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Why It’s Hard to Diagnose Bipolar Disorder

Why It’s Hard to Diagnose Bipolar Disorder

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Bipolar disorder, once known as manic depression, is a mental health condition that can cause dramatic shifts in mood, energy, thinking, and the ability to function. 

One of its main symptoms, mania, is signified by a state of exceptionally high energy, often accompanied by endangering behavior without regard to consequences, extreme elation, and a feeling of heightened self-confidence, self-importance, superiority, and grandeur. The counterpart, depression, features a pervasive sad or empty mood, decreased energy, and loss of interest in hobbies. These mood episodes are intense, and the fluctuation between mania and depression can be sudden and distinctly different in their manifestations. 

If these symptoms can be so intense and visible, why is diagnosing bipolar disorder so challenging? Misdiagnoses are all too common, which can lead to a change in treatment, unresolved symptoms, and, inadvertently, more severe outcomes.

In this detailed guide, we'll explain why it can be difficult to diagnose bipolar disorder and what to do if you think you've been misdiagnosed.

What is bipolar disorder?

Before exploring the complex diagnosis of bipolar disorder, it's essential to understand the basics. Bipolar disorder involves drastic mood fluctuations that can affect thought patterns, energy levels, and day-to-day functioning. It’s a chronic mental health condition that usually begins in late adolescence or early adulthood but can emerge at any age.

The American Psychiatric Association outlines the three types of bipolar disorders:

  • Bipolar I disorder is defined by having experienced one manic episode that occurs for a particular length of time unless treated and encompasses a complement of symptoms at a certain severity.
  • Bipolar II disorder is characterized by a pattern of symptoms that do not meet the characteristics of at least one full manic episode (known as hypomania) and major depressive episodes.
  • Cyclothymic disorder includes numerous periods of hypomanic symptoms as well as periods of depressive symptoms that don’t meet the criteria for major depressive episodes.

Diagnosing bipolar disorder

The process of diagnosing bipolar disorder can take time. Mental health professionals conduct a thorough assessment that includes speaking with you about symptoms, discussing family history, suggesting a physical exam, or considering other medical illnesses to explore potential causes of symptoms.

Preparing for your appointment

Preparation is key to getting an accurate diagnosis. Expect mental health professionals to ask about your personal and family psychiatric histories and symptoms. The doctor or licensed mental health professional might have a list of questions focused on the frequency and severity of the mood-related symptoms you’re experiencing.

To prepare: Start by documenting mood changes, sleep patterns, and any other behaviors that seem unusual for you. Also, make a list of any symptoms you are or have experienced and what happened, as well as any questions you have.

The tests that can be used

The diagnostic process for bipolar disorder might also include screening questionnaires and a series of tests to determine if other conditions might be causing mood-related symptoms.

These tests can include blood and urine tests to detect any underlying medical conditions, such as thyroid disease or vitamin deficiencies. Imaging scans like an MRI or CT scan could also be used to detect any brain anatomy or activity-related irregularities.

Getting a diagnosis

No matter anyone’s level of knowledge or preparation, it’s easy for all of us to get overwhelmed or have a difficult time processing all of the things we’re hearing when receiving any diagnosis. No matter what you’re diagnosed with, it’s important that you take the time to get all the information you need.

An image shows icons that highlight how to prepare for an appointment when seeking a mental health diagnosis, including taking notes, requesting time to process, and asking questions

Pro tip: Don’t be afraid to take notes or ask the medical professional to slow down if you need time to understand and ask questions. 

How common is misdiagnosis?

It’s alarmingly common. According to studies, approximately 70% of bipolar patients are initially misdiagnosed, with the most common false diagnoses being clinical depression or an anxiety disorder. Typically, an accurate diagnosis is only confirmed after 5 to 10 years from the first manic or depressive episode.

Some reasons for this high rate of misdiagnosis are associated with the inherently challenging nature of diagnosing bipolar disorder, including its symptom overlap with other mental health conditions and the variability in the duration, frequency, and intensity of mood swings for each individual.

Why bipolar is hard to diagnose

Several factors contribute to the complex diagnostic process of bipolar disorder, including the following:

  • Bipolar can mimic other disorders. The signs and symptoms of bipolar disorder can be similar to those of other psychiatric conditions, including major depressive disorder (MDD) and various anxiety disorders. This can lead to changes in diagnosis and treatment after more information or symptoms present, become known, or observed.
  • Bipolar can take several forms. Bipolar disorder is an umbrella term for several different variants, each with its own unique traits and diagnostic criteria that require a careful assessment of a patient's history and symptoms.
  • Incomplete information can hinder a diagnosis. Because it’s often based on observation or self-reporting, forgetting to share past experiences or details of personal or family histories can also lead to a misdiagnosis.

Its ability to look like other psychiatric conditions and manifest in various forms underscores the need for thorough and regular assessments and sharing an extensive personal and family history to get an accurate diagnosis.

Distinguishing bipolar disorder

Bipolar disorder is often confused with other psychiatric conditions due to similar symptoms, such as:

  • Bipolar disorder vs. MDD: The depressive episodes of bipolar disorder can closely resemble those of major depressive disorder (MDD). The key difference is that in bipolar disorder, individuals also experience manic or hypomanic episodes, which do not occur in MDD.
  • Bipolar disorder vs. ADHD: Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder have similarities, particularly with regard to attention and impulsivity issues. However, the underlying mood disturbance in ADHD is typically consistent, whereas in bipolar disorder, it fluctuates with distinct cycles of depression, mania, or hypomania.
  • Bipolar disorder vs. BPD: Bipolar disorder and borderline personality disorder (BPD) are both characterized by mood instability, which can lead to misdiagnosis. However, bipolar disorder involves distinct periods of depression, mania, or hypomania, which are not part of BPD. Instead, it’s characterized by a more pervasive pattern of instability in interpersonal relationships, self-image, and emotions, along with significant impulsivity.

Understanding the distinct characteristics of mental illnesses may help you assess if you’ve received an accurate diagnosis or not.

White woman on a video call with a white female medical professional

Do this if you think you were misdiagnosed

If you feel you should have a bipolar disorder diagnosis, but were diagnosed with something else, there are several steps you can take. Consider doing these things:

  1. Seek a second opinion. Consulting with a different mental health professional could provide further insight and a new perspective on your symptoms and diagnosis. 
  2. Find a specialized mental health professional. Specialists with extensive experience in bipolar disorder may be better equipped to identify its subtle symptoms and patterns. They're also well-versed in the diagnostic processes and tools for this condition.
  3. Be open about your symptoms. Don’t downplay or exaggerate symptoms — describe them exactly as you experience them. Additionally, be forthcoming about any negative effects your current treatment may be having.
  4. Consider bringing someone who has observed you. Having insight from someone like a family member, roommate, or significant other who has experienced your symptoms first-hand can provide the professional with a more complete picture, which can be particularly helpful if your symptoms have fluctuated over time.

Getting a bipolar diagnosis is the first step in treating and managing the disorder. By understanding the complexity of diagnosing this disorder, you can advocate for yourself, and live a more balanced life. 

Treating a bipolar diagnosis

Through a combination of education and open dialogues with healthcare providers, you can break down the barriers to a more precise evaluation.


Bipolar treatment can also be more accessible. We make getting the treatment easier by offering affordable access to online medication management and virtual therapy sessions.


Explore more: Treatment Options for Bipolar Disorder

Sign up to schedule your first session, where our mental health experts can better understand your current condition and help you get the support you deserve

Images by pressfoto and Drazen Zigic on Freepik.


The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.

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Accessibility: Connect with state-licensed therapists and mental health professionals from wherever you are in your state. Lower costs: Cerebral patients can save up to 80% on some  prescription medications, and the cost per therapy session is lower than traditional, in-person therapy on average. Cerebral offers online therapy and virtual medication management, making getting the help you need when you need it more accessible. Understanding and managing the triggers for bipolar episodes can help you maintain stability and improve your quality of life. By recognizing the common reasons mood episodes are triggered and implementing strategies to manage those triggers, you can reduce the frequency and severity of mood episodes. With the tools and support, you can lead a fulfilling life. Take the first step: Sign up to schedule your first session, where our mental health experts can better understand your current condition and collaborate with you on a personalized treatment plan. Images by freepik, Drazen Zigic, and ansiia on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.
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Bipolar Disorder
Does Bipolar Disorder Get Worse With Age?
Regardless of the mental health condition, it’s common for someone to wonder if their symptoms will worsen or change over time. Understanding how bipolar disorder, a condition that affects millions of people worldwide, emerges or evolves as one ages can be essential for effective management and treatment. Experiencing bipolar symptoms later in life, especially post-50, presents a unique set of characteristics. That makes it all the more important to understand this condition's trajectory across a lifetime. Here, we’ll explore how bipolar disorder impacts older adults, how symptoms and treatment needs might shift with age, and what you or loved ones could do to help manage these changes. {MiniWidget:Bipolar} Prevalence of bipolar disorder in older adults While bipolar disorder is often diagnosed in younger individuals, the prevalence of bipolar disorder among those in their later years has gained more attention. Studies indicate that about 5-10% of new bipolar disorder diagnoses are in adults over 50, sometimes referred to as ‘late-onset bipolar disorder.’ Why does this happen? It’s likely due to a variety of factors, including symptom overlap with other conditions and evolving views of the importance of mental health. Reasons for misdiagnosis Late-onset bipolar disorder can be challenging to diagnose due to its likelihood to exhibit symptoms differently, the complexity of symptoms, and the presence of other age-related health issues. Bipolar disorder in older adults can present predominantly with depressive episodes. Since these episodes can look very similar to clinical depression, it's not uncommon for the condition to be misdiagnosed as unipolar depression. Additionally, manic phases in those with bipolar disorder who are post-50 might not be as pronounced as in younger individuals. Sometimes, these manic episodes are less about traditional mania and more about irritability or less obvious changes in energy, which can be easily overlooked or misattributed. In some cases, there could be a misdiagnosis of dementia in patients who are actually experiencing bipolar disorder, or vice versa. The overlap in symptoms for both dementia and the depressive or manic phases of bipolar disorder can include: Memory loss Disorientation Impaired executive function  Both dementia and bipolar disorder can include behavioral disturbances, too. In the case of bipolar disorder, these might be part of a manic episode, whereas, in dementia, they could be due to cognitive decline, making the correct diagnosis challenging. Historical stigma and late diagnosis It’s no secret that mental health was heavily stigmatized and a taboo conversation topic in previous decades. Back then, this stigma often prevented individuals from seeking help or even acknowledging mental health issues. As societal understanding and acceptance of mental health issues have improved, more older adults could be seeking treatment for symptoms that may have been present but unaddressed for decades. This shift could explain an increase in diagnoses of late-onset bipolar disorder as well as re-evaluations of misdiagnoses. In short: Reasons for late diagnoses could be that people now in their 50s and beyond grew up during times when psychiatric treatment options weren’t as advanced or as socially accepted as they are today.  Late-onset bipolar disorder Typically diagnosed after the age of 50, late-onset bipolar disorder can present unique challenges and considerations. Unlike early-onset bipolar disorder, which generally appears in adolescence or early adulthood, late-onset bipolar disorder can be influenced by a range of factors.  Why bipolar disorder can develop in later years The development of bipolar disorder in adults age 50 and older can often be explained by the significant changes the brain and body undergo as part of the aging process. Some of the reasons why bipolar disorder might emerge late in life include: Increased biological vulnerability: Age-related physiological changes can make the brain more susceptible to bipolar disorder. Reduced resilience in brain function can lead to an inability to regulate mood effectively. Cumulative health issues: Older adults often have a higher burden of chronic illnesses, which can stress the body and brain, potentially triggering or unmasking psychiatric conditions, including bipolar disorder. Medication-induced: Sometimes, the treatments for other age-related health issues can have side effects that manifest as bipolar symptoms. Certain medications used to treat physical ailments could influence mood regulation or even directly trigger manic or depressive episodes. These triggers could complicate treatment plans, and, in some cases, a multidisciplinary approach to treatment will be needed. Other reasons for showing bipolar symptoms Neurological changes, other medical conditions, and hormonal imbalances can present symptoms that mimic those of bipolar disorder. Other explanations for those signs could include: Brain atrophy: As people age, there can be a general reduction in brain volume and mass. This atrophy can affect neurotransmitter systems, potentially triggering psychiatric symptoms, including those associated with bipolar disorder. Vascular changes: Microvascular disease can cause changes to the brain's small blood vessels, damaging brain tissue that contains nerve fibers and connects to other parts of the brain. This can produce bipolar-like symptoms. Neurodegenerative diseases: Conditions such as Alzheimer's disease or Parkinson's disease can exhibit symptoms that mimic bipolar disorder, such as mood swings and erratic behavior. Stroke and brain injuries: Strokes or traumatic brain injuries can lead to changes in personality and mood regulation, potentially initiating bipolar-like symptoms. Thyroid disorders: Thyroid dysfunctions, which are more common in older adults, can lead to significant mood swings and psychiatric manifestations that resemble bipolar disorder. Other endocrine changes: Changes in hormonal levels due to aging, such as decreases in estrogen or testosterone, can also impact mood and behavior. The complexity of diagnosing the issue could require careful psychological and medical evaluation. How does bipolar change as you age? As individuals step into their later years, the intensity and presentation of bipolar symptoms undergo significant transformations. Let’s explore how aging impacts bipolar disorder. How elderly bipolar symptoms differ Bipolar symptoms can shift with age. For instance, older adults might experience more depressive episodes and fewer manic episodes, or they may find that their episodes are more prolonged than when they were younger. Additionally, research suggests that while the frequency of manic episodes may decrease with age, depressive episodes can become more severe and last longer. This effect of aging on bipolar disorder can significantly impact an individual’s quality of life and requires tailored treatment. Symptoms also could blur into a mixed emotional state, making it challenging to differentiate between mania and depression.  Changes in the brain The impact of age on the brain further complicates the clinical picture. Aging affects brain structure and function, which can make symptoms harder to manage and predict. Studies have pointed to the possibility of accelerated brain aging in those with bipolar disorder, potentially influencing symptom severity and treatment responsiveness. Bipolar disorder and life expectancy Managing bipolar disorder is crucial to maintaining quality of life. People with bipolar disorder may have a shortened lifespan and may experience biological aging at a faster rate. The disorder’s associated behaviors and comorbid conditions such as cardiovascular disease can also impact life expectancy. Additionally, because one could experience more severe depressive episodes in their later years, thoughts of suicide could become more prevalent, increasing the risk of self-harm or suicide attempts. Remember: Seek immediate help if you're ever thinking about acting on suicidal thoughts, in a crisis, or experiencing extreme emotional distress.  Call or text 988 for the National Suicide Prevention Hotline. Call 911 if you’re having a mental health emergency. Text HOME to 741-741 if you're emotionally distressed and need immediate support. Regular monitoring and support for mental health alongside strategies to reduce these risks and maintain safety should be aspects of one’s treatment plan in their later years. It’s also vital for adults in their 50s and above to have routine health screenings and maintain a comprehensive care treatment plan that addresses both mental and physical health. Should treatments for bipolar change as you get older? The short answer: Most likely. As you age, both your body and your brain can undergo significant changes that can alter your symptoms and the way you respond to bipolar treatment options. Because of that, it can become important to make bipolar treatment adjustments in older age to account for these physiological and psychological developments. Let’s explore some of the common modifications people in their 50s and beyond may need to make. Medication for late-onset bipolar With age, the way drugs are processed can be affected in the following ways: Risk of adverse drug reactions: Older adults are more susceptible to side effects from medications due to changes in metabolism and increased sensitivity to drugs. Higher comorbidity rates: The presence of other health conditions often means that the interaction of various medications must be carefully managed to avoid issues. Considering some may experience cognitive decline in their later years, more straightforward medication routines may be needed to make it easier to stick to taking medications while aging with bipolar disorder. Therapy options for older adults with bipolar Therapy can be a cornerstone of treatment at any age. However, the focus might shift towards addressing specific life stage concerns, including retirement, loss of loved ones, and changes in independence. Cognitive behavioral therapy (CBT) and other forms of psychotherapy can be tailored to help cope with the transitions that aging naturally brings. Explore more: A Guide to Finding A Therapist For Bipolar Disorder The importance of complementary care Lifestyle adjustments and non-medical interventions can be a critical addition to finding balance while living with bipolar disorder, including: Seeing social connections and participating in support groups to combat isolation, which can exacerbate symptoms. Keeping a routine to maintain balance. Engaging in regular physical exercise to boost mood and preserve health. Using mindfulness and relaxation techniques, which can help manage stress and promote emotional stability. All of these strategies can enhance quality of life and support overall well-being.  Getting personalized mental health care While aging with bipolar disorder can present new challenges, understanding these changes can lead to better management strategies and a higher quality of life. It's important to consult licensed professionals who can tailor treatment plans with age-associated adjustments. After all, the aging process affects all of us differently. Some may feel and function just like they did in their younger years, while others may have developed health conditions that impact their mobility, ability to drive, or ability to perform daily tasks. Because retirement and aging can bring about many life transitions, you may want to consider online therapy and virtual medication management. Some of the benefits of choosing an online mental health service like Cerebral over traditional in-person visits include: Convenient access to care from the comfort of your home: This is especially helpful if you live in an area with few mental health resources, live in more than one home throughout the year, or have limited mobility.  Frequent monitoring and easier communication with licensed providers: This can be crucial in managing medication adjustments and addressing any emerging issues promptly. An integrated approach that includes both psychiatric medication management and psychotherapy: This holistic approach addresses both the biochemical and psychological aspects of the disorder in a coordinated manner under one simple, affordable monthly payment. Plus, Cerebral offers more flexible scheduling options than traditional in-person visits. This flexibility is particularly beneficial for individuals with bipolar disorder, whose symptoms can fluctuate unpredictably, requiring more frequent support or prompt interventions. Explore more: How Does Cerebral Work? Images by freepik, freepik, and freepik on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.
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mental-heath-support

Call 911 if you’re having a
mental health emergency

Text Home to 741-741 if you're in emotional
distress and need immediate support

Call 988 For National Suicide
Prevention Hotline