Bipolar Disorder: Symptoms and Diagnosis

What are the symptoms of bipolar disorder — and how can patients and doctors get a correct diagnosis?

Bipolar disorder isn’t always easy to spot. For one thing, bipolar symptoms manifest themselves a little differently in every patient — meaning the “textbook definition” of the disorder is often far from its reality.

On top of that, symptoms can resemble other mental disorders and, to add to the confusion, some physical disorders. The symptoms come and go, with periods of relatively normal mood and behaviors in between episodes of illness. There is no definitive medical test for bipolar disorder — however, doctors do look for a pattern of both manic and depressive symptoms in patients they evaluate.

Symptoms of Bipolar Disorder

How can someone with bipolar disorder ensure an accurate diagnosis? The first step is to know the basic signs. Symptoms of bipolar disorder can include, but are not limited to:

Depressive phases, typically far more prevalent than manic phases, characterized by:
> Feelings of sadness, hopelessness, and apathy
>Thoughts of suicide
>Extreme feelings of guilt and regret
>Sharp decrease in energy, sometimes described as “leaden paralysis”
>Distorted appetite — either noticeably increased or diminished
>Loss of interest in favorite activities
>Noticeably poor performance in work or school
>Frequent absences from work

Less frequent manic phases characterized by:
>Feelings of euphoria (30% of manias) or severe irritability (70% of manias)
>Unusually high self-esteem
>Poor judgment (particularly when it comes to risky behavior like drug or alcohol use, gambling, or promiscuous sex)
>Rapid speech — often to the point where the listener is unable to follow
>Behaving aggressively or too exuberantly
>Decreased need for sleep
>Dramatic boost in sex drive
>In very extreme cases, psychosis — breaking from reality — which can include delusions or hallucinations

These two phases, mania and depression, alternate back and forth in varying cycles. Each one lasts several weeks or more. In most cases of bipolar disorder, these symptoms start in the patient’s late teens or in early adulthood, with the average age of onset at around 18 years. However, scientists have recently started exploring a condition called “Early Onset Bipolar Disorder,” which can occur in children as young as six. Symptoms are similar to those listed above, but tend to include more extreme mood swings and quicker shifts between mania and depression.

One of the most frequent presentations in children is severe irritability that manifests in “affective storms” that last for four to six hours. These storms are more than a temper tantrum. I ask parents of children with this disorder “Are you physically afraid of your child?” Parents of bipolar children usually are afraid, but they hate to admit it.

If left untreated, bipolar disorder tends to get worse as time goes on. If this description of the depressive and manic symptoms seems familiar, make an appointment with your doctor to discuss your mental health. Don’t be surprised if your doctor doesn’t jump directly to bipolar disorder, however. Research suggests that 7 out of 10 people with the condition receive at least one misdiagnosis during their lifetime. For people living with bipolar disorder, this can be confusing, frustrating, and, in many cases, negatively affect their treatment.

Why Bipolar Disorder Is Misdiagnosed

The depressive phase of bipolar disorder is much more common than the manic phase. Most people with bipolar disorder experience depression about 70 percent of the time, and mania only 30 percent of the time. As a result, patients are often misdiagnosed with simple “unipolar depression.” This is particularly true for Bipolar II patients, who experience a much milder form of mania called hypomania.

Unipolar depression requires different treatments, and these treatments are often ineffective for someone who is actually suffering from bipolar disorder. Antidepressants can exacerbate bipolar symptoms.

In addition, alcohol or drugs — which are commonly used by untreated bipolar patients in an effort to self-medicate — can complicate the picture, making the condition harder to recognize. Doctors may credit drug abuse with causing manic or depressive symptoms, instead of the other way around.

Finally, symptoms of bipolar disorder can match up with those of some physical ailments, like thyroid disease, HIV, lupus, or syphilis. Bipolar-like symptoms can also be a side effect of certain medications like prednisone, a common steroid. ADHD is a special problem since the two conditions share 14 features in common. Up to 25 percent of people with bipolar disorder will have ADHD.

Track Your Moods to Improve Diagnostic Accuracy

To make a proper diagnosis, you and your doctor should start by carefully tracking your symptoms — noting in detail their frequency, duration, and severity. Your doctor will want to eliminate the possibility of any of the other medical conditions mentioned above, as well as another mental disorder like schizophrenia or ADHD.

Diligently tracking your mood may be a good start to uncovering a bipolar diagnosis. Mood-tracking smartphone apps, like iMoodJournal or Optimism, can help those who suspect they have bipolar disorder easily keep track of their ups and downs. By noting the situations or locations where their moods occur, app users can identify patterns and note possible triggers for shifts from mania to depression, or vice versa. The Depression and Bipolar Support Alliance (DBSA) also has an online mood-tracking tool. If you prefer low-tech solutions, write down your mood in a daily journal — just make sure you also keep note of other symptoms like speech patterns, energy levels, and changes in sleeping habits.

Research Your Family’s Medical History

If you suspect you have bipolar disorder, look into your family’s medical history, since the condition tends to run in families. Studies suggest that the risk of bipolar disorder is about 10 times higher in first-degree relatives of affected patients, as compared to the general population. First-degree relatives are also about three times more likely to have a major depressive disorder, suggesting overlapping genes between the two conditions.

Bipolar disorder doesn’t appear to be caused by a single gene. Studies have linked it to multiple genes, with each gene having a "mild to moderate effect” on the likelihood of developing the condition. However, the condition may not be purely hereditary. Studies of identical twins have shown that if one twin has the disorder, there’s only a 40 to 70 percent chance that the other twin will have it. This points to other factors behind bipolar disorder, not just genetics.

It’s unclear whether environmental factors can cause bipolar disorder, but research shows that they can definitely boost the likelihood of experiencing an episode in people who are genetically predisposed to bipolar. Childhood trauma, in particular, seems to be closely linked to bipolar disorder. Some studies estimate that as many as 50 percent of adults with bipolar disorder experienced severe trauma or abuse in childhood.

Major life changes (like losing a loved one, going to college, or going through a divorce) can trigger a dramatic mania or depression, eventually leading to a bipolar diagnosis. Other factors like stress, lack of sleep, drug and alcohol use, the last month of pregnancy, and seasonal changes can lead to an increased risk for a bipolar episode.

Getting the Right Diagnosis

Think about bringing a family member, spouse, or close friend along to the doctor’s appointment. He may be able to provide an objective view of your symptoms and any possible triggers.

Brain imaging has shown some promise in identifying brain patterns present in people with bipolar disorder, but it still has a long way to go. As of now, there are no definitive medical tests to determine if someone has bipolar disorder — the best method continues to be symptom tracking and good old-fashioned listening.

Bipolar disorder is not an easy diagnosis to make, and your doctor should not come to this conclusion lightly. Extensive questioning and an in-depth symptom history are always required — as well as honest and open communication between doctor and patient. Once a correct diagnosis is reached, however, treatment can help patients regain balance and control of their lives.

TAGS: Bipolar Disorder, Comorbid Conditions with ADD

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