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.

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 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 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.