when diagnosing and treating bipolar patients. If you have bipolar II, you might seek help during a period of extreme low mood, but you might not recognize your hypomanic episodes. This may result in an incorrect diagnosis like major depressive disorder.

Besides major depressive disorder, other common misdiagnoses include: 

• Thyroid problems — these can be ruled out with medical screening

• Attention-deficit hyperactivity disorder (ADHD) — diagnosed as well in as many as 20% of adults with bipolar disorder⁶

• Schizoaffective disorder — common in bipolar I patients who seek the help of medical professionals during manic or psychotic episodes

• Borderline personality disorder (BPD) —  shares several symptoms with bipolar including unstable mood and impulsive behavior

Why it’s important to advocate for yourself

Advocating for yourself will help you get a correct diagnosis. If you believe you have been misdiagnosed, or you are unhappy with the time your psychiatrist spent assessing you and the methods they used, you should seek a second opinion.

The best way to advocate for your own mental health is by paying close attention to your moods and symptoms and communicating them to your psychiatrist. For some, this is where keeping a mood diary is helpful.

Once you are confident with your diagnosis, work closely with your psychiatrist to find the best treatment for you. Be honest when you don’t believe things are working as expected. You and your healthcare provider should work as a team, and your input is essential to your ongoing care.

Moving forward after being diagnosed with bipolar disorder

If you have been diagnosed with bipolar disorder, you and your psychiatrist will decide on a treatment plan that includes one or a combination of the following:

1. Medication

Medication almost always plays a role in treating bipolar disorder. Recommended medications are similar for both bipolar I and bipolar II. A mood stabilizer or antipsychotic is often used to treat and prevent mood episodes. Sometimes, antidepressant medications are also recommended. These work together to reduce the severity of hypomania, mania, and depression.

Finding the right combination may take some time, as people respond to medicines and doses differently. That's why it's important to work closely with healthcare providers who have a solid background in prescribing psychiatric medication. Be confident in discussing how your medication makes you feel, whether that’s negative or positive.

2. Therapy

If you are diagnosed with bipolar disorder, you may benefit from therapy. Therapy can help you understand how bipolar affects you, repair damaged relationships, build healthy coping strategies, and develop confidence and self-acceptance.

Here are some types of therapy that could be recommended to you:

• Psychoeducation — helps you understand and self-manage bipolar by teaching you how to identify the early warning signs and triggers of bipolar episodes

• Interpersonal and social rhythms therapy (IPSRT) — focuses on common triggers for mood instability, such as circadian rhythm, environmental stressors, and relationship issues

• Family therapy — helps you and your family better understand and manage bipolar collectively

• Cognitive behavioral therapy — enables you to manage negative or intrusive thoughts (particularly helpful for depressive episodes)

3. Electroconvulsive therapy (ECT)

Electroconvulsive therapy is an effective treatment that is sometimes used to treat severe depression or mania. Unlike the “electric shock therapy” you see in old movies, ECT is a safe procedure carried out by experienced health professionals.

4. Mood and sleep tracking

Keeping a mood diary or using a tracking app can help you become more aware of your moods and sleep habits. When shared with a mental health professional, this information can help identify triggers for bipolar episodes and evaluate which medications work best.

5. Peer, social, and family support

Any health diagnosis can make you feel isolated, and bipolar disorder may, unfortunately, carry a degree of social stigma, which makes it more difficult to reach out for support. You might not know how to share your diagnosis with your loved ones or know who to talk to for peer support.

This is why the National Alliance on Mental Illness (NAMI) is a good place to start. NAMI offers many resources that can show your friends and family how to support you as you experience bipolar symptoms. The organization aims to replace false information and negative perceptions with valuable insights that can help to reduce the stigma associated with bipolar and other mental illnesses.

Through NAMI, you can also find in-person peer support groups, and if you have been discriminated against because of your condition, you can find legal resources and advocacy.

6. Wellness plan with crisis tools

Part of moving forward after a bipolar disorder diagnosis is putting a plan in place to help you if you find yourself in a mental health crisis.

A mental health crisis can be dangerous for you and those around you. A wellness plan should include vital information that will keep you safe should you experience suicidal thoughts, show signs of psychosis, or otherwise be in danger.

NAMI has an excellent guide for creating a crisis plan. Here are some of the things you should consider including in your plan:

• A list of your early warning symptoms and triggers

• Coping strategies

• Phone numbers for your primary care provider, mental health provider, and local emergency services

• Phone numbers for crisis support lines, including the National Suicide Prevention Lifeline at 800-273-8255

Health practitioners can help you develop an emergency plan, but it’s a good idea to involve close friends and family, as they can help identify warning signs and offer their support.

The lowdown

It's understandable if you are afraid to be diagnosed with bipolar disorder, but seeking a proper diagnosis can help you move forward with your life. Although it might be scary, a diagnosis can be a positive thing as it can answer many of your questions and make your symptoms and experiences easier to understand.

If you think you might have bipolar disorder, reach out to your primary healthcare provider. Your doctor may refer you to a psychiatrist who will evaluate your health and symptoms and assess your personal and family history. The sooner you seek help, the sooner you’ll get the tools you need to manage your condition.