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The Challenges of Bipolar Disorder Diagnosis

Sarah Tabi's picture

Bipolar disorder is a severe mental illness that can negatively affect a person’s relationships and his performance in job or school if left untreated because of its difficult symptoms.  Yet, the complexity with this disorder is that it has such a wide range of symptoms to the extent that they overlap with symptoms of other mental illnesses.  Therefore, it is a challenge to correctly diagnose that a person even has it; so many people deal with the disorder for years before it’s even treated (6).  Sometimes it can also be difficult to diagnose a person because the symptoms may be considered individually instead of as collectively rooted from a larger problem.  Would it make a difference if possible approaches to treatment for bipolar disorder consider the role of the I-function?

Bipolar disorder is considered to be a manic depressive illness characterized by unstable mood changes.  People that have it display an alternating range of emotions from “highs” (manic) to “lows” (depressive).  These two phases are associated with different types of symptoms.  When a person is undergoing the manic phase, they may exhibit rapid speech, extreme optimism, impaired judgment, etc. (2)  People in the manic state also sleep less without experiencing fatigue, along with having increased impulsive activity such as substance abuse or spending sprees (3).  In the depressive phase, people tend to possess feelings of fatigue, guilt, anxiety, self-loathing, loneliness, etc.  They may entertain thoughts of death and suicide; and have a chronic pain without knowledge of the source.

If left untreated, the condition of a person suffering with bipolar disorder can worsen; the suicide rate is high for people dealing with this illness.  Other serious consequences include drug and alcohol abuse, isolation from other people, financial problems, and even psychosis in which the person experiences hallucinations (2).  Also, bipolar disorder can co-occur with Attention Deficit Hyperactivity Disorder and anxiety disorders like social phobia or Post Traumatic Stress Disorder (6).  As you can see, it is imperative for people with bipolar disorder to be treated before their social, mental, and physical health declines and possibly lead to other illnesses or suicide.

But the complexity with treatment for bipolar disorder partially lies in the fact that some of the previously mentioned symptoms are found in other disorders.  Psychosis, for example, which results from severe manic or depressive episodes, is characterized by symptoms such as hallucinations, detachment from reality, delusions, etc. (1) The same symptoms are found in people with schizophrenia, which also includes delusions and hallucinations.  Bipolar disorder characteristics are also similar to those of borderline personality disorder because the shared symptoms are impulsive behavior, suicidal thoughts and actions, and difficulty controlling emotions (2).  Differentiating between these symptoms amongst these various disorders is part of the reason why it is so difficult to diagnose bipolar disorder.  It is especially complicated since not every person with bipolar disorder exhibits the same symptoms (1).

Maybe it would be beneficial to consider the role of the I-function when tackling the treatment of bipolar disorder.  It seems that the input boxes in the nervous system of people with bipolar disorder contain internal stimuli because there may be no concrete reason why they may have feelings of self-loathing or guilt; and researchers feel that people with bipolar disorder have chemical imbalances in the brain.  Therefore, the input must be coming from within the person’s nervous system.  Their I-function probably has no awareness of why they’re feeling the way they do, but their I-function is conscious of their behavior and chooses to act.  Their I-function chooses to not sleep because the input tells them that they are not tired.  In another case, their I-function may decide to impulsively go on a shopping spree because their input is making them feel restless.  

If it is the case that people with bipolar disorder have little control over their actions, then maybe their I-function has control over less output boxes in their nervous system than someone who doesn’t have this disorder.  Perhaps if there’s a way for a person with bipolar disorder to command more boxes in their nervous system with their I-function, they would have more control over their behavior.  On the other hand, if people with bipolar disorder have complete control over their actions, then maybe their behavior is logical to their I-function.  In that case, their mental construct and thought processes would need to be rearranged in order for it to be consistent with the societal construct in order for them to “fit in”.

Approaching treatment through the I-function perspective may also be advantageous because it may help to distinguish between the different overlapping disorders.  Possibly the question can come down to the type of role the I-function plays in the nervous system of each respective disorder, especially since not every person with bipolar disorder exhibits the same symptoms.  For instance, the I-function of schizophrenics appears to be conscious of more internal stimuli than people with bipolar disorder.  Their distortions of their perception affect all their senses: sight, touch, hearing, taste, smell, etc. and they even have disorganized thinking to the extent that their speech is incoherent (4).  Whereas, people with bipolar disorder generally interact more with their environment, and would only experience hallucinations in very severe cases.  In another example, for people with borderline personality disorder, the I-function itself is called into question because they have “identity disturbance” in which their sense of self is considered to be unstable (5).  Evidently, the distinction is much clearer amongst the different disorders when the I-function is brought into consideration, so maybe this approach to treatment can help after all.

In summary, diagnosis of bipolar disorder is extremely difficult because of the added challenge of deciphering whether the symptoms are individual issues or are they characteristic of another disorder.  It is a huge problem that many people live for years with bipolar disorder without being treated because of misdiagnosis, since the condition worsens with time and the symptoms can become more severe.  But maybe if researchers consider the significance of the I-function when treating people, it may aid in diagnosis and treatment of bipolar disorder.


1.       Bipolar disorder. Retrieved May 8, 2009, from Wikipedia Web site: 

2.       Bipolar disorder. Retrieved May 8, 2009, from Mayoclinic Web site:  

3.       Bipolar Disorder. Retrieved May 8, 2009, from NAMI Web site:

 4.       Schizophrenia. Retrieved May 8, 2009, from Wikipedia Web site: 

5.       Borderline personality disorder. Retrieved May 8, 2009, from Wikipedia Web site:

6.      Bipolar Disorder. Retrieved May 8, 2009, from NIMH Web site: 


ET's picture

Very interesting perspective

Very interesting perspective that may be expanded by considering the I-Thou relationship (Martin Buber). Impressive literature.

Paul Grobstein's picture

Mental health and the I-function/story teller

"Would it make a difference if possible approaches to treatment for bipolar disorder consider the role of the I-function?"

Very interesting exploration of this question, both with regard to classification and, perhaps, with regard to therapeutics.  Worth thinking more about.