Bipolar disorder explained, and why no quiz can name it

What the diagnosis covers

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Bipolar disorder is defined by stretches of time rather than by a single feeling. The National Institute of Mental Health describes it as an illness that causes clear shifts in a person's mood, energy, activity levels and concentration, and the word shifts is doing the work there. One pole is a period of unusually high or irritable mood with more energy than usual: less need for sleep, faster thinking and speech, more plans, more confidence, and often more spending or risk-taking. The other pole is a period of low mood and low energy, when interest drains out of things that normally matter, sleep and appetite change, and everything takes longer.

Public health bodies name two main types, and the World Health Organization's fact sheet says so directly: there are two main types of bipolar disorder, depending on patterns of manic or hypomanic and depressive episodes.

• Bipolar I involves at least one manic episode, a high period severe enough to disrupt ordinary life and sometimes to require hospital care, usually alongside depressive periods.
• Bipolar II involves hypomanic episodes, which are milder and less disruptive, together with at least one depressive episode and no history of mania.

How severe, how long, how disruptive: those thresholds are where a diagnosis is made or not made, and they are not things you can judge from a list of statements about yourself.

Why a quiz cannot tell it apart from the things that look like it

The NHS is blunt about the difficulty: bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions. A questionnaire sees a snapshot, and the diagnosis lives in the timeline. Several very different situations produce answers that look identical on a quiz.

• Depression on its own. Help is commonly sought during a low period, and high periods surface only when someone asks about them directly.
• ADHD. Restlessness, fast speech, impulsive spending and racing thoughts are everyday features of ADHD rather than stretches that arrive and pass.
• Anxiety. Racing thoughts, restlessness, fast speech and nights of broken sleep are everyday features of anxiety, and on a questionnaire they read exactly like a high stretch.
• Thyroid problems and other physical conditions. An overactive or underactive thyroid can imitate either pole, and a blood test settles what no questionnaire can.
• Alcohol, other drugs and some prescribed medicines. Substances can produce high and low stretches directly, and stopping them produces stretches of their own.
• Lost sleep, grief and a genuinely hard year. Weeks of broken sleep or bereavement change energy, appetite and interest for reasons that are not an illness.

This is not a small technical caveat. The World Health Organization's fact sheet records that many people with bipolar disorder are misdiagnosed or untreated, and the error runs both ways: a depression diagnosis can stand for years because nobody asked about the high stretches, and an internet quiz can hand out a label that nothing in a history supports.

What an assessment actually involves

In the UK, a GP who thinks bipolar disorder is possible refers you to a mental health specialist, and the NHS describes that specialist asking about your moods, behaviour, health and family history. The route differs by country; the content is much the same.

• A history across years rather than weeks: when each stretch started, how long it lasted, and what you could and could not do during it.
• Sleep, including how much you needed during a high stretch, not only how much you got.
• Alcohol, recreational drugs and every prescribed medicine, including anything started shortly before a change.
• Physical checks, commonly thyroid function and other blood tests, to rule out causes that have nothing to do with mood.
• Family history, because the condition runs in families more than chance explains.
• Where possible an informant, such as a partner, parent, sibling or close friend, because high stretches are far easier to see from outside than from inside.

Rating scales may be used along the way, but they inform a conversation rather than settle it. Nobody is diagnosed by a form.

What to write down before an appointment

The most useful thing you can bring is a record of time. Adjectives are easy to produce and hard to interpret; dates and durations are the opposite.

• A rough calendar of the last two years, marking any weeks that were clearly above or below your ordinary level.
• For each marked stretch, how long it lasted and how much sleep you needed while it was running.
• Two or three concrete incidents with dates: a purchase, a message you regret, a fortnight of missed work.
• What other people said at the time, and who said it.
• Every medicine, supplement and substance you were taking, and any change to them.
• The thing you are most worried about, written out before you go, so it survives a short appointment.

Where the self-check on this site fits

MyTestAtlas has one mood route, the Mood and Energy Patterns Self-Check. It asks about eighteen everyday situations from the last year or two and returns four named patterns: high-energy stretches, low-energy stretches, shifts and cycles, and what those stretches cost. It has no cut-off, produces no total and returns no verdict, because a questionnaire that did any of those things would be pretending to do the assessment described above.

What it is good for is language. People often arrive at an appointment able to say only that their mood is all over the place. Leaving instead with four named patterns and dated examples behind them turns that into something a clinician can work with. That is the whole of the claim.

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