It would be nice if there were a simple answer to the question — or even a blood test, MRI, or brain scan — to determine bipolar disorder. We're not there yet.
What we do have is a set of symptoms which exist on a broad continuum. What gets tricky is identifying where the threshold lies between normal functioning and psychopathology.
People come in all shapes and forms. So do personalities. In fact, the uniqueness of each individual's thought process, behavior, and temperament is akin to the snowflake analogy. We just don't see duplication of the mind, even with identical twins.
On the bell curve of human experience, there are those whose thoughts, feelings, and behaviors lie far outside the middle. If their uniqueness works for them, that's excellent. After all, there's nothing inherently good about being in the middle.
But what if this uniqueness means mood and behavioral patterns recurrently shift without clear reason and apart from a sense of choice? And what if this experience also leads to recurrent painful and unwanted difficulties?
In other words, this isn't just a simple choice to be idiosyncratic. It's more like these individuals have little sense of agency about being the way they are.
There's been a lot said about the drawbacks of psychiatric diagnosis. They tell us little or nothing about the cause of an illness. They are often not prescriptive with regard to specific treatment approaches. There's also the unfortunate reality that psychiatric diagnoses still carry a moderate degree of social stigma.
But the one positive outcome I do observe through clinical assessment is that the rendering of the bipolar diagnosis often helps people begin to make sense of their experience. Instead of becoming distraught by the diagnosis, it's common to hear the expression of relief at finally knowing what's wrong. In fact, I've often heard patients say something to the effect of, "Oh, now I finally get what's been going on with me." And "getting it" can then open the door to the process of dealing with it. This brings us back to the question: Where does being "moody" cross over into the realm of bipolar disorder?
One of the most important features to distinguish in this comparison is whether mood variability occurs exclusively in relation to situational variables. If that's the case; if there's always something going on which would account for your shifting mood, then it's likely you don't have bipolar disorder.
That's not to say that individuals with bipolar disorder are not influenced by situations. In fact, they often are. But most who have bipolar disorder also report times when mood elevates or becomes depressed without any apparent cause.
The classic scenario here is that you're just going about your life and you notice you're gradually feeling more upbeat and energized. Your mind is moving faster than usual and you feel like you're on a creative high that will generate all kinds of wonderful outcomes. You welcome your sense of optimism and wellbeing. Your concerns about finances disappear and you want to spend simply because it feels good to do so; and besides, you're confident you'll come up with some new means of covering all your expenses. For now, they just don't matter. There's so much to do and three to five hours sleep seems sufficient to recharge your batteries and easily keep you energized through the next day.
And all this is happening on its own — no lottery ticket, no exciting new love in your life, no Fulbright scholarship, nothing. It's all just coming your way because your mind is bringing it. You want to hold on and cherish the high for as long as you can.
But after about a week, the intensity begins to feel too much and it all starts getting ragged around the edges. Irritability creeps in and gradually replaces the euphoria. Your lessened need for sleep morphs into exhaustion plus insomnia. You begin to have a sense of dread. The good is turning bad ... and next thing you know you're crashing, hard and fast. No one died; no bad news, no defeat. It all just ends like it started: for no clear reason, except that your brain's neurocircuitry is overworked and your reserve of resilience is on empty.
You've just had a quick tour from mid-range mood to mania (or maybe the upper end of hypomania) and then down into depression. It's important to note that the bipolar journey doesn't always take this same route. Sometimes, it can start with an event that stimulates excitement, or it can even be activated as a function of sustained high stress. Same with a depressive crash — it can be brought on by a very painful or disappointing event.
However, despite the presence of these clear causal connections, most with bipolar disorder will tell you that at some point they've also experienced mood shifts that occur in the absence of any situational precipitant. I'm thinking of one patient whose mood would radically shift during her previous night's sleep. She would go to bed in mid-range mood and awaken fully hypomanic after not having experienced any mood elevation in the preceding several months. She and others like her often find themselves on the bipolar coaster without purchasing a ticket.
Two other salient aspects of the moody vs. bipolar discussion involve mood intensity and duration. If you're not bipolar but having a rough time with moodiness, you'll likely find that your mood intensity is lower than someone with bipolar disorder. Even more relevant than intensity is the issue of mood duration.
We all have good days and bad days. Someone who thinks of themselves as "moody" may perceive that they've had more than their share of bad days. But if you're truly bipolar then you've had episodes of fairly acute depression which at some point have lasted two weeks or more.
Additionally, you've seen an elevated mood that has lasted a minimum of four days and often longer. Unless your different mood experiences have met these duration criteria and your "up moods" have involved symptoms such as high energy, lessened need for sleep, accelerated thought, rapid speech, impulsivity, euphoria and/or intense sustained irritability, then your moodiness probably reflects something other than bipolar disorder.
What exactly that may be is hard to know without more specific information. If you're wondering what diagnostic categories are most frequently associated with moodiness (besides bipolar) you should investigate the categories involving personality disorders, particularly the borderline and narcissistic types.
If you're unsure, it's worth your while to see a professional about your concerns. Sometimes the telling symptoms of bipolar disorder can be present at a low level that has not yet reached the threshold of bipolar diagnostic criteria. The problem here, and it's one where the moody vs. bipolar distinction becomes murky, is that the mild to moderate symptoms can represent an early phase of emerging bipolar disorder. Essentially, the full symptom picture is still in the process of emerging.
Technically this is referred to as the prodromal phase. I often like to refer to this as "bipolar brewing." This is a situation where closely examining one's family history of mood disorders can be instrumental in identifying patterns that could become problematic later on.
And if you're someone who does identify with the moody label, you may wonder, why not just let things take their own course and worry about bipolar disorder if and when it arrives on the scene? Simple: If you are genetically vulnerable to bipolar illness, the future course of your symptoms may be mitigated if you can get help and make necessary adjustments early on. Conversely, bipolar symptoms will usually worsen if ignored. Bipolar disorder doesn't go away simply because we don't want it.
If your moodiness is no big deal and is just part of what constitutes the evolving colors of your life, then let yourself flow with it. But if you are concerned about your fluctuating mood intensity and if it's present much more than is acceptable for you, then please speak with someone who knows a lot about the bipolar diagnosis. Your mental health is precious. It deserves your close attention.
Russ Federman, Ph.D., ABPP is Director of Counseling and Psychological Services at the University of Virginia, as well as the co-author of Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar Disorder.