Bipolar disorder, sometimes called “manic depression” or “manic depressive disease,” is a mental health condition marked by extreme, often long-lasting mood swings and episodes of extreme ups and downs.
Due in part to the overuse of the word bipolar to describe when a person is just being moody, bipolar disorder is not well understood. At FHE Health, we treat patients from many walks of life with a wide range of different conditions. As such, we make the commitment to provide information about the diagnosis and treatment of both mental and behavioral health conditions.
On this page, we’ll discuss issues surrounding the diagnosis of bipolar disorder, including the signs and symptoms, potential different types and what a diagnosis means for those who receive it.
How Bipolar Disorder Begins to Manifest
According to the National Alliance on Mental Illness (NAMI), bipolar disorder only affects 2.8 percent of adults in the United States, but 83 percent of all cases are considered to be “severe.” A potential explanation for this is that the longer it goes untreated, the more serious a single case of bipolar disorder can become. Because early symptoms may appear similar to a number of other disorders, the case may be that bipolar disorder isn’t often diagnosed before these symptoms are classified as “severe.”
Early symptoms of bipolar disorder include bouts of extreme low energy, a lack of motivation and an unexplained sadness. On the other side of the spectrum, a person with the beginnings of this “manic depressive” disease may exhibit sudden bursts of energy or motivation to complete large undertakings or may suddenly appear hyperactive.
These are the warning signs of bipolar disorder, but they may not be noticeable for a while after they appear. The average person won’t be diagnosed with bipolar disorder until they’re 25 years old. Complicating the detection of mental health conditions like bipolar disorder is that not all the ways that these illnesses can manifest are necessarily mental/behavioral — there are some little-known ways that mental illnesses can actually have physical symptoms.
Early Warning Signs in Other People
Unfortunately, it’s often difficult to recognize bipolar disorder in people who you don’t know well. Early warning signs are often subtle, for example, such as a sudden shift in behavior that may not seem out of the ordinary unless you’re spending a lot of time with the person exhibiting symptoms.
This is why the earliest detection of bipolar disorder often stems from a change in behavior that’s noticed by a close friend or loved one. People may notice a child or a spouse suddenly moving slowly or seeming more tired or less upbeat than usual. Still, due to a general misunderstanding of the symptoms of bipolar disorder, friends and family members who are not well-versed in mental health conditions will likely not recognize these symptoms as belonging to this particular disease.
Mistaking Other Conditions for Bipolar Disorder
A 2019 study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging found that bipolar disorder is initially misdiagnosed as major depressive disorder in about 60 percent of individuals seeking diagnosis — a misdiagnosis that can delay accurate treatment by up to 10 years. The signs of bipolar disorder are very broad and are often common to a variety of other mental health problems. Manic episodes can resemble bouts of obsessive-compulsive disorder. Depressive episodes can easily be mistaken for clinical depression. The hallmark of bipolar disorder is a personality that fluctuates between manic and depressive episodes in a way that’s often severe and impacts a person’s career, relationships and life.
Similar Conditions and Common Misdiagnoses: Can Signs of Bipolar Actually Be Something Else?
Because many of the signs and symptoms of bipolar disorder are relatively common, they may overlap with several similar diseases. The disease may also be misdiagnosed as certain other conditions. Here are a few of the most common cases:
- schizophrenia: Sometimes, people with bipolar disorder experience psychotic episodes that resemble those associated with schizophrenia, another condition that is not widely understood.
- Clinical depression: Since bipolar disorder can manifest so differently in different patients, they may go as long as full years in between episodes. Someone who experiences a long-term depressive episode after years of not exhibiting any behavioral changes can easily be misdiagnosed with depression.
- ADHD: The same applies to the opposite end of the spectrum. A person whose personality appears to be unchanged for years who suddenly experiences mania and a prolonged period of high energy may be diagnosed with a disease marked by symptoms of hyperactivity.
- Borderline Personality Disorder: The most common misdiagnosis involves a similar condition called borderline personality disorder, in which a person engages in self-destructive behaviors. Because BPD and bipolar disorder share a range of symptoms, they can easily be mistaken for each other.
Co-Occurring Disorders With Bipolar Disorder
Further complicating the process of diagnosing a patient with bipolar disorder is the fact that many people with the condition may also be experiencing other mental health disorders at the same time. For example, depression, anxiety and post-traumatic stress disorder (PTSD) are commonly experienced in conjunction with bipolar disorder. When a person goes to their doctor complaining about certain symptoms and one of these other conditions is present, bipolar disorder will likely not even be considered.
The manic episodes of someone who is bipolar can cause reckless and impulsive behavior, which can manifest in the form of substance abuse and addiction. One study went so far as to suggest that around 40 percent of people with bipolar disorder 1 (more on this distinction in a moment) are also suffering from a substance abuse disorder (SUD).
Different Types and Symptoms of Bipolar Disorder
According to the National Institute of Mental Health (NIMH), there are two types of bipolar disorder (and one more borderline condition):
Bipolar Disorder I
People with BDI typically experience extremely severe, prolonged manic episodes with occasional — often less severe — bouts of depression. Occasionally, they may experience both types of episodes at the same time. People with BDI often need treatment in a hospital setting for the mania they experience.
Bipolar Disorder II
BDII is defined by a pattern of manic and depressive episodes, neither of which is typically as severe as the manic episodes experienced by those with bipolar disorder I. These patients may need to be hospitalized with their condition, but most likely will not. People with BDII respond better to conventional bipolar disorder treatments than those with BDI.
Cyclothymic Disorder
People in the cyclothymic group experience both manic and depressive episodes that aren’t severe enough for a full diagnosis of bipolar disorder. It’s thought that those in this category may be more likely to actually have borderline personality disorder rather than bipolar disorder.
Signs of Manic and Depressive Episodes
Bipolar disorder shows up as episodes of mania and depression that tend to alternate over time. Recognizing the behavioral and emotional signs of each is often the first step toward an accurate diagnosis.
Signs of a possible manic episode include:
- Feeling good. A distorted sense of well-being and confidence.
- Racing thoughts. Your thoughts jump from one thing to another.
- Rapid speech. Being unusually talkative and having something to say on everything.
- Excess energy. You feel full of energy and don’t need much sleep.
- Poor judgment. A greater likelihood of risky decisions buoyed by overconfidence.
Periods of mania are typically preceded or followed by periods of deep depression, with symptoms that include:
- Fatigue. You feel continually exhausted.
- Loss of interest. You don’t have interest in doing anything.
- Suicidal thoughts. You may experience thoughts of suicide.
- Low self-worth. You feel that you’re useless.
- Poor sleep. You find it difficult to get a good night’s sleep.
Physical Symptoms of Bipolar Disorder
Bipolar disorder is a mental health condition, but it can also involve physical symptoms — and those are easy to overlook or mistake for something else. Both phases of the disorder (mania or hypomania and depression) can produce physical effects, and recognizing them is part of seeing the full picture of the condition.
During Mania or Hypomania
During the manic period, people can experience physical effects that include:
- Insomnia. During the manic phase, people may have so much energy or feel so agitated that they simply can’t sleep. Racing thoughts during this phase can also trigger insomnia.
- Increased or decreased appetite. Some people are so busy during mania that they forget to eat. Others feel an increase in appetite but may not eat healthy foods or follow their diet plan.
- Weakness and fatigue. The lack of sleep and proper diet during mania can result in powerful feelings of fatigue, often hitting hardest toward the end of a manic period. Bipolar disorder is also linked to loss of skeletal muscle mass over time, which can intensify feelings of weakness.
- Heart palpitations. The high energy of mania can trigger cardiovascular symptoms like heart palpitations or elevated blood pressure. This can also occur during the depressive phase if people experience anxiety symptoms as part of their bipolar diagnosis.
- High-risk behaviors. During the manic phase, many people engage in riskier behaviors — unprotected sex, excessive drinking, reckless driving — that may result in injury or illness.
During Depression
The depressive phase of bipolar is also associated with various physical effects, and in some cases these symptoms may be even more pronounced. They may include:
- Fatigue. Many people find it difficult to perform normal activities during the depressive phase. Even getting out of bed can prove taxing.
- Abdominal pain, nausea, and vomiting. The gastrointestinal tract may be more vulnerable to upset during depression. Mental health symptoms of depression and anxiety can cause an upset stomach severe enough to lead to nausea, vomiting, and diarrhea.
- Decreased sex drive. During the manic phase, people can experience a big increase in libido. The opposite often occurs during depression, which can cause relationship problems for couples.
- Cardiovascular problems. The depressive phase can trigger feelings of anxiety or even panic. When these symptoms become chronic, they can affect blood pressure. Both phases can trigger cardiovascular problems.
- Suicide attempts. Feeling suicidal is a serious mental health issue, and attempts can have long-term and serious impacts on physical health. Always report any thoughts of self-harm to your doctor.
