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Different Diagnosis and Co-morbid Disorders

Differential Diagnosis

Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering. Also called differentiation.” (1)


Other conditions to be considered before a bipolar disorder diagnosis are as follows:(2)


Epilepsy is a disorder of the brain caused by sudden, large discharges of electrical impulses from brain cells. This disturbance affects the brain’s normal functions and produces changes in a person’s movement, behavior or consciousness.


Fahr Disease

A rare, inherited, progressive brain disorder that is characterized clinically by involuntary movements, prolonged muscle contractions, anddementia. It is characterized by abnormal deposits of calcium in the basal ganglia and cerebral cortex of the brain. There is no cure for Fahr syndrome.Treatment is directed toward relieving symptoms.



As HIV and AIDS progress, many symptoms show up, some of them mental, including mood swings, depression and suicidal ideation.


Brain Tumor/Head Injury

Any condition affecting the central nervous system can affect emotional stability as well.



Many people don’t see a doctor when they’re manic, because it has a tendency to feel good, but they’ll go during a depressed episode. Often, the bipolar disorder is “missed” and they are given medications for depression (usually an SSRI or SNRI) which can cause irritability, anger, and mixed or manic episodes.


Circadian rhythm desynchronization

An interruption in the regular recurrence in cycles of about 24 hours from one point to another, such as certain biological activities that do this regardless of long periods of darkness or other changes in environmental conditions.


Sodium Imbalance

Too much or too little sodium in the system can cause drastic mood swings, confusion and irritability.


Cushing syndrome

This is an imbalance in the pituitary gland, which is part of the brain(6). This causes depression by causing hormonal and metabolism changes, which can cause dramatic mood swings, or just major depression.


Hyper or hypothyroidism

If too much of the hormone is found, it causes nervousness. If too little of it is found, it can cause extreme fatigue.


Multiple Sclerosis

MS damages white matter in the brain, in that the central nervous system controls most of the bodies functioning. It most commonly mimics bipolar disorder.



If syphilis (an STD) reaches the brain, it can cause dementia and other psychiatric disturbances.


Lyme Disease

This is a serious bacterial infection that in late stages, affects the neurology of the brain causing, depression, psychosis and bipolar-like mood swings.



Lupus is an autoimmune (the body attacking itself)| disease which can affect the central nervous system functioning.


Co-morbid Disorders(3)

Most (95%) of the respondents with BPD in the National Comorbidity Survey met criteria for 3 or more lifetime psychiatric disorders(4)



Anxiety is often diagnosed with bipolar disorder and it can have devastating effects on treatment and diagnosis. There can be social impairment and the risk of suicide is much higher.(7)


Substance abuse disorder

Up to 50% of those diagnosed with bipolar disorder have abused substances in their life. They are often self medicating(8) but some of the symptoms of substance use disorder are the same as bipolar disorder, such as poor impulse control and poor judgement.



21.2% of those diagnosed with ADHD also meet the criteria for bipolar disorder.

One study found that the symptoms of elation, grandiosity, flight of ideas/racing thoughts, less need for sleep, and hypersexuality were best for distinguishing between ADHD and bipolar disorder in a sample of prepubertal and adolescent youth. However, this same study found that the symptoms of irritability, hyperactivity, accelerated speech, and distractibility were all common in both bipolar disorder and ADHD, and were therefore not as useful for making good differential diagnoses.”


Cluster B personality disorders

Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions between bipolar disorder and cluster B personality disorders remain a source of unresolved clinical controversy. The extent to which comorbid personality disorders impact course and outcome for bipolar patients also has received little systematic study.”(10)

Borderline personality disorder is often misdiagnosed or comorbid with bipolar disorder.


Cardiovascular disease

There is a link between the heart and mind and bipolar patients are more likely to die of cardiovascular disease than people that are not mentally interesting. It is frequently undiagnosed and treated.(11) Those will bipolar disorder should get regular physicals and have their hearts checked more than those without bipolar disorder. (EKG, echo, stress test, and so on)


Type 2 diabetes mellutis and other endocrin disorders

Because their bodies cannot regulate blood sugar and glucose, so the high’s and low’s in blood sugar can cause irritability, fatigue, and other symptoms associated with depression or bipolar disorder.



47% of people that have migraines are clinically depressed(12). Bipolar disorder and migraines is, in fact, a subtype of bipolar disorder itself.


Eating disorders

Studies show that there is an associated between subthreshold bipolar disorder and eating disorders, particularly in adolescents, and between hypomania and eating disorders, especially in binge eating disorders, which is more likely to be an adult. Clinical studies show that many with bipolar disorder overlap with eating disorders. There are many parallel’s between bipolar disorder and eating disorders, such as: eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity or exercise.(13)

* I personally suffered from an eating disorder for 8 years: ED-NOS and my moods were most turbulent through those times.



11% to 39% of those with bipolar also qualify for the diagnosis of Post Traumatic Stress Disorder.(14)

Many with bipolar disorder have had traumatic experiences in life, for example, taking a serious risk during a manic episode.


Before a diagnosis is made, all other conditions must be ruled out. On average, it takes five years to get a correct bipolar diagnosis.(5)


  1. http://medical-dictionary.thefreedictionary.com/differential+diagnosis

  2. http://emedicine.medscape.com/article/286342-differential

  3. http://www.psychiatrictimes.com/image/image_gallery?img_id=1391585&t=1237832000655

  4. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2516

  5. http://bipolar.about.com/cs/menu_diagnosis/a/diag_physcond.htm

  6. http://health.gather.com/viewArticle.action?articleId=281474978229499

  7. http://www.ncbi.nlm.nih.gov/pubmed/16426110

  8. http://www.medscape.com/viewarticle/515954

  9. http://www.medscape.org/viewarticle/549973

  10. http://www.ncbi.nlm.nih.gov/pubmed/15766300

  11. http://www.ncbi.nlm.nih.gov/pubmed/19794361

  12. http://headaches.about.com/od/comorbidconditions/a/BipolarMx.htm

  13. http://www.ncbi.nlm.nih.gov/pubmed/15935230

  14. http://ptsd.about.com/od/relatedconditions/a/PTSDBipolarDisorder.htm



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