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How is bipolar disorder diagnosed? Details on the diagnostic exam for bipolar disorder, the importance of getting treatment for bipolar, and comorbid conditions.
Bipolar disorder can be difficult to detect. Some people go as long as 10 years or more before being correctly diagnosed.1 The reason for this has to do with the dual nature of the disorder. When someone is feeling manic or hypomanic, they are full of energy and usually feel good. They are "high on life" and seldom seek treatment. By contrast, they often seek treatment when they fall into a major depressive episode. At that time, they describe only depressive symptoms to their doctor. Therefore, it is common for the individual to be incorrectly diagnosed with depression instead of bipolar disorder.1 Bipolar disorder also shares many of the signs and symptoms associated with other psychiatric illnesses such as anxiety disorders and schizophrenia, further complicating diagnosis.2
Unfortunately no laboratory test can detect bipolar disorder. However, a simple questionnaire can help a doctor determine if someone has common symptoms of bipolar disorder.4 This questionnaire is called the Mood Disorder Questionnaire, or MDQ. The MDQ is a checklist that helps a doctor identify bipolar-related symptoms.4 Remember, only a doctor can provide an accurate diagnosis.
What does a diagnostic exam for bipolar disorder consist of?
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A complete psychiatric history detailing not only your current and past symptoms, but also the symptoms or diagnosis of immediate family members and relatives. Bipolar disorder has a strong genetic component. Therefore, if there is a family history of depression or bipolar disorder, there's a good chance the patient may have it as well.
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A complete medical history and physical exam to rule out any physical illnesses that may be producing or mimicking the symptoms of bipolar disorder. AIDS, a brain tumor or head injury, diabetes, epilepsy, Lupus, Multiple Sclerosis, a salt imbalance or thyroid disorder can produce bipolar-like symptoms.
If no physical cause is found, if no other psychiatric disorder better accounts for symptoms, if the current symptoms have been of significant duration or cause significant impairment in functioning, a patient may then be diagnosed with bipolar disorder. It is important to note here that if there is no previous history of mania or hypomania, the current symptoms must be those of mania or hypomania for a diagnosis of bipolar disorder. In that this disorder is characterized by both extremes of mood (mania and depression), symptoms of just depression will obviously incur a diagnosis of unipolar depression.
Why early diagnosis and treatment are important
It is important to get treatment for bipolar disorder as early as possible.
Many people with bipolar disorder do not know they have it. Some do not seek treatment because they are ashamed of what they feel, while, as mentioned above, others are incorrectly diagnosed with other illnesses, such as depression, anxiety, or schizophrenia.1,2 Without the appropriate treatment the disorder could become more difficult to treat.3
Getting the appropriate treatment for bipolar disorder can help alleviate the following risks1:
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Suicide
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Alcohol and substance abuse
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Problems at school/failing out of school
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Divorce
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Not being able to function at work
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Alienating oneself from friends and family
Learning how to recognize bipolar disorder may help someone receive an accurate diagnosis and appropriate treatment more quickly.
What happens when someone is diagnosed with bipolar disorder?
Patients diagnosed with bipolar disorder will be evaluated for treatment. The 3 basic elements of treatment for bipolar disorder are medication, psychotherapy and group support, and education.
A patient diagnosed with bipolar disorder will be started on medication to stabilize his or her moods and address acute symptoms. Most people are aware of the role that medication plays, but often underestimate the importance of psychotherapy. In order to accept the diagnosis of bipolar disease and manage it in the long run, patients must learn how to cope in healthier ways. Such awareness is difficult to gain without the professional help of psychotherapy. Psychotherapy, also know as "talk therapy" permits a patient to identify the impact of the disorder on his or her life and to begin recognizing events and thinking patterns that may lead or have led to episodes of illness. This process of therapy occurs within a safe and private setting that is difficult to create otherwise.
Prescription medication is important in treating bipolar disorder. Prescription medication may help control the number of episodes a person experiences. The older a person gets, the more frequent their episodes become.2 If a person experiences 4 or more episodes a year the disorder can become more difficult to treat, so it is important to get treatment as early as possible.2
Are there any other illnesses associated with bipolar disorder?
People who develop symptoms of bipolar disorder when they're relatively young and remain undiagnosed are more likely to also develop alcohol and other substance abuse problems.2 These problems worsen the course of bipolar disorder and increase the number of hospitalizations.2
Other mental disorders associated with bipolar disorder include: Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/Hyperactivity Disorder, Panic Disorder, and Social Phobia.2 All of these disorders can be potentially dangerous and may require medical treatment.
next: Symptoms of Bipolar Disorder
References: 1. Depression and Bipolar Support Alliance. Perceptions and impact of bipolar disorder: how far have we really come? Presented at: Fourth International Conference on Bipolar Disorder; June 14-16, 2001; Pittsburgh, Pa. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Text Revision. Washington, DC: American Psychiatric Association; 2000. 3. Kaplan HI, Sadsock BJ. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1998. 4. Hirschfeld R, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. Am J Psychiatry. 2000;157;1873-1875.
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