I Think I’m Bipolar. How Can I Be Sure?

“I think I’m bipolar.” If you’ve ever had this thought or said these words aloud, that leads me to believe you’re noticing some irregularities with your mood, energy, or thought processes. Perhaps you’ve been unusually happy these days or maybe people have been telling you that you’re particularly moody. Maybe you suspect that you have bipolar disorder because you’ve been extremely impulsive with your words and your actions and it has been getting you into trouble.

If you’ve had the thought, “I think I’m bipolar,” you may be asking questions like How can I know if I have bipolar? or What are the signs of bipolar disorder, anyway? These are fair questions. Before you settle in on a self-diagnosis, though, let’s take a look at signs of bipolar disorder.

Signs of Bipolar Disorder

For a variety of reasons, any one of us can experience various mood swings from time to time, but those experiences do not automatically equate to a mood disorder; in this case, bipolar disorder.

A certain set of symptoms must exist in order to qualify for a bipolar disorder diagnosis. In addition, those symptoms must exist for a particular duration of time. Only then does a person meet the criteria for a diagnosis of bipolar disorder.

The two primary types of bipolar disorder are Bipolar I (previously known as manic-depressive disorder) and Bipolar II. To qualify for Bipolar I, a person must have experienced at least one manic episode in their lifetime.

To qualify for Bipolar II, a person must have experienced at least one episode of major depression and at least one hypomanic episode in their lifetime. I’ve listed the criteria for a manic episode, major depressive episode, and hypomanic episode below. The information is taken from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (also known as the DSM-5).

Manic Episode

A. 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 one week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy and 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). Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis

C. 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.

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.

Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis.

Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of Bipolar I disorder.

Hypomanic Episode

A. 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 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: 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).
• 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).

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. 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.

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).

Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode nor necessarily indicative of a bipolar diathesis.

Note: Criterion A-F constitute a hypomanic episode. Hypomanic episodes are common in Bipolar I disorder but are not required for the diagnosis of Bipolar I disorder.

Major Depressive Episode

Five (or more) of the following symptoms have been present during the same two week period and represent a change from previous functioning. At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

• Depressed mood most of the day nearly every day as indicated by either subjective report (e.g. feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children or adolescents, can be irritable mood).
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% body weight in a month) or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate, or indecisiveness nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important area of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Note: Criterion A-C constitute a major depressive episode. Major depressive episodes are common in Bipolar I disorder but are not required for the diagnosis of Bipolar I disorder.

Note: Responses to a significant loss (e.g. bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered

What do these symptoms look like in real life?

Not every case of bipolar disorder looks the same, regardless of whether one has Bipolar I or Bipolar II disorder. Each person may have a different cluster of symptoms and the way those symptoms are manifested or expressed can look different from one person to the next. With that in mind, below are two case studies of bipolar disorder that may bring a little more clarity as to how bipolar disorder may present in an individual.

Case One: Bipolar I

Betty has become aware that approximately every two months she experiences about seven days where her mood is extremely good, and her energy increases dramatically. She has begun to look forward to these times because she realizes she is extremely productive and can get a lot of things accomplished.

Her apartment gets squeaky clean, she is able to get herself to the gym every day versus once or twice per week, and she gets at least one new project completed during that time (for which she gives herself a pat on the back). One time she cleaned and organized her walk-in closet to almost showroom floor perfection. Another time she baked twelve dozen cookies, put them in decorated cookie tins, and gave them to all her neighbors.

Betty also loves the extra time she’s afforded during those seven days as a result of being able to sleep only four hours yet still be refreshed (as opposed to her typical eight hours of sleep). Betty’s boyfriend, however, is not so fond of the episodes Betty experiences every several months. He gets frustrated by her flight of ideas and difficulty sitting still. He feels like they are unable to hold a decent conversation.

He’s also not too thrilled by the fact that she becomes extremely flirty with other men to the point of being inappropriate. He wonders, “If she is that flirty when we’re out together, I wonder what happens when I’m not around.” It’s gotten to the point where he’s questioning whether he wants to continue dating her.

Case Two: Bipolar II

For five days Eddie experienced a noticeable mood fluctuation. His fraternity brothers that he lived with noticed it, too. Eddie kept hearing comments from them to the effect of, “Hey, Bro! Chill out. No need to get so uptight.” Usually, Eddie was fairly easy-going and fun to be around, but not for those five days.

At the same time, Eddie was finding it difficult to concentrate on his college studies, because of racing thoughts and being easily distracted. He would sit down to work on an assignment and get sidetracked by the smallest thing. The excessive energy he was feeling didn’t help either. When he wasn’t able to take a take a run, he found himself tapping his foot or wringing his hands.

In addition, Eddie exhibited some grandiosity. He himself wasn’t aware of it, but his fraternity brothers observed it right away. Eddie started talking about this big new idea he had. Given that the t.v. room in the fraternity house could get pretty packed with guys during a big football game, Eddie suggested they take the next weekend and tear down a couple of walls and extend the t.v. room out.

“We could easily do it in a weekend. No sweat! Just rip down the old walls. Throw up some new ones. Bada-bing-bada-boom! By Sunday night we’ll have a brand new t.v. room.” When his fraternity brothers attempted to talk some reason into Eddie, saying that it is a bigger and more time-consuming job than he is making it out to be, Eddie insisted that they didn’t know what they were talking about. “You guys are wimps.”

Recommendation

Although the above cases and the lists of criteria may shed a little light on whether or not you have bipolar disorder, the only way to really know if you have this condition is to be assessed by a professional health care provider trained to diagnose it. A psychiatrist can provide this assessment, but a licensed therapist skilled in doing assessments can provide it, also.

With the ever-increasing amount of information available on the internet, it is tempting to diagnose one’s self. I’d like to caution you, though, against self-diagnosing. Mental health disorders are very complex and some of the disorders have shared symptoms.

It’s important to be seen by a professional who can ask the right questions and discern what your condition is. I encourage you not to let any insecurities stop you from seeking help. At the risk of sounding a bit cliché, may I just say: you’re worth it.