Bipolar disorder is defined as a disorder of cycling mood.  Individuals with bipolar disorder experience mood states that are too “high” as well as depressed states that are too “low” that typically cycle back and forth over time.  Episodes in which the person’s mood is too high are called manic episodes, or hypomanic episodes if less severe.  Episodes in which the person’s mood is too low are called major depressive episodes.  In bipolar disorder, the untreated individual has chronically unstable mood.  Periods of wellness, manic episodes, and depressed episodes shift back and forth in an unpredictable pattern.

To diagnose bipolar disorder, most clinicians use the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5 (American Psychiatric Association. and American Psychiatric Association. DSM-5 Task Force. 2013).  Bipolar disorder is considered to exist on a spectrum from most severe to least severe.  The most severe form is called Bipolar I (One) Disorder, followed by Bipolar II (Two) Disorder.  Less severe forms of bipolar disorder are Cyclothymia and Other or Unspecified Bipolar and Related Disorders.  The diagnosis of Bipolar I Disorder will be briefly reviewed in this article.

Diagnosing Bipolar I Disorder

To diagnose Bipolar I Disorder, the most severe type of the illness, an individual must have experienced at least one lifetime episode of mania, and typically has experienced one or more depressive episodes as well.  A manic episode consists of elevated, expansive, or irritable mood that is clearly different from the person’s normal mood state.  Several other symptoms must also accompany this change in mood state, as follows:

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual, called “pressure of speech”
Racing thoughts, called “flight of ideas”
Distractibility
Excessive involvement in highly pleasurable activities that can result in bad consequences, such as excessive spending, gambling, indiscriminate sex, or drug abuse.
Excessive goal-directed activity in work, school, or personal situations, or excessive restlessness in pointless non-goal directed activity, called psychomotor agitation

A manic episode is clearly different from the person’s normal mood and behavior when not in an episode.  The person’s symptoms are so severe as to interfere with routine occupational or social functioning, or the person requires hospitalization, or the person expresses psychotic symptoms (a break with reality).

Most patients with Bipolar I Disorder also have one or more major depressive episodes.  A major depressive episode is a distinct period of mood lasting 2 weeks or longer in which the person feels either depressed or has little or no interest in day to day activities.  In addition to either or both of these symptoms, the individual also must have several of the following additional symptoms nearly daily over the same 2 week period:

Increased or decreased appetite, or significant weight loss or gain
Insomnia or excessive sleep
Noticeable psychomotor agitation, as noted above, or psychomotor retardation, which is moving more slowly and sluggishly than normal
Feeling tired and worn out for no apparent reason
Feeling worthless or irrationally guilty
Cognitive problems involving thinking, concentration, or indecisiveness
Thoughts of death, suicidal thoughts, suicidal plans, or a suicide attempt

Some but not all patients with Bipolar I Disorder also have psychotic experiences, such as hallucinations and delusions.  Hallucinations are false sensory experiences, such as hearing voices, and delusions are false beliefs, such as believing that others are out to harm the person when there is no objective evidence confirming the belief.

Bipolar I Disorder can be confused with other psychiatric and medical conditions.  It is important to have an expert evaluate the patient in order to make an accurate diagnosis.

References

American Psychiatric Association. and American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C., American Psychiatric Association.