Using Symptoms in Diagnosing Bipolar Disorder

Why is it so tough to diagnose bipolar disorder? Here's one reason!

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Ask almost any individual with bipolar disorder about how they were diagnosed. You will probably hear of a long and difficult journey through many wrong turns and misdiagnoses, numerous dead ends and new doctors. The path will have included abundant changes of direction and differing medications before arriving at the correct diagnosis of bipolar disorder. Why is this so often the case? It's because the list of psychiatric conditions with symptoms similar to those of bipolar disorder is rather long.

To further complicate the picture, most of these disorders can also occur with bipolar disorder.

Psychiatric conditions that can manifest symptoms similar to bipolar disorder include:

Attention Deficit Hyperactivity Disorder (ADHD)

Hyperactivity and distractibility are two of the hallmark symptoms of ADHD. However, they are also quite predominant in bipolar disorder, especially as it relates to children. Many children diagnosed with ADHD are later diagnosed with bipolar disorder as well.

Alcohol/Substance Abuse

It is very common for those with bipolar disorder to struggle with alcohol and substance abuse issues. This is often an attempt, even on an unconscious level, to self-medicate. Additionally, the effects of these drugs (such as hallucinations or the inability to sleep) can be confused with the symptoms of bipolar disorder.

Borderline Personality Disorder

The diagnostic criteria for this disorder include impulsivity, suicidal behavior, reactivity of mood, inappropriate anger, and paranoia.

All of these are also associated with bipolar disorder. It is possible for an individual to be diagnosed with both of these disorders.

Delusional Disorder

The hallmark of this disorder is nonbizarre (the situations are possible) delusions. Mood episodes can be a symptom but they are brief in duration and are part of the delusion.

If a doctor is not aware of the delusion, the mood may appear to be incongruent to current circumstances and therefore confused as bipolar disorder.


The one thing that distinguishes unipolar depression from bipolar disorder is mania/hypomania. If a patient with depression swings into an episode of mania, the diagnosis becomes bipolar disorder.

Eating Disorders

It is not uncommon for those with bipolar disorder to experience eating disorders. Moreover, depression, anxiety and irritability often result from eating disorders. Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight or getting fat. Those with this disorder often have a body weight of less than 85 percent of that what is considered normal. Bulimia nervosa is typified by periods of binge eating followed by purging (purposely vomiting).

Panic Disorder

This disorder is characterized by recurrent, spontaneous panic attacks. In that these attacks are traumatic, they do create instability of mood which may be confused with the mood episodes of bipolar disorder. Furthermore, panic attacks are also common in those with bipolar disorder.


Schizophrenia is a mental disorder that causes intense disturbances in both cognition (thinking) and emotions (feeling).

It consists of two classifications of symptoms – positive and negative. Positive symptoms include delusions, hallucinations, disorganized speech and thinking, disorganized behavior, catatonic behavior, and inappropriate moods. Negative symptoms are flattened emotions, lack of speech and a reduction in goal-directed behavior. The symptoms of schizophrenia are easily confused with those of bipolar disorder.

Schizoaffective Disorder

A diagnosis of schizoaffective disorder is given when the symptoms of both schizophrenia and bipolar disorder (predominantly mania) are both present – occurring simultaneously.

If the symptoms alternate or are not present throughout an episode, a diagnosis of schizophrenia or bipolar disorder (perhaps with psychotic features) is more likely depending on the dominant symptoms. As you would expect, there is a great deal of confusion and controversy surrounding this disorder.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TRTM).

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