A preliminary diagnosis of Bipolar Disorder may be made by your GP but an official diagnosis is made by a psychiatrist and will be based on current presentation and or clinical history along with patient reported history.
For an official diagnosis of Bipolar Disorder type 2, the patient must have a history of at least one major depressive episode and meet the criteria for having had at least one hypomanic episode. People with Bipolar type 2 generally get more depressive episodes than they do hypomanic episodes.
Bipolar can take a long time to be correctly diagnosed, in particular types 2 & 3 which are often initially misdiagnosed as major depression. The reason for the commonality of this misdiagnosis is that naturally, people go to the doctor when they are feeling unwell and depressed but people don’t tend to go to the doctor when they are feeling happy or excitable. Even if the level of their ‘happiness’ has developed a pattern of causing disturbances in their work or social lives, understanding of the consequences of inappropriate actions and impulsive decisions tends to only come in hindsight. Often times patients and their families will simply put this intermittent elevated behaviour down to personality ‘quirks’ or ‘behavioural problems’ with many undiagnosed bipolar sufferers turning to alcohol or addictive substances to help them calm down and sleep or to ‘pick them up’ as a form of self-medication. Another kicker here is that some anti-depressants will actually trigger or exacerbate manic symptoms in individuals with Bipolar, so misdiagnosis of Major Depression and subsequent treatment with anti-depressants rather than mood stabilisers can actually make things worse.
For an official diagnosis of Bipolar 1 Disorder there only needs to be the presence of a single Manic episode (providing that it wasn’t triggered by an underlying ‘organic’ medical condition or a substance or medication). Patients usually have a history of depressive episodes but these are not actually required for diagnosis and if Psychosis is present then other conditions that cause similar symptoms such as Schizo-Affective Disorder and Schizophrenia will need to be ruled out first.
Bipolar type 1 is usually more easily spotted due to the intensity of the Manic episodes, people experiencing Mania will be obviously unwell to others through uncharacteristic behavioural symptoms such as incessant pressured and erratic speech, sudden intense focus on a singular topic such as religion is common, a person may develop a lack of inhibitions and start acting inappropriately with disregard for environment, often their thought processes seem bizarre and disconnected and symptoms of psychosis are common.
If you suspect that you may have Bipolar Disorder, this Bipolar Disorder self-test from The Black Dog Institute can give you a better indication, it can also be printed out and taken to your doctor as a useful tool in aiding a correct diagnosis if required.