Is It Bipolar or a Different Diagnosis?

by Julie A. Fast Patient Advocate

Oh, she is so bipolar! The weather is so bipolar. I have a boss who is bipolar and he can’t make up his mind! As a person with the illness, I can tell you that bipolar disorder is not what most people think. This article gives you a clear grasp of the symptoms of the ancient, genetic mood disorder called bipolar disorder and the other diagnoses that are often mistaken for the illness.

Many different moods.

Bipolar disorder is a mood disorder

Bipolar disorder is a genetic mood disorder. Individuals with this diagnosis experience episodes of mania or hypomania and depression. It has been mentioned in medical texts for over a thousand years with little change in symptoms. It’s an illness that affects a person’s ability to regulate the mood. It is impossible to have bipolar disorder unless mania or hypomania is present. All mood swings in bipolar have a discrete beginning and end and the person returns to stability when not manic or depressed. Bipolar responds to lifestyle changes and medications.

Woman going through a manic episode associated with bipolar disorder.

Bipolar disorder always includes mania

Bipolar is an illness defined by mania. Mania is about energy that flows through a person’s mind and body without the person being tired as a result. It can have a positive feel called euphoric mania or a negative feeling energy called dysphoric or mixed mania. There are two levels of mania: hypomania and full-blown mania. People with bipolar 1 have hypomania and full-blown mania. People with bipolar 2 have hypomania. People with bipolar can also present as psychotic, but only during a manic or depressed episode.

Man with depression.

Unipolar depression is not bipolar disorder

Most people with bipolar have depression. (There is a type of bipolar that is mania only.) People with unipolar depression can be irritable, have significant sleep problems, and move around with restless energy, but this is not necessarily mania. Mania’s excessive energy is filled with ideas, rapid-fire talking, impulsive decisions around money and sex, and heightened sociability. Mania is extremely active physically. Depression is a mood disorder, but it’s not bipolar.

Woman with borderline personality disorder feeling lonely.

Borderline personality disorder is not bipolar disorder

Bipolar is episodic and not related to a person’s personality. Personality disorders are consistent over time and color the way a person interacts with the world. Borderline personality disorder is defined by symptoms of feeling abandoned, unstable relationships, suicidal threats and self harm, emptiness, and inappropriate anger responses. It is not episodic like bipolar. It is a part of the person and affects actions on a daily basis. There is no mania with borderline personality disorder. Borderline personality disorder can be treated with a specific therapy called DBT.

Smug businessman with narcissistic personality disorder.

Narcissistic personality disorder is not bipolar disorder

People with bipolar are often narcissistic, but the behavior ends when the mood swing ends. Like borderline, narcissism is a personality disorder that is consistent over time. People with narcissistic personality disorder need to be the center of attention, don’t care about the lives of others, and expect special favors and praise. They lack empathy and have no insight. People with narcissism don’t ask, Tell me about your day! and they will regularly accuse others of being narcissistic.

Expressionless man with schizophrenia.

Schizophrenia is a psychotic disorder, not a mood disorder

Bipolar is often mistaken for schizophrenia at first as the majority of people in a full-blown manic episode are also psychotic. People with bipolar can present as psychotic, but they do not have the general symptoms of schizophrenia that are more consistent over time, including hygiene struggles, abnormal body postures, lack of expression, and disorganized thinking. People with schizophrenia can have depression, but they do not get manic. Like bipolar, schizophrenia is genetic.

Different personalities portrayed through abstract art.

Dissociative identity disorder is not bipolar disorder

Dissociative identity disorder used to be called multiple personality disorder. Although people with bipolar seem to change personalities, the behavior is temporary and related to specific symptoms of mania and depression. The personality is simply cloaked by bipolar until the episode ends. In contrast, DID involves switching to alternative identities. Each identity is different in terms of talking, writing, dressing, and habits. The personalities split and are called unique. DID is often a reaction to trauma.

Child with dysmorphic mood dysregulation disorder having an outburst in a supermarket.

Defining dysmorphic mood dysregulation disorder

The very new DMDD diagnosis was created to get help for children who are extremely active, aggressive, irritated, unable to self sooth, and physically abusive. This is not trauma-based as the child is born with the symptoms. There can be depression and anxiety, but there are no clear signs of mania. Occupational therapy, meditation skills, and learning to recognize and manage anger are treatment options. There is no research to show that DMDD becomes bipolar disorder.

Happy circle of friends.

Strategies to get a correct psychiatric diagnosis

Why do we need all of these terms? For clarity and stability. I believe a set of symptoms shared by people around the world lead to an accurate diagnosis. Knowing why we act as we do or why a loved one has certain thoughts and behaviors helps balance relationships and heal families. It’s also important to know what a person doesn’t have. The incorrect diagnosis of bipolar or calling someone bipolar when there is a different set of symptoms disrupts lives. The correct diagnosis of a psychiatric disorder saves lives.

Julie A. Fast
Meet Our Writer
Julie A. Fast

Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get it Done When You’re Depressed, and The Health Cards. Julie won the Mental Health America Journalism Award for the best mental health column in the U.S. and was the recipient of the Eli Lily Reintegration award for her work in bipolar disorder advocacy. Julie is CEU certified and regularly trains health care professionals, including psychiatric residents, social workers, therapists, and general practitioners on bipolar disorder and mental health management skills. She was the original consultant for Claire Danes for the show "Homeland" and is on the mental health expert registry for People Magazine. She is a sought-after coach for parents and partners of people with bipolar disorder.