How Bipolar Disorder is diagnosed

by Elia Strange

First of all, what you need to understand is that there are three types of disorders that come under the umbrella of bipolar disorder: cyclothymic disorder, bipolar I disorder, and bipolar II disorder.

The symptoms for each disorder are different, and so are their criteria for diagnosis.


Cyclothymic Disorder

Cyclothymia is a less serious version of bipolar mood disorder, and in comparison to major bipolar disorder it does not include certain extreme symptoms and psychotic features, such as delusions.

Individuals experiencing cyclothemia do not have the serious effects on their lives as would be from full-blown manic or major depressive episodes (although it can have a significant distress or impairment in functioning).

Cyclothemia has 2 phases: depressive and hypomanic. During the depressive state, the person feels deep sadness (depression) and a loss of interest and pleasure in most activities.

The person can also have low energy, feelings of inadequacy, social withdrawal, and a pessimistic, brooding attitude.

During the hypomanic phase (the less extreme type of mania), the person can become exceptionally creative and productive because of increased physical and mental energy.

The diagnosis may be a very important step for some, as it is known that individuals with cyclothemia are at increased risk of later developing full-blown bipolar disorder.

For a diagnosis of cyclothemia, there should be at least 2 years during which the person experiences numerous hypomanic and depressive episodes (1 year for children and adolescents).

The symptoms must also cause clinically significant distress or impairment in functioning (although not as severe as in bipolar disorder).

Bipolar Disorder I

Bipolar disorder may be described as ‘a series of attacks of elation and depression, with periods of relative normality in between, and a generally favourable prognosis’. Bipolar disorder used to be known as manic-depressive illness.

What is Bipolar Disorder and the symptoms of this disorder are described in my other articles. Those articles can give you a bigger picture of what the depressive and manic phases are.

To be diagnosed
with bipolar disorder I, the person would experience at least one episode of mania or a mixed episode.

A mixed episode means that the person experiences the symptoms of both full-blown manic and major depressive episodes for at least 1 week. These symptoms may be intermixed or alternate rapidly every few days. The symptoms must also cause clinically significant distress or impairment in functioning.

Many affected people experience depressed mood, anxiety, guilt, and suicidal thoughts, even if they are not severe enough to qualify as a mixed episode.

Even when a person exhibits only manic symptoms, it is assumed that the person has a bipolar disorder (not ‘unipolar’) and that the depressive episode will eventually occur.

Criteria for diagnosis of a Manic Episode:

• Elevated or irritable mood for at least one week, plus three of the following (four if mood is irritable):

• Increase in activity level at work, socially, or sexually

• Unusual talkativeness; rapid speech

• Flights of ideas or subjective impression that thoughts are racing

• Less than usual amount of sleep needed

• Inflated self-esteem; belief that one has special talents, powers, abilities

• Distractibility; attention easily diverted

• Excessive involvement in pleasurable activities that are likely to have undesirable consequences, such as reckless spending

Bipolar Disorder II

To be diagnosed with Bipolar II Disorder, the person would experience clear-cut hypomanic episodes (a change in mood and behaviour that is less extreme than full-blown mania as in Bipolar Disorder I), as well as major depressive episodes as in Bipolar I disorder.

More specifically, episodes of hypomania need only last for about four days and do not markedly impair social or occupational functioning, whereas an episode of mania must last for at least one week and cause marked impairments in social and occupational functioning.

In about two-thirds of cases, the manic episodes either immediately precede or immediately follow a depressive episode.

In other cases, the manic and depressive episodes are separated by episodes of normal functioning. Bipolar disorder may be more significant in some periods of person life, for example, during certain seasons. In these cases the diagnosis may be made as bipolar disorder with a seasonal pattern.

There are approximately 3 percent of US population suffers from one or the other disorder, and Bipolar II disorder is slightly more common that the type I.

Other Articles you might be interested in:

What to do when you are stressed

What are the common irrational beliefs?

7 Reasons for our unhappiness

... or go to: Archives of all Articles

Coping with Stress (HOME PAGE)

'How is Bipolar Disorder diagnosed' References:
Nolen-Hoeksema, S. (2008). Abnormal Psychology. (4th ed).
Butcher, J.N., Mineka, S., Hooley, J.M. (2007). Abnormal Psycholgy. (13th ed.)
Davidson, G.C., Neale, J.M., & Kring, A.M. (2004) Abnormal Psychology. (9th ed.)

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