Diagnosing Bipolar Disorder
Bipolar disorder, previously known as manic depression, is a mood disorder characterised by swings from mania to depression. While most people experience highs and lows from time to time, people with bipolar disorder are likely to experience mood swings as well as other symptoms of the disorder over a significant period of time. These symptoms or mood swings are of a higher intensity from normal highs and lows and are often without any life events to trigger them.
Approximately one to two percent of the population is affected with bipolar disorder. Generally symptoms will begin to show in an individual between the ages of 15 and 19. Men and women are equally affected. There is often a five to ten year gap between the onset of symptoms and a correct diagnosis. Bipolar disorder is commonly misdiagnosed as depression.
It is still unsure what the exact cause of Bipolar Disorder is. However experts agree there are several factors which can contribute, such as; Genetic inheritance, brain chemistry, malfunctioning body clock, psychological factors, other illnesses and drugs and other conditions that affect the brain.
There is more of a family link between Bipolar Disorder than there is with major depression. Genetic factors can explain up to 80% of the cause, although as yet no specific gene has been identified as “the bipolar gene”. Individuals who have parents, siblings or children with Bipolar Disorder are at a significantly higher risk of developing a mood disorder.
An imbalance of neurotransmitters in the brain chemistry is also thought to be associated with Bipolar Disorder. Mood stabiliser’s act to correct this, though it is largely unknown how they work in preventing mood swings.
A malfunctioning body clock (known as circadian rhythm) can also contribute to Bipolar Disorder. Our body clock governs our sleep/wake cycle, menstrual cycle, the production of growth and other hormones and other bodily processes. All of our biological functions are subject to this daily pattern/rhythm and it has been found that in individuals who are depressed or manic the rhythms are disturbed (not knowing the ‘right’ time to eat or sleep etc). The seasons also play a role in this with depression being more common in winter, whereas mania is more common in the spring and summer.
Psychological factors such as stressful events, and intense emotions can trigger off people into episodes if they are already susceptible genetically or chemically to mood disorders.
Bipolar disorder comes in varying degrees of intensity and can be classified into four different categories; Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder Not Otherwise Specified (NOS). Bipolar I is the most serious and severe manifestation of this disorder with the manic and depressive episodes being more intense and severe than those found in the other types of bipolar. Cyclothymia is the least severe, with episodes generally alternating between hypomania and mild depression. Patients diagnosed with Bipolar II disorder suffer primarily from episodes of moderate to severe depression with occasional episodes of ‘mild’ mania, clinically termed hypomania. Hypomania differs from mania in that no delusions are experienced, but like mania, hypomania can cause severely impaired functioning of the individual.
There are several psychological tests that can be evaluated and used to make a tentative diagnosis of Bipolar disorder. Often a definitive diagnosis is not made unless the patient shows signs of responding to treatment options and all other factors such as life events, hormonal or other physical factors have been ruled out.
The Kessler Psychological Distress Scale (known as the K10), which was developed in Australia, is the primary diagnostic tool general practitioners will use in all cases of suspected mental illness. The ten question test evaluates an individual’s level of psychological distress, with a focus on whether the individual is experiencing symptoms of anxiety or depression.
Although the K10 is not bipolar specific, when combined with further diagnostic tools, it can give a good indication of whether an individual may be suffering from bipolar disorder.
The Goldberg Bipolar Spectrum Screening Questionnaire was developed by Dr Ivan K Goldberg and is designed to be used as a self test (though it can be administered by a doctor) which gives an indication of whether bipolar disorder may be present in the individual. When combined with the K10 it can often be one of the most valuable tools in making a tentative diagnosis of bipolar disorder.
The Minnesota Multiphasic Personality Inventory (MMPI-2) was developed at the University of Minnesota in the late 1930s and has since been revised several times, including in 2001. The 567 question test was designed to be administered and evaluated by a mental health professional. The MMPI-2 is evaluated using ten scales; hypochondriasis, depression, hysteria, psychopathic deviate, masculinity/femininity, paranoia, psychasthenia, schizophrenia, hypomania and social introversion. Typically, an individual suffering bipolar disorder would score higher on the depression and hypomania scales with mid-range scores on the paranoia and psychopathic deviate scales.
Although psychological testing can be used as a tentative diagnostic tool for bipolar disorder, it is important to remember that these are general, standardised tests. They generally do not take into consideration the individual’s past or present life circumstances which can be a large factor in determining if bipolar disorder is present or not. They do not take into account physical conditions which have the potential to manifest as mental illness, such as hormonal conditions, and most of them focus only on the symptom not the cause of the symptom. For example, a young mother may answer that she has experienced changes in her sleeping habits over the last six weeks, which will lead to a higher score on the K10 and indicate that she is suffering psychological distress when she is merely dealing with a teething toddler.
Another flaw in psychological testing is that often individuals taking the tests tend to downplay symptoms or, in the case of a person experiencing mania or hypomania, not recognise their own symptoms as an issue. Though an outsider can see they are engaging in risky behaviour, the hypomanic individual is incapable of seeing that and therefore will score low on that section of testing.
It is for this reason that psychological testing should be thought of more as a guide, than a complete diagnostic tool. If it is suspected that the individual is suffering from psychological distress or is symptomatic of bipolar disorder, they should then be referred to a psychiatrist who can cancel out physical or other emotional factors before making a definitive diagnosis of the individual.