How to tell

Accurately diagnosing Bipolar Disorder is often not a straightforward matter. Many people go 10 years or more before their illness is accurately diagnosed as Bipolar Disorder.

There are two starting points for considering whether you might have Bipolar Disorder. Firstly, you must have had episodes of clinical depression. Secondly, you should ask yourself the following questions:

"Compared to when you are depressed, or in your normal mood, do you ever have times when you are more 'up' than usual, feeling more wired and hyper?"

If the answer is 'yes', then you might like to consider whether you also experience any of the 6 key features of mania and hypomania?

• increased energy
• positive mood
• irritability
• inappropriate behaviour
• creativity
• mystical experiences

Read more about these features.

Finding out when the 'highs' first commenced can also help in determining the possibility of a Bipolar Disorder. People with true Bipolar Disorder often identify a period of change - most commonly in adolescence or early adulthood - that often occurs close to the onset of depressive episodes, whether before or after. The identification of a clear onset period goes some way toward distinguishing Bipolar Disorder from certain personality states and other conditions (e.g. Attention Deficit Hyperactivity Disorder) - however, Bipolar Disorder can occur (rarely) in childhood and this makes identification somewhat more difficult.

The presence of a positive family history also increases the probability of Bipolar Disorder. Read more about the genetic links to Bipolar Disorder.

We believe that the duration of manic or hypomanic episodes is not important in establishing the probability of Bipolar Disorder. There are many people who can be given a firm clinical diagnosis of Bipolar II - and even of Bipolar I - who have highs lasting for one or two days or even only for a few hours.

Try our Self-Assessment Test for Bipolar Disorder

Read about Getting Help for Bipolar Disorder

Why is Bipolar Disorder so often undiagnosed?

Some of the reasons why Bipolar Disorder can go for a long time undiagnosed include the following:

• Mild cases of Bipolar Disorder can be hard to distinguish from a normal volatile or cyclothymic personality style. Other psychiatric conditions (e.g. Attention Deficit Hyperactivity Disorder, Borderline Personality Disorder, and Conduct Disorder) can show some similar features.
• Bipolar Disorder does not always present in a consistent pattern (that is, highs followed by lows). For example, it may follow on from an unexpected physical condition such as an eating disorder, or an episode of insomnia.
• The 'highs' that are symptomatic of mania or hypomania may also occur in people who do not have Bipolar Disorder. For example, in creative people, when caught up in a burst of creative activity (such as the writer who may describe a feeling of being 'taken over' by a train of thought, writing in a state of excitement and needing only a few hours' sleep), or in people who use either legal or illicit drugs that induce a sense of 'being high'.
• Mild cases of 'bipolar depression' (a form of depression where manic episodes are also experienced) are quite common. Often no-one else other than the individual may notice their differing mood.
• Some practitioners are unaware of Bipolar Disorder or are untrained in its assessment and may not ask the right screening questions.
• Many patients with mild Bipolar Disorder enjoy their 'highs' and prefer not to seek treatment.
• People usually present for help when depressed, and then - in discussing symptoms with the health practitioner - commonly focus on the current depression rather than on the longitudinal pattern of 'mood swings'.