Clinically Distinguishing Bipolar Disorder From Other Psychiatric Conditions

Bipolar disorder is a severe mental illness, and rates of diagnosis have risen in recent years. Accurately diagnosing bipolar disorder can be difficult when a patient is not actively manic, as screening questionnaires are not reliable diagnostic tools, patient self-report can be unreliable, and bipolar symptoms overlap with other psychiatric conditions. Much has been written about the overlap between bipolar disorder and borderline personality disorder, but many other disorders present with similar symptoms, including unipolar depression. Accurate diagnosis is important to ensure optimal treatment and patient outcomes. The goal of this article is to provide an evidence-based approach to diagnosing bipolar disorder and distinguishing it from other psychiatric disorders in clinical settings. Using the mnemonic "DIGFAST" (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleeplessness, talkativeness), we review the DSM-5-TR diagnostic criteria for mania. Distinguishing features include the episodic nature of elevated/irritable moods, severity of symptoms, and the simultaneous occurrence of multiple manic symptoms. Insight is typically impaired in bipolar disorder, and collateral information can help improve diagnostic clarity. Hypomanic symptoms can be distinguished from other conditions by their duration and accompanying changes in functioning. A thorough clinical interview is the most important asset in making an accurate diagnosis of bipolar disorder.