Table of Contents

Bipolar Disorder Testing & Evaluation

Bipolar disorder evaluation is typically recommended for individuals who exhibit symptoms or experiences that raise concerns about the possibility of Bipolar Disorder.

If an individual experiences extreme mood swings characterized by periods of unusually high energy, euphoria, or irritability (manic or hypomanic episodes) alternating with episodes of depression, and these mood swings significantly impact a person’s ability to function in various areas of life, such as work, school, relationships, or self-care, it is important to consider a bipolar evaluation.

Sometimes, individuals may have been misdiagnosed with other conditions such as Depression, Generalized Anxiety Disorder, or ADHD when Bipolar Disorder is the underlying cause of their symptoms. If symptoms persist despite treatment or if there is a lack of response to medications typically used for other conditions, a Bipolar Disorder evaluation may be necessary.

What Is Bipolar Disorder Testing?

Bipolar disorder testing is the process through which an individual receives an official diagnosis. Typically, it involves multiple types of testing, including a physical evaluation and psychiatric review that assess signs of bipolar disorder. People need to have had at least one manic or hypomanic episode to receive the diagnosis, and mood swings alone are not enough to qualify for a diagnosis.

Diagnosis requires unusual periods of extreme elevation then irritability alongside increases in energy, sleeplessness, and fast thinking or speech. Symptoms will be fully assessed alongside criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or DSM-5.

Clinical Guidelines for Bipolar Disorder Diagnosis

Clinical guidelines provide evidence-based recommendations for the diagnosis and treatment of bipolar disorder. The guidelines help standardize the diagnostic process and ensure that clinicians follow best practices in assessing and diagnosing the condition.

According to the DSM-5, the clinical guidelines for bipolar disorder diagnosis include at least one episode of mania or hypomania. That includes at least three of the following symptoms, lasting for more than a week:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual
  • Flight of ideas or subjectively racing thoughts
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in activities with high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions, foolish business investments
  • Abnormally and persistently elevated, expansive, or irritable mood
  • Abnormally and persistently increased activity or energy
  • Severe mood disturbance that impairs functioning
  • Needs hospitalization to prevent harm to self or others
  • Episode not attributable to a substance

The other side of Bipolar Disorder involves depressive episodes. These are described by the DSM-5 as at least three or more of the following symptoms, lasting for more than one week:

  • Depressed mood most of the day, nearly every day
  • Loss of interest or pleasure in all, or almost all, activities
  • Significant weight loss or decrease or increase in appetite
  • Engaging in purposeless movements, such as pacing the room
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

Guidelines specify the duration and frequency requirements for diagnosing Bipolar Disorder. For example, the presence of a manic episode is typically required for at least one week, while hypomanic episodes must persist for at least four consecutive days.

Bipolar Disorder 1 Testing

As the main difference between Bipolar Disorder 1 and 2 is the presence of severe manic episodes, a doctor can diagnose bipolar 1 on this basis alone. An extreme manic episode, not better explained by schizophrenia or psychosis, is enough to diagnose bipolar disorder.

A manic episode involves a severe period of mania that is disruptive to daily life but can sometimes be confused for productivity. For that reason, physical tests are required to rule out other health conditions that may cause these symptoms. Features of Bipolar Disorder 1 testing include:

  • Blood tests. Blood tests will be taken to ensure there are no underlying conditions that may be causing symptoms of erratic mood.
  • Brain imaging testing. This will provide a more thorough check of any other physical conditions if required.
  • Psychological review. A psychiatric assessment will highlight the patient’s mood, thoughts, and feelings, as well as how the individual reacts to triggers.
  • Mood journal. Keeping a daily mood diary may help psychologists identify extreme patterns in behavior, attitude, and sleep, assisting in a diagnosis.
  • Manic episode. At least one manic episode lasting around one week is typically required for diagnosis.

Bipolar Disorder 2 Testing

Bipolar disorder 2 is difficult to diagnose due to the difficulties associated with differentiating between bipolar and recurrent unipolar depression, the depressive periods present in depressed patients.

As with bipolar 1, a physical examination is required to rule out other medical disorders that might be the source of these symptoms.  In the absence of manic episodes, the identification of hypomanic episodes is crucial to diagnose bipolar 2. Hypomanic episodes are the same as manic episodes, only less severe. Bipolar disorder 2 testing characteristics include:

  • Blood tests. In order to rule out any underlying disorders that could be contributing to the symptoms of unpredictable mood, blood tests will be performed.
  • Brain imaging. If necessary, this will offer a more complete examination of any further physical issues.
  • Psychological examination. A psychiatric evaluation will focus on the patient’s disposition, ideas, and emotions as well as how they respond to stimuli.
  • Mood diary. Keeping a daily mood journal can aid psychologists in making a diagnosis by allowing them to spot severe trends in behavior, attitude, and sleep.
  • Hypomanic phase. Typically, a diagnosis requires at least one hypomanic episode lasting 4 days or more.

Bipolar Disorder Tests and Quizzes Online

While there are online tests and questionnaires available that claim to assess Bipolar Disorder, it is important to understand their limitations. Online tests can provide a preliminary indication of potential symptoms or risk factors but should not be used as a definitive diagnostic tool. Bipolar Disorder is a complex mental health condition that requires a comprehensive evaluation by a qualified mental health professional for an accurate diagnosis.

Bipolar Disorder Tests for Women

Bipolar disorder tests are the same for both men and women, but there is evidence to suggest that the disorder manifests differently based on gender. Studies show that men will experience manic or depressive episodes earlier in life than women, and women will more frequently follow a seasonal pattern. Generally, less severe bipolar disorder symptoms in females show that bipolar disorder 2 is more common in women than in men, and this type of bipolar is more difficult to diagnose. This means some women may spend longer without a diagnosis, as they are more susceptible to delayed diagnosis and treatment.

As women tend to present with depressive symptoms more often than manic or hypomanic symptoms, misdiagnosis is common. As women typically experience the onset of Bipolar Disorder later in life than men, the stress of pregnancy can be a trigger.

Women are at an increased risk of developing Bipolar Disorder during the postpartum period. Postpartum Bipolar Disorder refers to the onset of manic or depressive symptoms within the first few weeks after giving birth. It is important to screen for and differentiate between Postpartum Blues, Postpartum Depression, and Postpartum Bipolar Disorder.

The hormonal changes women experience during their menstrual cycle may also impact Bipolar Disorder symptoms. For this reason, many women may go years without a correct diagnosis, as they blame their symptoms on extreme premenstrual syndrome. As women experience frequent hormonal changes, bipolar symptoms may stay under the radar for longer than in men. Mood-stabilizing medications have also been known to interact with and affect birth control.

At LifeStance mental health care centers we apply a multidisciplinary approach and integrated care to diagnosing and treating bipolar disorders in women.  Our psychiatrists, psychologists, and therapists work closely with OBGYNs and Primary Care Physicians to provide a comprehensive care plan. Find one of our mental health care clinics near you to schedule a testing and evaluation for Bipolar Disorder.

photo of LifeStance provider Nicholette Leanza, LPCC-S
Medically Reviewed By:
Nicholette Leanza, LPCC-S
View Profile

Nicholette is a faculty member at John Carroll University’s Clinical Counseling program, and she is also the host of the LifeStance podcast, Convos from the Couch.