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Do I have Bipolar Disorder?

Your doctor says you’re bipolar but what you’ve read about bipolar disorder and its “highs” just doesn’t sound like you. Or your doctor is treating you for depression, but you’re not getting better.

You may have bipolar II disorder.

Researchers have recently been developing new insights into bipolar II, also known as “soft” bipolar disorder or “bipolar spectrum disorder,” because its characteristics occur along a continuum.

People who have bipolar disorder are often misdiagnosed. In a recent Depression and Bipolar Support Alliance (DBSA) survey, nearly seven out of ten people with bipolar disorder had been misdiagnosed at least once. Sixty percent of those had been diagnosed with major depression.

Accurate diagnosis is critical — if someone with bipolar disorder is treated only with antidepressants, their condition will be unlikely to improve, and, in fact, may get much worse, which could result in needless suffering and even suicide.

Why is bipolar disorder so difficult to diagnose?

“Textbook” symptoms
When doctors suspect bipolar disorder, they ask standard questions looking for signs of mania, such as “high” or euphoric feelings, little need for sleep, racing thoughts, trouble concentrating, continuous high energy or delusions.

These characteristics of mania make up the narrow criteria for a bipolar I diagnosis found in the DSM-IV, the main diagnostic reference of U.S. mental health professionals. The DSM-IV says the hypomania symptoms of bipolar II are similar to those of type I, but “less severe.” A growing number of experts disagree.

Symptoms often missed
For many with bipolar disorder, hypomania symptoms are rarely feelings of euphoria, says Jim Phelps, M.D., author of Why Am I Still Depressed?. “The ‘racing thoughts’ can be very negative. The ‘high energy’ can be experienced as severe agitation.
People may have trouble concentrating or getting things done.

Other symptoms may include eating too much, sleeping too much, feeling worse towards evening and intense tiredness. Some types of hypomania produce irritability, emotional distress, impulsiveness and impaired judgment.

The “down side” of bipolar disorder is depression, with symptoms of:

  • persistent sad, anxious, or empty mood
  • hopelessness or pessimism
  • loss of interest in once pleasurable activities
  • fatigue or decreased energy
  • thoughts of death or suicide

Many people who have bipolar disorder seek professional help only when they are depressed and may not recognize their other symptoms as mania or hypomania. “Depression is the dominant symptom of the mood spectrum,” says Phelps. “Hypomania makes up less than five percent of the time someone is ill.”

The right questions
It’s easy to see why doctors may fail to ask the right questions and patients may fail to recognize the right answers for an accurate diagnosis to be made.

Clinicians using less rigid diagnostic criteria were able to make more accurate diagnoses. Avoiding yes or no questions, they were able to get a more accurate picture of mood changes.

Dr. Phelps suggests that instead of asking “Am I bipolar?” the question should be “How much bipolarity might I have?” He points out that, while hypomania or mania are factors, so is family history, history of depressions and response to medications.

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