Key Takeaways
- Bipolar disorder is diagnosed from history and observation, not a test, so it can be missed for years or applied when something else explains the symptoms better.
- A meta-analysis put the average gap between the first symptoms and treatment at 5.8 years. Depression is the most common diagnosis people receive first.
- The opposite also happens: borderline personality disorder, ADHD and trauma-related symptoms can look like bipolar disorder, and they can also occur alongside it.
- The most useful records show what happened over time: past episodes, every medication and how you responded, and observations from people close to you.
- Keep taking your medication as prescribed while you seek a second opinion.
A second opinion on bipolar disorder is worth considering if your diagnosis never felt right, in either direction. Some people are treated for depression for years before anyone asks about the highs. Others are told they have bipolar disorder when their mood shifts are better explained by borderline personality disorder, ADHD or trauma. Because there is no blood test or scan for bipolar disorder, the answer depends on a careful history, ideally with records and someone who knows you. This page explains both directions, what to bring, and what a second evaluation looks like.
Why bipolar diagnoses get revisited
NIMH states plainly that no blood test or brain scan can diagnose bipolar disorder. A diagnosis comes from the pattern of episodes over time: how long elevated periods lasted, whether they came with less need for sleep and more energy, how much they changed your functioning, and what happened between them. That pattern is easy to miss in one visit, especially if you come in during a low point.
The numbers reflect it. A meta-analysis of 27 studies with 9,415 patients found a pooled interval of 5.8 years from the onset of bipolar disorder to its management. The VA/DoD guideline cites delays of up to 14.5 years from first presentation to diagnosis. In one survey of 600 members of a patient support organization, 69% said they had been misdiagnosed at first, most often with depression; that sample was self-selected, so treat the figure as a signal rather than a rate.
The general page on getting a second opinion on a psychiatric diagnosis covers your right to your records, how to raise it with your current clinician, and how a second opinion differs from a medication review. This page focuses on what is particular to bipolar disorder.
Direction one: bipolar disorder that was missed
The most common miss is bipolar disorder diagnosed as depression. NIMH notes that people with bipolar II may seek help only for depression, so hypomania goes unnoticed; a few days of high energy can feel like a good week rather than a symptom. The VA/DoD guideline adds that a depressive episode in bipolar disorder is not reliably different from one in major depression, so bipolar disorder cannot be diagnosed from the depression alone. The full comparison is on depression or bipolar disorder.
Signs that a depression diagnosis may deserve a second look:
- past stretches of days when you needed much less sleep without feeling tired, talked faster, spent more or took risks unlike you;
- an antidepressant that left you wired, agitated or sleepless, or seemed to make mood swings faster (NIMH notes an antidepressant alone can trigger mania or rapid cycling in bipolar disorder);
- depression that keeps coming back in distinct episodes;
- a parent, sibling or child with bipolar disorder;
- people close to you describing periods when you were "a different person", even if you remember them as good times.
A second, less common miss: NIMH notes that bipolar disorder with psychotic symptoms can be misdiagnosed as schizophrenia, and psychotic symptoms tend to match the extreme mood.
Direction two: a bipolar label when something else fits better
Over-diagnosis is a real concern too, and a second opinion can confirm that you do not have bipolar disorder. NICE CG185 lists the conditions clinicians should consider before diagnosing it, including personality disorders, ADHD, drug or alcohol misuse, schizophrenia-spectrum disorders and thyroid problems. Three come up most often:
Borderline personality disorder
Mood shifts in borderline personality disorder (BPD) tend to be rapid, often within hours, and closely tied to relationships and fear of rejection. Bipolar episodes typically last days to weeks and can arrive without an obvious trigger. A 2019 review found the most useful differences were family history, developmental history, the course of the illness, how the mood states look, personality style and relationship patterns; impulsivity and treatment response told them apart less well. The two also overlap: a meta-analysis found BPD in 21.6% of people with bipolar disorder. See bipolar disorder vs BPD.
ADHD
ADHD restlessness, distractibility and fast speech are usually lifelong and steady, while bipolar symptoms come in episodes that are a change from the person's usual self. About 1 in 6 adults with bipolar disorder also has ADHD (17.1% in a 2021 meta-analysis), so one does not rule out the other. See bipolar disorder vs ADHD.
Trauma, substances and medical causes
Trauma-related symptoms such as irritability, poor sleep and emotional swings can be mistaken for a mood disorder, and PTSD also co-occurs with bipolar disorder in a meaningful minority of people. Stimulants, steroids, some other prescribed drugs and thyroid disease can mimic or worsen mood symptoms, which is why NIMH and NICE both point to ruling them out.
What a second evaluation weighs
| Question | Why it matters |
|---|---|
| Were there distinct episodes, or is the mood instability constant? | Bipolar disorder is episodic; BPD and ADHD patterns tend to be persistent. |
| How long did elevated periods last, and did sleep need drop? | Hypomania lasts at least four days in a row and mania at least a week (or any length if hospital care was needed), with more energy, not just more emotion. |
| What happened on antidepressants? | A switch into agitation or high energy is an important clue. |
| What do people who know you describe? | Others often notice hypomania that the person experienced as simply feeling well. |
| Could a medical condition, medication or substance explain it? | These are standard rule-outs before a bipolar diagnosis. |
| Could more than one thing be true? | Co-occurring BPD, ADHD, anxiety or substance use is common and changes the plan. |
Our page on how bipolar disorder is diagnosed explains the criteria and the screening questionnaires; screeners such as the bipolar self-check can prompt a conversation but never make the diagnosis.
Records and information to bring
A bipolar second opinion depends on the timeline more than on any single note. Gather what you can:
- every diagnosis you have been given, roughly when, and by whom;
- a medication history: each mood stabilizer, antipsychotic, antidepressant and sleep medicine, about how long you took it, what changed, and why it stopped;
- any episode where an antidepressant seemed to cause agitation, sleeplessness or a high;
- emergency room or hospital discharge summaries, including any from a manic or psychotic episode;
- recent lab results, particularly thyroid tests and any lithium levels;
- mood charts, journals or sleep-tracker data, even if incomplete;
- past questionnaires or testing reports, labeled as screeners where that is what they were;
- a short family history: relatives with bipolar disorder, depression, suicide or substance problems;
- a list of alcohol, cannabis and other substance use, honestly stated;
- a few written lines from a partner, parent or friend describing what they noticed during the highs and lows.
You do not need everything. Even a rough timeline you write yourself is a strong starting point.
While you wait: keep your treatment steady
Call your prescriber or get help now if…
Do not stop or reduce a mood stabilizer because you suspect the diagnosis is wrong. Stopping suddenly raises the risk of relapse, and that risk applies whether or not the second opinion agrees. Any change should be planned with whoever prescribes for you, step by step.
At Willow & Stone
A bipolar second opinion at Willow & Stone is a full 90-minute integrative psychiatric evaluation with Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, in person in Arlington or by telehealth in Texas, New Mexico, Florida, Alaska, Arizona, Colorado and Washington, for people aged 10 and up. Sometimes the honest answer is that more information is needed, such as a period of mood charting or input from family, before the question is settled. You can share the findings with your current clinician. Willow & Stone provides scheduled outpatient care and is not an emergency service. Read more about bipolar disorder treatment at Willow & Stone, see our full guide to bipolar disorder, or book a consultation.
Common Questions
Can bipolar disorder be misdiagnosed?
Yes, in both directions. It is often first diagnosed as depression, because people seek help when they are low and hypomania can feel like ordinary good mood. It can also be diagnosed when borderline personality disorder, ADHD, trauma, substances or a medical condition explain the symptoms better.
How long does it take to diagnose bipolar disorder?
Studies show long delays: a meta-analysis found an average of 5.8 years between onset and treatment. A careful evaluation can often reach a working diagnosis at the first visit, but sometimes the clearest answer comes from mood tracking over weeks or months.
Can you have bipolar disorder and BPD at the same time?
Yes. A meta-analysis found borderline personality disorder in about 21.6% of people with bipolar disorder, and bipolar disorder in about 18.5% of people with BPD. When both are present, treatment usually addresses each one.
Can ADHD be mistaken for bipolar disorder?
It can. Both can involve restlessness, fast speech and impulsivity. ADHD symptoms are usually lifelong and steady, while bipolar symptoms come in distinct episodes. They also co-occur: about 1 in 6 adults with bipolar disorder has ADHD.
Should I stop my bipolar medication if I think I was misdiagnosed?
No. Keep taking it as prescribed and raise your concerns with your prescriber or the clinician giving the second opinion. Stopping a mood stabilizer suddenly can trigger relapse. If a change is right, it should be planned gradually.
Is there a test that proves whether I have bipolar disorder?
No. NIMH states that no blood test or brain scan can diagnose bipolar disorder. Questionnaires are screeners only. Tests may be used to rule out other causes, such as thyroid disease.
Part of our bipolar disorder guide
Sources & Further Reading
- NIMH: Bipolar Disorder (NIH Pub. No. 25-MH-8088, revised 2025)
- VA/DoD Clinical Practice Guideline: Management of Bipolar Disorder (Version 2.0, 2023)
- NICE CG185: Bipolar disorder: assessment and management (last updated 2 September 2025)
- Dagani et al. Meta-analysis of the interval between the onset and management of bipolar disorder. Can J Psychiatry 2017
- Hirschfeld et al. Perceptions and impact of bipolar disorder (NDMDA survey). J Clin Psychiatry 2003
- Fornaro et al. The prevalence and predictors of bipolar and borderline personality disorders comorbidity. J Affect Disord 2016
- Bayes, Parker & Paris. Differential diagnosis of bipolar II disorder and borderline personality disorder. Curr Psychiatry Rep 2019
- Schiweck et al. Comorbidity of ADHD and adult bipolar disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev 2021
This article is general education, not a diagnosis or advice for your situation. Do not start, stop, or change a medication without talking to the clinician who prescribes it; stopping a mood stabilizer suddenly can trigger relapse.
If you need help right now
Willow & Stone is an outpatient practice and is not an emergency service. If you or someone you care about is in immediate danger, call 911.
For urgent mental health support at any hour, call or text 988 to reach the Suicide & Crisis Lifeline, or text HOME to 741741 for the Crisis Text Line. Both are free, confidential, and available 24/7 nationwide.
Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Board-certified Psychiatric-Mental Health Nurse Practitioner and founder of Willow & Stone Integrative Mental Health. Nearly two decades of clinical experience; integrative, root-cause psychiatry in person in Arlington and by telehealth. Licensed in Texas, New Mexico, Florida, Alaska, Arizona, Colorado & Washington.
About Dr. Forbes →