Why Is It So Hard to Get a Bipolar Diagnosis?

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There is nothing subtle about bipolar disorder. It’s a disease characterized by drastic shifts in mood, energy, and activity levels. Yet as dramatic as the disorder can be, it’s often frustratingly difficult to find out what’s wrong.

On average, it takes 5 to 10 years to get a correct diagnosis. That delay can have serious consequences. There’s more opportunity for the symptoms to wreak havoc in your life. Plus, the longer bipolar disorder goes undiagnosed and untreated, the worse it may become.

Fortunately, there are things you can do to help get the right diagnosis sooner. Once you begin receiving proper treatment, you’ll be on your way to a healthier, more satisfying life.

Confusion with Depression

People with major depression and people with bipolar disorder both have bouts of depression as part of their illness. The difference: Those with bipolar disorder also have bouts of mania, an extremely “high” or excitable state. Those with major depression don’t experience mania.

That distinction can be lost when a doctor or therapist has seen only your depressed side. People with bipolar disorder are more likely to seek help when depressed than when manic. Consequently, as many as two-thirds of those with bipolar disorder are initially misdiagnosed with major depression.

More Causes of Misdiagnosis

Here are some additional reasons a diagnosis of bipolar disorder is often delayed:

  • Bipolar disorder can take several forms. Some people don’t have full-blown mania, for example. Instead, they have a milder version called hypomania. Others have symptoms of depression and mania at the same time rather than separately.

  • It can be mistaken for other disorders. Both mania and attention deficit hyperactivity disorder (ADHD) can lead to being overactive, easily distracted, and extremely talkative. Both severe bipolar disorder and schizophrenia can cause hallucinations and delusions.

  • There isn’t a single test to diagnose it. Things would be easier if there were a blood test or brain scan that could definitively tell whether you have bipolar disorder. Unfortunately, that isn’t the case. Instead, a trained professional evaluates your symptoms and makes a judgment call about whether they meet the diagnostic criteria. Different professionals sometimes reach different conclusions.

How to Get the Right Diagnosis

Scientists are looking for more objective ways of diagnosing bipolar disorder. One promising possibility uses new brain scan technology. In a 2013 study in Psychological Medicine, researchers using an advanced MRI technique were able to tell bipolar brains from healthy brains with more than 70 percent accuracy.

For now, you can help yourself get the right diagnosis by taking these steps:

  • Don’t wait. Seek professional help as soon as you’re aware of a problem.

  • Look for a mental health professional with expertise in mood disorders.

  • Be open with the professional about your symptoms, past and present.

  • Bring your spouse or someone else close to you to the first appointment. He or she may have observed changes in your behavior that you didn’t notice.

Don’t give up. With appropriate diagnosis and treatment, you can gain better control over your moods.

 Key Takeaways

  • It can take 5 to 10 years to be diagnosed with bipolar disorder.

  • People with bipolar disorder are more likely to seek help when depressed than when manic. This means they may be misdiagnosed with major depression.

  • Bipolar disorder can also be mistaken for schizophrenia or ADHD.

  • Although there’s no single test to diagnose bipolar disorder, you can help by seeing your doctor as soon as you’re aware of a problem and being open about your symptoms.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Aug 27

  1. Bipolar Disorder Diagnosis: Challenges and Future Directions. Phillips, ML. Lancet. 2013; 381:1663-71.;

  2. Examination of the Predictive Value of Structural Magnetic Resonance Scans in Bipolar Disorder: A Pattern Classification Approach. Rocha-Rego, V., et al. Psychological Medicine, published online June 5, 2013.;

  3. Prevalence and Characteristics of Undiagnosed Bipolar Disorders in Patients with a Major Depressive Episode: The BRIDGE Study. Angst J., et al. Archives of General Psychiatry. 2011;68: 791-99.;

  4. Attention Deficit Hyperactivity Disorder (ADHD). National Institute on Mental Health, undated. (http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.);

  5.  Bipolar Disorder. National Institute of Mental Health, undated. (http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.);

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