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February 4, 2019

How Do I Know if I Have Bipolar Disorder?


Bipolar disorder, sometimes referred to as manic depressive disorder, is a serious, chronic psychiatric illness affecting roughly three percent of the U.S. population, and characterized by extreme shifts in mood and energy that can be disabling. The disease can cause significant impairment, and can often lead those who suffer from it to self-medicate with drugs and/or alcohol— bipolarity multiplies the risk of a co-occurring substance use disorder by seven times, according to a 2005 study in the journal Science & Practice Perspectives. Bipolar disorder is also implicated in one in four suicides.

For these reasons, letting a suspected diagnosis of bipolar disorder go untreated can be devastating to anyone’s health, relationships, quality of life and sheer livelihood. If you’re wondering whether you may have bipolar disorder, this article will educate you on the symptoms and defining marks of the illness, so that you can determine whether to consult a psychiatrist for an in-depth assessment. The information provided here should not be used in lieu of a professional assessment by medical and psychological professionals, but can assist readers in better understanding the illness that is bipolar disorder— and, whether they may benefit from further consultation with their doctor.

What Is Bipolar Disorder?

Bipolar disorder is defined by dramatic fluctuations in mood: in their “manic” episodes, a person with bipolar disorder can feel very happy and energized; they can then feel very down and depressed in their depressive episodes; or, they can have so-called mixed episodes that include both manic and depressive symptoms.

There are two types of bipolar disorder, bipolar I and bipolar II. Bipolar I is usually distinguished by more severe and dangerous manic episodes, whereas bipolar II can involve longer periods of serious depression.

Symptoms of Bipolar Disorder

A manic episode may be distinguished by one or more of the following symptoms, according to a pamphlet on bipolar disorder from the National Institute of Mental Health (NIMH):

  • Feeling very “up” or “high”
  • Feeling “jumpy” or “wired”
  • Having trouble sleeping
  • Becoming more active than usual
  • Talking really fast about a lot of different things
  • Agitation or irritability
  • Feeling like your thoughts are going very fast
  • Thinking you can do a lot of things at once
  • Doing risky things, like spending a lot of money or having reckless sex

NIMH characterized a depressive episode with these symptoms:

  • Feeling very “down” or sad
  • Sleeping too much or too little
  • Feeling like you can’t enjoy anything
  • Feeling worried and empty
  • Having trouble concentrating
  • Forgetting things a lot
  • Eating too much or too little
  • Feeling tired or “slowed down”
  • Having trouble sleeping
  • Thinking about death or suicide

If you have experienced any of these symptoms lately, ask yourself how long they have lasted. Were they fleeting and maybe only present for a day? Or, did they last for a week or more? During a bona fide manic or depressive episode, the symptoms usually last every day for at least week, usually longer.

Another reliable indicator of bipolar disorder will be whether these symptoms are disrupting your life. Are you unable to carry out your daily responsibilities at work and/or at home, because you are feeling so depressed that you cannot sleep or concentrate? The same may be true if you are experiencing a manic episode and feel so energized, wired and pulled in multiple directions that you cannot focus on your usual obligations.

Assessing Whether You Have Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the handbook that healthcare professionals use to diagnose mental disorders like bipolar disorder. The DSM-5 lays out the following criteria for diagnosing a manic episode that characterizes bipolar 1 disorder:

  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
  • During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity)
  • Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The DSM-5 uses the following criteria to diagnose bipolar II:

  • The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
  • The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or to another medical condition
  • Criteria have been met for at least one hypomanic episode and at least one major depressive episode
  • There has never been a manic episode
  • The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
  • The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the criteria for a current or past major depressive episode
  • Hypomanic Episode: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
  • During the period of mood disturbance and increased energy and activity, 3 (or more) of the above symptoms (4 if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree.
  • The episode is associated with an unequivocal change in functioning that is

uncharacteristic of the individual when not symptomatic.

  • The disturbance in mood and the change in functioning are observable by others.
  • The episode is not severe enough to cause marked impairment in social or
  • occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
  • The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment).

Just How Bipolar Am I?

The “Bipolar Index” is an assessment tool for diagnosing bipolar disorder that was developed by Harvard researchers like Dr. Gary Sachs, a professor of psychiatry at Harvard Medical School and the founding director of the Bipolar Clinic and Research Program at Massachusetts General Hospital. The Index takes a continuum approach in evaluating whether someone may have bipolar disorder, meaning someone could score as only slightly bipolar or very bipolar, with potentially different treatment options as a result. The clinician who uses the Bipolar Index is seeking to answer to what extent the patient has bipolar disorder (not merely whether they have the illness).

In measuring the extent to which a patient has bipolar disorder, the Bipolar Index looks at these five factors, which are given equal weight:

  1. The characteristics of mood episodes – whether they have involved full mania or milder hypomania
  2. Age of onset of mood episodes – and whether these began either in the teens or early twenties, which would more typically describe bipolar disorder
  3. Course of illness – whether there are classic episodes of mania and depression as well as periods where you are well
  4. Response to medications – whether a mood stabilizer medication (which is the usual treatment for bipolar disorder) is working for you
  5. Family history – whether you have a parent or sibling with the illness or no history at all (which would decrease the likelihood that you have bipolar disorder)

If you have not been assessed for bipolar disorder, then #4 above will probably not pertain to you. The other four factors, however, are worth considering in determining whether you might have bipolar disorder— in which case you should consult a healthcare professional (ideally a psychiatrist) who is qualified to diagnose bipolar disorder.

If you are struggling with a drug or alcohol problem, an addiction treatment provider that offers dual diagnosis treatment will be able to conduct an in-depth assessment of your condition and determine whether you have bipolar disorder.

For related information, check out the following articles:

  1. Common Co-Occurring Disorders Associated with Addiction
  2. Would My Loved One Benefit from Dual Diagnosis Treatment?
  3. Dual Diagnosis: How Treatment for Co-Occurring Disorders Improves Recovery Outcomes
  4. What to Expect at Beach House Center for Recovery