Do I Have Bipolar Disorder? Recognizing When to Seek Treatment

Bipolar disorder is perhaps one of the most mythologized mental illnesses in existence. In the popular imagination, the illness is defined by full-blown mania and psychosis, overt and unmistakable presentations that cannot fly under the radar. But in reality, bipolar disorder doesn’t look any one particular way. In fact, bipolar disorder itself is not a specific illness, but an umbrella term for a family of related illnesses, each with unique symptomatology and endlessly varied manifestations. Unfortunately, the nature of some forms of bipolar illness, especially bipolar II and cyclothymia, renders them difficult to identify even for trained physicians, leading all too often to misdiagnosis and incorrect treatment.

While certain mental illnesses can be relatively easy to identify even to the untrained eye, bipolar symptoms vary drastically in form depending on the specific type of bipolar disorder you are experiencing. If you suspect that you may have bipolar disorder, understanding the basics of bipolar symptomatology is the first step to determining whether you are suffering from a bipolar illness.

Symptoms of Mania

Manic episodes may include feelings of euphoria, increased energy, grandiose beliefs, irritability, markedly increased sexual desire, increased risk-taking, extravagant spending, rapid speech, and decreased need for sleep. In some cases, you may experience psychosis. According to the diagnostic criteria, these symptoms must be “sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others.”

Symptoms of Hypomania

The symptoms of hypomania mimic the symptoms of mania but differ in intensity. The diagnostic criteria require that “the episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.”

Symptoms of Depression

The symptoms of depressive episodes include persistent depressed mood, diminished interest in most activities, sleep disturbances, loss of energy, poor concentration, feelings of worthlessness or guilt, and suicidal ideation. These symptoms must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” and cannot be accounted for by substance use or bereavement.

While mania, hypomania, and depression serve as the ingredients of bipolar disorders, the specific type of bipolar disorder you have determines which symptoms you experience. Bipolar I requires the presence of at least one manic episode, which may or may not be accompanied by depression. Bipolar II requires oscillation between hypomanic and depressive episodes. Cyclothymia requires prolonged periods of depressive and hypomanic symptoms that never become severe enough to meet full diagnostic criteria.

The symptomatology of bipolar II and cyclothymia mean that these illnesses often go undiagnosed or misdiagnosed, typically as unipolar depression. In fact, research indicates that “almost 40 percent of bipolar disorder patients are initially diagnosed with unipolar depression.” Unfortunately, misdiagnosis typically results in subjection to pharmacotherapies that not only fail to adequately address your symptoms, but may even exacerbate both the severity and frequency of mood switching.

“The problem is that the milder types of bipolar disorder are often hard to recognize as an illness because the symptoms are chronic and less severe,” says Dr. Friedman. “In contrast, a person who develops a florid acute disease, whether appendicitis or full-scale mania, is obviously ill to any casual observer, because the contrast between the normal base line and the illness is stark.” As such, people with bipolar II and cyclothymia may not even recognize their own thoughts, feelings, and behaviors as clinically significant and fail to report them, typically only seeking treatment for depressive symptoms. And, as Bruce experienced, psychiatrists may fail to conduct appropriate assessments to identify hypomanic symptoms, allowing these illnesses to go undiagnosed. This is particularly true when hypomanic symptoms are experienced as positive reactions rather than obvious distress.

However, even bipolar I may fly under the clinical radar in some cases. Melody Moezzi first began experiencing hallucinations in college. “It had been easy to chalk up many of my earliest manic episodes and depressive symptoms to adolescent moodiness or too much Morrissey or an artistic spirit—but not the hallucinations. They freaked me out,” she says. But during the years of weekly therapy sessions that followed the onset of her hallucinations and increasingly severe mania, her condition was “consistently misdiagnosed as unipolar depression.” She too never thought to ask, “Do I have bipolar disorder?” It wasn’t until she suffered a psychotic break, over a decade after her first hallucinations, that she was diagnosed with bipolar I disorder. In other cases, bipolar I disorder may be misdiagnosed as borderline personality disorder, schizophrenia, or schizoaffective disorder.