From Kimberly Read & Marcia Purse,
Your Guide to Bipolar Disorder.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

by Kimberly Read

You wake up one morning with your head all congested and a bit of a fever. You keep sneezing. Your throat is sore. By mid-afternoon you are miserable and head for the doctor. He takes one look and says, "You have a cold." He prescribes a decongestant, a cough syrup and rest. He might even order a lab test or two and prescribe an antibiotic if evidence of an infection is found. Perhaps your doctor schedules a glucose tolerance test because your complaint of numb toes and frequent thirst indicates you may be developing diabetes. Within a couple of days, you'll know for sure if you are going to have to start counting carbohydrates.

Unfortunately, diagnosing bipolar disorder is nowhere near this straightforward.

While there are some promising breakthroughs on the horizon, there is currently no definitive medical test for this disorder. Furthermore, there are a number of physical conditions and quite a few psychiatric disorders which present symptoms that can be confused with those of bipolar disorder. And just to complicate things a bit more, a great many psychiatric disorders can occur in tandem.

Therefore, to reach a diagnosis of bipolar disorder, a psychiatrist will usually conduct the following:

• A complete medical history and physical exam
  These are conducted in order to rule out other physical conditions.
  Ruling Out Other Physical Conditions
  
  
• A complete psychiatric history
  As previously noted, the possibility of other mental disorders should be considered. Furthermore, bipolar disorder is characterized by mood swings that tend to cycle. In reviewing a patient's history, previous mood swings (perhaps of less severity or duration) may come to light.
  Ruling Out Other Psychiatric Conditions
  
  
• A family history of medical and psychiatric concerns
  Current research indicates that mood disorders have genetic underpinnings - they tend to run in families. Therefore, if there is a family history of depression or bipolar disorder, it is a good indication that this is the case for the current patient as well.
  
  
• An evaluation of current symptoms
  There are a number of symptoms that are common for manic and depressive episodes:
  How to Recognize a Manic Episode
  How to Recognize a Depressive Episode

If no physical cause is found, if no other psychiatric disorder better accounts for symptoms, and if the current symptoms have been of significant duration or cause significant impairment in functioning, a patient may then be diagnosed with bipolar disorder. It is important to note here that if there is no previous history of mania or hypomania, the current symptoms must be those of mania or hypomania for a diagnosis of bipolar disorder. Since bipolar disorder is characterized by both extremes of mood (mania and depression), symptoms of depression only will obviously lead to a diagnosis of unipolar depression.