How Doctors Diagnose Bipolar Disorder

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Figuring out whether someone has bipolar disorder can be a challenge for doctors. Doctors can’t diagnose mental diseases with a blood test. Diagnosis is also hard because bipolar disorder symptoms mimic those of other illnesses.

For example, the "lows" of bipolar disorder can be much like symptoms of depression. During a period of “highs,” bipolar disorder can look like hyperactivity, rage or anxiety.

Doctors need to carefully check your symptoms to know for sure whether you have bipolar disorder. This starts with your primary care doctor. Your doctor will check whether other health problems might be causing your symptoms. 

Tests and brain scans cannot identify bipolar disorder. However, they can help eliminate other possible causes, like a brain tumor or a stroke. If your doctor rules out other illnesses, you should see a psychiatrist or other mental health professional. This specialist will check for symptoms of both mania (the “ups”) and depression (the “downs”).

What Your Doctor Will Look For

The manic episodes of bipolar disorder often last a long time. Typically, your symptoms will be strong enough to seem unusual and disrupt your daily life.

Symptoms of mania might include:

  • Impulsive, high-risk behavior
  • Increase in activity levels
  • Irritability or anger
  • Rapid speech
  • Rapid thought progression
  • Restlessness
  • Trouble focusing mentally
  • Trouble sleeping
  • Unusually happy or outgoing mood

With bipolar disorder, you will also have depressive episodes. These symptoms are similar to depression:

  • Change in eating habits, either not eating or overeating
  • Change in sleep patterns
  • Extreme sadness or hopelessness
  • Loss of interest in activities
  • Thoughts of suicide or death
  • Trouble concentrating

You can also have other symptoms. For instance, sometimes a person with bipolar disorder experiences a “mixed state.” This is when mania and depression are present at the same time. Someone with severe bipolar disorder may have psychotic symptoms. These include delusions or hallucinations.

Fine-tuning Your Diagnosis

Once it is established that you have a bipolar disorder, your doctor will try to figure out what specific type you have. Again, your symptoms are the key. How often you have symptoms and how severe they are will make a difference.

Mental health professionals use standard guidelines to determine the type of bipolar disorder. These guidelines are in a book called the Diagnostic and Statistical Manual of Mental Disorders. It describes five types of bipolar disorder:

  • Bipolar I disorder. Manic episodes last at least seven days. Depressive episodes often last two weeks or more. Symptoms include a major change from the person’s normal behavior. Symptoms are severe enough to require treatment in a hospital.
  • Bipolar II disorder. Manic episodes are milder than in bipolar I. Depressive episodes follow the manic ones.
  • Bipolar disorder not otherwise specified (BP-NOS). The person shows out-of-the-ordinary manic and depressive behavior. But the symptoms don’t meet the specific guidelines for bipolar I or II.
  • Cyclothymia. This is also called cyclothymic disorder. It is a milder form of bipolar disorder. Mania is milder, and so are depressive episodes.
  • Rapid-cycling bipolar disorder. This is the most severe form of bipolar disorder. Someone with this type has four or more episodes each year. They may be manic, depressive or mixed episodes.

From Diagnosis to Treatment

Although bipolar disorder is a challenging diagnosis, it’s an important one to get right. Bipolar disorder, as with other mental illnesses, can worsen without treatment. There are many effective treatments that can make the highs and lows of bipolar disorder less severe and tolerable. Medications and other forms of therapy can improve the quality of life for people with bipolar disorder. All of these factors make careful diagnosis by a mental health professional very important.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Feb 3
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Frequently Asked Questions about Bipolar Disorder. Brain & Behavior Research Foundation. https://bbrfoundation.org/frequently-asked-questions-about-bipolar-disorder
  2. Bipolar Disorder. National Institutes of Health. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  3. Bipolar Disorder Fact Sheet. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder