Bipolar, Borderline or Both? Diagnostic/Formulation Issues in Mood and Personality Disorders
How to Diagnose Mood Disorders
Everyone feels stressed or sad now and then, but how do you know when to be concerned? Deal with mood disorders, such as depression or bipolar disorder, as you would physical illnesses. A cold might go away on its own, but you need to see a doctor for pneumonia. In the same way, passing feelings might go away, but intense, long-lasting symptoms might need medical care. If you or a loved one have symptoms of a mood disorder, see a healthcare provider to get an accurate diagnosis and treatment.
Recognizing Symptoms in Yourself
Get help immediately if you experience suicidal thoughts.If you’re thinking of harming yourself, call a relative, friend, or medical professional. These feelings may feel like they’ll never go away, and you may feel overwhelmed or embarrassed. However, they are part of a treatable medical illness, and there is nothing embarrassing about getting help.
- Take immediate action and call a trusted loved one, your doctor, or emergency services.
- In the United States, call the 24-hour National Suicide Prevention hotline at 1-800-273-8255 (1-800-273-TALK).
Take note of ongoing feelings of sadness or emptiness.Signs of depression include loss of interest in all or most activities, sadness, hopelessness, guilt, feeling worthless, and trouble concentrating or making decisions. To some degree, everyone experiences these in passing. For people with depression, these feelings are intense, last most of the day for 2 weeks or longer, and may disrupt various aspects of your daily life (e.g., work, school, social life, or basic self-care).
- Major depressive disorder, or clinical depression, is the most common mood disorder. Other signs include excessive fatigue, changes in sleep habits, significant weight loss or gain, and suicidal thoughts.
- Try writing in a journal to keep track of these or any other symptoms.
- Symptoms might develop for no apparent reason, or they might be triggered by life events, such as losing a loved one or financial troubles.
Ask yourself if you experience unusual highs and lows.Think about any times you’ve felt energetic, overconfident, or like you don’t need to sleep. During these periods, your thoughts might race beyond control, you might engage in risky behaviors, and family or friends might mention that you don’t seem like yourself. When these highs subside, you might feel the symptoms of depression, such as hopelessness or excessive fatigue.
- Bipolar disorders are characterized by alternating cycles of highs, or mania, and lows, or depression. Depending on the type of bipolar disorder, high and low periods may last at least 1 or 2 weeks, or they may cycle more rapidly over a period of hours or days.
Note changes in your energy levels and sleeping habits.It’s one thing to feel tired after a long day or energized when you get good news. However, feeling like you can’t get out of bed or like you have so much energy you could explode might be signs of a mood disorder. Additionally, you might start sleeping a lot more than usual or feel well-rested after just 2 or 3 hours of sleep.
- Changes in energy level and sleeping habits might indicate depression, bipolar disorder, or another mood disorder. They could also be related to a number of other medical conditions, so see a doctor for an accurate diagnosis.
- The more extreme your symptoms and the longer they last, the more important it is to talk to a healthcare provider.
Think about how your symptoms affect your daily life.Recall any occasions that a loved one told you they were worried about you. Ask yourself if your feelings or behaviors have damaged relationships, caused problems at work or school, or impacted your ability to function in any way.
- Take action if your relationships and responsibilities have been affected. Don’t feel embarrassed or ashamed about getting help. There’s no difference between maintaining your mental health and your physical health.
- If you're not sure, try asking a friend or relative if they've noticed anything different about you.
Helping a Loved One
Bring up your concerns in a comfortable location.Talk to your loved one if you suspect they might have a mood disorder. Choose a private, comfortable space, such as their home or a quiet park. You should both be free of distractions, so talk to them on a day you both have off from work or school.
- If you or your loved one have children, see if a trusted friend or relative can watch the kids while you talk.
Tell your loved one that you care and want to listen.Begin the conversation by expressing how much your loved one means to you. Invite them to confide in you instead of coming out and saying, “I think something is wrong with you.”
- Say, “It seems like you’re going through a difficult time. You are not alone. I care about you, and I want to help in any way I can.”
Reduce stigma by comparing mental illness to physical illness.Mental health stigma is the attitude that mental illness is shameful or frightening. When you talk to your loved one, emphasize that there is nothing embarrassing about getting help for a mood disorder or other mental health issue. Tell them that mental illness might seem scary, but it’s no more frightening than having a physical illness.
- Tell them, “There is no reason to be embarrassed about taking care of your mental health. You wouldn’t be embarrassed about seeing a doctor to treat the flu or heal a broken leg. This is no different.”
- Additionally, mention that there are different degrees of illness. Say, “Sometimes, colds go away on their own. Other times, people get the flu and need medicine. Sometimes feelings go away on their own, and other times they’re more intense, last longer, and need treatment by a doctor.”
Offer to go with them to see a medical professional.Suggest that they might be more comfortable seeing their regular doctor before going to a therapist. Let them know you understand that they might be afraid to see their primary doctor, psychiatrist, or other healthcare provider. Remind them that they’re not alone and that you’re there for them every step of the way.
- Unless they’re your child, a minor in your care, or in danger of hurting themselves or others, there isn’t much you can do if they refuse to see a doctor.
- If they’re dismissive, do your best to support them, remind them they shouldn’t be ashamed or afraid, and encourage them to care for their overall health.
Volunteer to go with them to support group meetings.Once your loved one has been diagnosed with a mood disorder, you can continue to show support by offering to go with them to group therapy. Meeting with others who are struggling with the same mood disorder can help them gain a better understanding of what they are going through and feel less alone. Offering to go with them may help them feel more comfortable and secure.
- Your loved one’s healthcare provider or counselor may be able to recommend good support groups in your area.
Call emergency services if you think they'll harm themselves or others.Get help immediately if you believe your loved one is in danger. When you call emergency services, explain that your loved one is experiencing a mental health crisis and you’re concerned for their safety. Ask specifically for a first responder who has been trained to diffuse a mental health crisis.
- Before making the call, let your loved one know whom you are calling, and why. For example, you might say, “Lisa, because of the way you’re talking right now, I’m really afraid that you’re going to try to hurt yourself. I’m going to call 911 so that we can get you some help.”
- Your loved one might get angry or upset about you calling emergency services on their behalf. However, if you really feel that they are in danger or may be a danger to others, making a call is the right thing to do.
- If you can, stay with your loved one so you can provide support when emergency services arrive.
Seeing a Mental Health Professional
Schedule an appointment with your primary doctor.Many people are more comfortable seeing their regular doctor when they first seek treatment for mental illness. Sometimes, medical conditions other than mental illness cause similar symptoms, so the doctor can also rule out other issues.
- If necessary, your doctor can also recommend a mental health professional in your area.
Get a referral or look online for a mental health professional.While you might be more at ease with seeing your regular doctor at first, you should eventually find a mental health professional. They can make an accurate diagnosis and work with you to develop the best treatment plan.
- If you are in the U.S., look for a local mental healthcare provider on the American Psychological Association’s search page at .
- You can also use Psychology Today’s “Find a Therapist” tool to search by geographical region and specialization: .
- Check your insurer’s directory to find a healthcare provider in your network.
- If meet with a potential therapist and feel you do not have a good rapport with them, don’t be afraid to try someone else. It is important to find someone you trust and feel comfortable with, so meet with a few therapists, if you need to.
Be open and honest to get an accurate diagnosis.Your healthcare provider will ask you questions about your symptoms, when they started, their severity, and how they affect your daily life. You might be hesitant to discuss your personal life with a stranger, but remember that your health is their priority.
- Sometimes mood disorders are associated with drugs and alcohol. Be honest if you drink or use recreational drugs. Your healthcare provider is there to help, not to judge you or get you in trouble.
Discuss treatment options with your healthcare provider.Mood disorders are often treated with a combination of medication and therapy. The right medication and appropriate form of therapy depend on the diagnosis.
- Ask your healthcare provider about the pros, cons, and side effects of any medication. You might have to switch medications or change dosage amounts before you find what’s most effective for you.
- After starting to take medication, tell your healthcare provider about any new or unusual symptoms, such as worsening depression or suicidal thoughts.
Attend therapy according to healthcare provider's recommendations.Treating a mood disorder doesn't happen overnight. Many people benefit from regular therapy sessions over a long-term period. You shouldn't stop seeing your healthcare provider without consulting them first.
- Your therapist will discuss the best form of therapy for your circumstances. For example, talk therapy, or psychoanalysis, aims to find feelings, memories, or unconscious thoughts at the root of the mood disorder.
- Cognitive behavioral therapy is commonly recommended for mood disorders. In this form of therapy, your therapist helps you recognize thoughts and behaviors related to the mood disorder. They also help you develop coping skills, such as positive self-talk and relaxation techniques, to help you control related symptoms.
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