The Hidden Signs of Bipolar Disorder Even Doctors Can Miss

Why Standard Mental Health Screenings May Fail

Traditional mental health assessments often focus on depressive symptoms rather than mood fluctuations, which means bipolar disorder can go unnoticed. A 2020 study found the average delay in diagnosing bipolar disorder can be 10 to 15 years from the onset of symptoms. This delay can prevent people from getting the right treatment early on.

SUBTLE SIGNS OF BIPOLAR DISORDER

Bipolar disorder doesn’t always involve extreme mood swings or obviously dramatic behavioral changes. Here are some lesser-known symptoms or often unrecognized symptoms of bipolar disorder:

• Chronic irritability & angry outbursts – Unexplained frustration or sudden aggression without an apparent cause.
• Unpredictable sleep patterns – Staying up late with high energy for days, followed by prolonged exhaustion for days.
• Impulsive decision-making – Engaging in reckless spending, quitting jobs impulsively, or taking on unrealistic projects.
• Periods of intense productivity (“hypomania”) – Feeling unstoppable, highly creative, or hyper-focused, but eventually burning out.
• Feeling “high” on life without a reason – Experiencing sudden surges of confidence, optimism, or grandiosity. This can often lead to making impulsive choices with what should be clearly dangerous potential outcomes.
• Depressive episodes that feel different from typical depression – A mix of deep sadness, agitation, and restlessness.
• Unstable self-image – Fluctuating between feeling highly capable and worthless with other issues like body dysmorphia, imposter syndrome, or identity crisis.

THE EMOTIONAL ROLLERCOASTER: MORE THAN JUST MOOD SWINGS

Bipolar disorder isn’t just about mood swings—it affects your relationships, work, and daily routines in profound ways.

Bipolar Disorder and Relationships

Research shows that having bipolar disorder has a negative impact on relationships. In part, this is can be due to intense emotional reactions, impulsive behaviors, and periods of withdrawal.

Loved ones may feel confused by sudden shifts in mood and energy levels. Communicating your concerns and being transparent about what you’re each going through can help you find solutions to common problems when dealing with bipolar disorder.

The “Bipolar Hangover”

After a hypomanic episode, many people with bipolar disorder can experience what’s known as a “bipolar hangover”—a period of exhaustion, regret, and emotional depletion.

These post-hypomania hangovers can lead to feelings of guilt or embarrassment over actions taken during a hypomanic phase. It can also make it harder to recognize the pattern of mood swings because the emotional crash can be mistaken for ordinary stress or fatigue rather than a sign of the underlying condition.

The Risk of Self-Medication

Some people turn to alcohol, caffeine, or drugs to manage their fluctuating moods. Research reveals up to 60% of people with bipolar disorder struggle with substance abuse at some point in their lives.

However, self-medicating only worsens symptoms and increases the risk of long-term consequences. It is critical to your mental and physical health and safety to speak openly and honestly with your mental health professional and physician about using alcohol, marijuana, or other substances to self-medicate.

HOW TO TELL IF YOU HAVE SIGNS OF BIPOLAR DISORDER

If you suspect that you or someone you love may have bipolar disorder, here are some questions to start:

• Do I experience periods of extreme energy or restlessness, followed by deep exhaustion?
• Have I made impulsive decisions that I later regretted?
• Do my moods shift dramatically without an obvious cause?
• Have I ever felt “on top of the world” for no reason, only to crash into depression later?
• Have mental health professionals diagnosed me with depression, ADHD, or anxiety, but treatments haven’t fully worked?

Keep a Mood Journal

Tracking your mood patterns over time can help identify hidden signs of those high and low emotions. To help identify the bipolar disorder signs most people miss, or if you just don’t know where to start, here’s a breakdown of what a mood journal should include:

• Night/morning routine and sleep patterns
• Energy levels throughout the day
• Emotional state at the start and end of the day
• Major life events and stressors

WHAT TO DO IF YOU RECOGNIZE THESE SIGNS

If you or a loved one exhibit these symptoms, early intervention for bipolar disorder is key, according to a review in the American Journal of Psychiatry. Tracking symptoms as soon as they appear can simplify the diagnosis process and development of an effective treatment plan.

Brain-Healthy Treatments for Bipolar Disorder

Some bipolar disorder interventions include:

• Nutrition – A consistent diet rich in omega-3 fatty acids, lean proteins, complex carbohydrates, and micronutrient supplements supports mood stability.
• Therapy – Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) can help with emotional regulation.
• Lifestyle – Regular exercise, stress management, and proper sleep hygiene play a crucial role in mood stability.
• Medication – Mood stabilizers and other bipolar disorder medications may be necessary for some people after speaking with their doctor.

Related: Cognitive Behavioral Therapy: What Is It and Who Can Benefit?

How To Talk to Your Doctor

• Be honest about your mood fluctuations and impulsive behaviors.
• Keep a detailed symptom tracking journal to share with your physician.
• Ask about objective diagnostic tools like brain SPECT imaging for a more comprehensive evaluation.

Bipolar disorder isn’t always obvious, but recognizing the hidden signs can be life changing. If you or someone you love struggles with mood swings, impulsivity, or unexplained emotional shifts, seeking a comprehensive mental health evaluation is the next step.

To help rule out other mental health conditions, such as ADHD, clinical depression, and schizophrenia, consider seeking an evaluation that includes brain SPECT imaging. This functional brain imaging technology helps detect underlying brain activity patterns associated with a variety of mental health problems.

This leads to a more accurate diagnosis and more effective treatment. With the right treatment plan for bipolar disorder, stability, balance, and a fulfilling life are possible.