This fact sheet can be on the “Black Dog Institute” website.
The information in this fact sheet is not intended as a substitute for professional medical advice, diagnosis or treatment.
What this fact sheet covers:
• Problems with diagnosing bipolar disorder
• Self‐test (scoring & results)
• What to do if you suspect bipolar disorder
Why is bipolar disorder so often undiagnosed?
Some of the reasons why bipolar disorder can go for a long time undiagnosed include
• Mild cases of bipolar disorder can be hard to distinguish from a normal volatile or
cyclothymic personality style. Other psychiatric conditions (e.g. Attention Deficit
Hyperactivity Disorder, Borderline Personality Disorder, and Conduct Disorder)
can show some similar features.
• Bipolar disorder does not always present in a consistent pattern (that is, highs
followed by lows). For example, it may follow on from an unexpected physical
condition such as an eating disorder, or an episode of insomnia.
• The ‘highs’ that are symptomatic of mania or hypomania may also occur in people
who do not have bipolar disorder. For example, in creative people, when caught
up in a burst of creative activity (such as the writer who may describe a feeling of
being ‘taken over’ by a train of thought, writing in a state of excitement and
needing only a few hours’ sleep), or in people who use either legal or illicit drugs
that induce a sense of ‘being high’.
• Mild cases of ‘bipolar depression’ (a form of depression where manic episodes are
also experienced) are quite common. Often no‐one else other than the individual
may notice their differing mood.
• Some practitioners are unaware of bipolar disorder or are untrained in its
assessment and may not ask the right screening questions.
• Many patients with mild bipolar disorder enjoy their ‘highs’ and prefer not to seek
• People usually present for help when depressed, and then – in discussing
symptoms with the health practitioner – commonly focus on the current
depression rather than on the longitudinal pattern of ‘mood swings’.
Self‐test for bipolar disorder
This self‐assessment test comprises three initial questions followed by a checklist.
Only if you answer ‘yes’ to the first three questions should you continue on with the
checklist. At the end of the test you will be given your results.
Firstly, have you had episodes of clinical depression – involving a period of at least 2
weeks where you were significantly depressed and unable to work or only able to
work with difficulty – and had at least 4 of the following:
• Loss of interest and pleasure in most things
• Appetite or weight change
• Sleep disturbance
• Physical slowing or agitation
• Fatigue or low energy
• Feeling hopeless and helpless
• Poor concentration
• Suicidal thoughts?
If yes, proceed.
Secondly, do you have times when your mood ‘cycles’, that is, do you experience ‘ups’
as well as depressive episodes?
If yes, proceed.
Thirdly, during the ‘ups’ do you feel more ‘wired’ and ‘hyper’ than you would
experience during times of normal happiness?
If yes, proceed.
Please complete the checklist below, rating the extent to which each item applies to
you during such ‘up’ times.
Items are scored as follows:
‘2’ ‐ Much more than usual
‘1’ ‐ Somewhat more than usual
‘0’ ‐ No more than usual
The total score is the sum of all 27 items.
Please note that while great care is taken with the development of this self-assessment
tool, it is not intended to be a substitute for professional clinical advice.
While the results of the self‐assessment may be of assistance to you, users should always seek the advice of a qualified health provider with any questions they have
regarding their health.
22 or more
A score of 22 or more, together with episodes of clinical depression, suggests possible
bipolar I or II disorder and would warrant detailed clinical assessment.
less than 22
A score of less than 22 is only returned by about 2% of those with true bipolar
disorder, so that if your score was less than 22, the likelihood of you having the
condition is low ‐ but cannot be excluded.
NB: This self‐assessment test may also be done online: www.blackdoginstitute.org.au
What to do if you suspect bipolar disorder
If you scored 15 or more, it is advisable to seek a professional assessment from a
mental health practitioner. The first step is to arrange a consultation with your
general practitioner. They will provide a professional diagnosis and, where necessary,
refer you to a psychiatrist for further treatment.