Identifying bipolar disorder in yourself or either a loved one is a difficult, confusing time as the mental illness isn’t as apparent or clear at birth as say, a deformed leg or a congenital abnormality.
Bipolar disorder develops over time with different factors to consider: genetics, stressful situations, and substances abuse, among others; and contrary to negative perceptions about it, a person diagnosed as having bipolar disorder can still live a normal, productive life if managed consistently.
According to the National Institute of Mental Health, approximately 5.7 million adult Americans are affected by bipolar disorder every year, with the Journal of Clinical Psychiatry adding that there are three times more women diagnosed than men in a year.
However, patients are more often than not misdiagnosed as they commonly seek out treatment during a depressive episode, which can rule out their history of manic episodes.
Women’s Health Magazine writes that they challenge for doctors then is to identify whether the depression is clinical, or a case of bipolar disorder.
They spoke with Claudia Baldassano, M.D., director of the Bipolar Disorder Clinic at University of Pennsylvania Medical School, who said doctors ultimately look out for whether a patient has reported to feel “too good,” which is a possible sign of a manic high that involves “being so emotionally elevated that the patient’s movement, speech, and activity is loaded with energy and confidence (or lack of awareness).”
She added that the intense mood of mania is completely opposite of depression, and often acts as the cue for medical professionals that a patient might have bipolar disorder. They typically ask the following questions to be able to accurately diagnose bipolar disorder:
“Have you ever felt that your mood was elevated or ‘too good’ for a series of consecutive days?”
Baldassano says a manic high isn’t just about constantly feeling happy, rather it’s feeling “a notch above” or even euphoric. Patients experiencing mania can also quickly go from an elevated, overly confident mood to agitated and “touchy.”
Doctors will also typically ask if the patient has found a decreased need for sleep and they didn’t feel tired, reckless behavior, and an unusual period of high optimism and self-confidence.
“During that period, did you find that you were sleeping less than normal but didn’t feel tired or necessarily affected?”
If a patient isn’t sleeping or is sleeping fewer hours than usual yet feels refreshed or energized, it might be a sign that they’re bipolar, says Elizabeth Cohen, Ph.D., a cognitive behavioral therapist who talked with Women’s Health. Sudden changes in a patient’s sleep pattern is an important flag to look out for, so it’s imperative medical providers be able to ask this in order to better track any behavioral changes (depressive or hypomanic periods) that are indicative of bipolar disorder.
“During that ‘good mood’ period, did you ever have the sense that you had a lot of ideas and that your brain felt ‘sped up’?”
This question enables medical providers to determine if the patient has another symptom of bipolar disorder: racing thoughts, which can often render a patient completely unaware of what is going on around them.
But since it could also be a symptom of Obsessive- Compulsive Disorder and anxiety, Baldassano doesn’t like to use it often.
“Some people with hypomania don’t have racing thoughts,” Baldassano explains. “Their thoughts are really deep, crisp, and clear. So it’s important to ask that as well to capture the more mild cases.”
“Do you feel more talkative?”
Patients with bipolar disorder will usually have difficulty carrying a conversation, jumping from one topic to another during a manic episode.
But in order to not confuse it with anxiety, doctors consider other questions to themselves like “Is it hard to follow what they’re saying?” or “Does it feel like they’re talking a mile a minute?” Another red flag of bipolar disorder is a lack of insight, which when a patient doesn’t realize they are acting, speaking, or thinking differently in a manic episode.
“Have you taken on more projects than usual, such as at work?”
When having a manic episode, patients with bipolar disorder tend to have an “increase in goal-directed activity,” Baldassano says. Therapists will then correlate their ‘yes’ to recent workplace feedback, and if they’ve been receiving negatives, then it could be an indication of bipolar disorder.
If a patient is taking on more projects, and suffering from it without recognizing they’re having problems, these could be signs that they’re bipolar.
“Have you done things that you would consider risky?”
Manic episode can cause a patient to be more impulsive, so therapists commonly ask this question to try and figure out if these actions are far from their normal behavior.
These can include reckless driving, making poor business decisions, and they might even get involved in dangerous sexual encounters, Baldassano says. But it doesn’t have to be brash or dangerous activity, it can even be something as normal like shopping, but done excessively and out of their control.
“Have you felt smarter, more attractive, or more accomplished?”
As their mood is elevated, patients in a manic episode often have uncontrollable self-confidence, self-esteem, and optimism. Many clinicians, however, don’t ask this question directly to the patient, but rather discern if the patient’s feeling “grandiose” as a symptom of bipolar disorder through observation—especially since manic patients don’t have the insight to realize, “Oh yeah, I’m feeling way more successful than I did last week.”
“What’s your family history like?”
As there isn’t a one-size fit all test yet to determine bipolar disorder off the bat, your doctor will turn to family history to try to find clues that may have contributed to the patient’s condition.
The National Institute of Mental Health has found bipolar disorder tends to run in families. Doctors emphasize as well the importance of involving family beyond just medical records: the patient’s family can be better reporters of their symptoms and condition as the patient might not be able to verbalize or articulate completely what they are feeling and how they’ve been acting.
The important thing to remember is to never be shamed into thinking you can no longer be a fully functioning, productive person when diagnosed with bipolar disorder.
A variety of options in medication and treatment, as well as necessary lifestyle changes can aid significantly in the treatment and maintenance of yourself, or a loved one diagnosed with bipolar disorder.