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Bipolar Spectrum: Diagnostic Scale and More

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Bipolar disorder is sometimes characterized by symptoms that change a person’s moods rapidly, from depression to high-energy mania. In reality, symptoms of bipolar disorder are much more varied and complex.

Some mental health experts believe that bipolar disorder is actually a spectrum of moods with varying degrees of severity.

On one end of the spectrum are very low moods, or episodes of depression, and on the other end are elevated moods, called episodes of mania.

The bipolar spectrum incorporates elements of the four bipolar disorder types found in the Diagnostic and Statistical Manual for Mental Disorders 5th Addition (DSM-5):

  • Bipolar I disorder: includes episodes of mania or a combination of both depression and mania, called mixed episodes, that last at least 7 days
  • Bipolar II disorder: involves episodes of depression and hypomania, which are typically less severe than those in bipolar I disorder
  • Cyclothymia: involves episodes of hypomania with alternating periods of less severe depression present for at least 2 years
  • Bipolar disorder not otherwise specified (NOS): a bipolar disorder that doesn’t follow a specific pattern like the types above, such as experiencing periods of hypomania without depression

The spectrum of bipolar disorder includes symptoms found in other mental health conditions, such as major depressive disorder and generalized anxiety disorder.

Knowing where you fall on the spectrum is important because it can help your doctor find the treatment that’s most likely to improve your symptoms.

The Bipolar Spectrum Diagnostic Scale was created by Ronald Pies, MD, a professor of psychiatry at Harvard Medical School.

While the scoring section is titled “likelihood of bipolar disorder,” this scale can’tconfirm if you have bipolar disorder. It can show where on the spectrum of bipolar disorder you fall.

You should talk with a mental health professional if you have questions or concerns about bipolar disorder.

To use this scale, first read the entire passage below (the blanks are provided for a later step):

Used by permission of Dr. Nassir Ghaemi and developer Dr. Ron Pies.

Some individuals notice that their mood and/or energy levels shift drastically from time to time ____. These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high ____.

During their “low” phases, these individuals often feel a lack of energy; a need to stay in bed or get extra sleep; and little or no motivation to do things they need to do ____. They often put on weight during these periods ____.

During their low phases, these individuals often feel “blue,” sad all the time, or depressed ____. Sometimes, during these low phases, they feel hopeless or even suicidal ____. Their ability to function at work or socially is impaired ____.

Typically, these low phases last for a few weeks, but sometimes they last only a few days ____. Individuals with this type of pattern may experience a period of “normal” mood in between mood swings, during which their mood and energy level feels “right” and their ability to function is not disturbed ____.

They may then notice a marked shift or “switch” in the way they feel ____. Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do ____.

Sometimes, during these “high” periods, these individuals feel as if they have too much energy or feel “hyper” ____. Some individuals, during these high periods, may feel irritable, “on edge,” or aggressive ____.

Some individuals, during these high periods, take on too many activities at once ____. During these high periods, some individuals may spend money in ways that cause them trouble ____. They may be more talkative, outgoing, or sexual during these periods ____.

Sometimes, their behavior during these high periods seems strange or annoying to others ____. Sometimes, these individuals get into difficulty with co-workers or the police, during these high periods ____.

Sometimes, they increase their alcohol or non-prescription drug use during these high periods ____.

Now check one of the following four boxes:

__ This story fits me very well.

__ This story fits me fairly well.

__ This story fits me to some degree but not in most respects.

__ This story does not really describe me at all.

Next, put a checkmark after each sentence in the passage above that definitely describes you.

Scoring: Each checked sentence is worth 1 point. Add 6 points for “fits me very well,” 4 points for “fits me fairly well,” and 2 points for “fits me to some degree.”

This is only a guide to help you understand your symptoms and what the proper treatment may be. If you score “moderately likely” or higher on this scale, you should consult with a mental health professional for further evaluation.

The bipolar disorder spectrum may include symptoms of any of the four bipolar types. They can consist of episodes of depression or depression alternating with mania or hypomania.

During depressive episodes, you can feel many ways. Each of the following symptoms must be occurring nearly every day for a bipolar disorder diagnosis:

  • depressed mood most of the day
  • loss of interest or pleasure in most (or all) activities
  • significant weight loss without dieting
  • weight gain
  • decrease or increase in appetite
  • slowed down thinking or physical movement
  • fatigue or loss of energy
  • feelings of worthlessness
  • feelings of excessive or inappropriate guilt
  • diminished ability to concentrate
  • indecisiveness
  • recurring thoughts of death, thoughts of suicide

During episodes of mania, you can feel:

  • elevated, expansive, or irritable mood for at least 1 week
  • very high self-esteem or superiority to others
  • like you need less sleep, such as feeling rested after sleeping for 3 hours
  • more talkative than usual or pressure to keep talking
  • racing thoughts or jumping from idea to idea
  • distractable
  • fidgety or agitated
  • like engaging in behaviors with potentially harmful consequences, such as overspending, impulsive business investments, or excessive drug or alcohol use

In very severe cases, a person may experience symptoms of psychosis.

Symptoms of hypomania are similar to mania. With bipolar disorder, they’re considered less severe and only need to be present for 4 days. Hypomania symptoms typically don’t affect social or occupational functioning and there are no features of psychosis.

A mental health professional may perform the following tests to diagnose bipolar disorder:

  • physical exam
  • mental health interview
  • certain lab tests to rule out other reasons for symptoms

Blood tests and brain imaging scans can’t diagnose bipolar disorder, but they can help rule out conditions with similar symptoms, such as hypothyroidism.

Your doctor will do an in-depth interview with you to understand your symptoms, including how long they have been happening and how much they are affecting your day-to-day life.

They also may use two screening tests to help diagnose your symptoms on the spectrum of bipolar disorder:

Together, these tests are more accurate at diagnosing symptoms on the bipolar spectrum than either test alone.

Your bipolar disorder symptoms and their severity will determine which treatments your doctor recommends. Treatments for bipolar disorder include:

  • antidepressant medications to reduce depression and anxiety
  • mood stabilizers and antipsychotic drugs to treat both depression and mania
  • cognitive behavioral therapy (CBT) to help you cope with your symptoms and help reduce symptoms of anxiety or depression

Make sure to discuss potential side effects with your doctor before starting any treatment.

Along with medication and therapy, these tips can help control symptoms of bipolar disorder:

  • Try to avoid things that trigger your symptoms, including stress, alcohol, and drugs.
  • Exercise as often as you can. Aerobic activities such as walking, swimming, and cycling can help with depression symptoms.
  • Eat a varied diet with lots of fruits, vegetables, whole grains, and lean protein (chicken, fish).
  • Relax with deep breathing, yoga, or a warm bath before bedtime to help you sleep better.
  • Keep a diary of symptoms, including what triggers them and what improves them.

Ask your doctor for other options for self-care.

If you’ve had symptoms of bipolar disorder but you don’t quite meet the criteria for a bipolar I diagnosis, you might identify with other parts of the bipolar spectrum.

Make sure you get a thorough evaluation from a mental health professional. Ask for a second opinion if you don’t feel like your diagnosis fits you.

Bipolar disorder is treatable but can require patience. It might take some trial and error to find the right treatment to help with your symptoms.

https://www.healthline.com/health/bipolar-disorder/bipolar-spectrum

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