What Is the Bipolar Spectrum Diagnostic Scale?

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Researchers have begun to view bipolar disorder as a spectrum, with varying intensity in moods and symptoms. Ronald Pies, MD, professor of psychiatry and SUNY Upstate Medical University and Tufts University, developed the Bipolar Spectrum Diagnostic Scale. It’s used as a means to assess severe cases of bipolar disorder, and to recognize those who have milder cases.

Bipolar disorder is a mental health condition that can manifest differently from individual to individual. It is classified into the following:

The DSM-5-TR also recognizes three other types of bipolar disorder: cyclothymic disorder, other specified bipolar and related disorder, and unspecified bipolar and related disorder.

Bipolar disorder affects about 1% of the worldwide population, irrespective of socioeconomic status, nationality, or ethnicity, and remains a significant cause of disability among the younger population. Scientific data has found the condition to be highly heritable.

Before diving into the scale and its applications, it’s important to understand the two major features of bipolar disorder– manic and depressive episodes.

Manic and Bipolar Episodes

Manic episodes last for at least one week. During this time, individuals will exhibit three or more of the following, according to the DSM-5-TR:

  • Racing thoughts or flight of ideas
  • Reduced need for sleep
  • Feelings of grandiosity, or elevated self-esteem
  • Heightened distractability
  • Risky behavior, including impulsive shopping, unsafe sexual behavior, or physically harmful actions
  • Increased goal-oriented activity or agitated movement

A major depressive episode entails five (or more) of the following symptoms, lasting two weeks or longer, according to the DSM-5-TR:

  • Lowered or absent interest in activities
  • Difficulty sleeping or increased time spent sleeping
  • Restlessness
  • Decreased appetite or weight loss
  • Depressed mood lasting most of the day
  • Feelings of guilt or worthlessness
  • Difficulty concentrating
  • Suicidal ideation or thoughts of death 

Using The Bipolar Spectrum Diagnostic Scale

Given these symptoms, bipolar disorder can have a marked impact on all aspects of a person’s life, including their professional life, academics, relationships, and general health.

The Bipolar Spectrum Diagnostic Scale aims to capture the nuances that are often missed in diagnosing bipolar disorder.

It is written as a series of statements, such as “Some individuals notice that their mood and/or energy levels shift drastically from time to time. These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high.”  

Participants are then asked to indicate one of the following:

  • This story fits me very well.
  • This story fits me fairly well.
  • This story fits me to some degree but not in most respects.
  • This story does not really describe me at all.

After this, participants are to place a check next to each item in the first series of statements that describes them.

Finally, individuals will tally up 1 point for every checked statement. For “fits me very well,” participants receive 6 points, for “fits me fairly well,” they receive 4, and for “fits me to some degree,” they receive 2.

The scores range from 0-25 points. At 0-6 points, a bipolar disorder is highly unlikely; at 7-12 points, there is a low probability of bipolar disorder; scoring between 13-19 indicates likely probability; and 20-25 points indicates a high probability.

Scale items used with permission of Dr. Nassir Ghaemi 

It’s important to note that, though the scale can help individuals determine where they fall on the spectrum, it can’t confirm a bipolar disorder diagnosis. Only a mental health professional can diagnose bipolar disorder.


Bipolar disorder remains an under-recognized mental health condition. Individuals often have to wait 5-10 years prior to receiving a diagnosis, and one study found that over 76% of participants with bipolar disorder were misdiagnosed.

According to Dr. Keming Gao of the Case Western University School of Medicine, The Bipolar Spectrum Diagnostic Scale can mitigate this problem by “providing a bridge between bipolar disorder and major depressive disorder.” Patients can then receive the proper treatment they need for an optimal quality of life, such as therapy and medication.

Cross-cultural studies have also looked into the Bipolar Spectrum Diagnostic Scale’s reliability and validity. One study with Persian participants found it to be a valid and reliable measure of assessing bipolar spectrum disorders in a hospital setting. 


Dr. Howard Pratt at Community Health of South Florida, Inc. sheds light on potential drawbacks of the Bipolar Spectrum Diagnostic Scale. “People don’t have the ability to accurately diagnose themselves because of inherent biases.”

He states, “As a professional trained to understand what many of the scale’s questions are probing for, there remain too many grey areas in those questions and the possible answers to make me fully comfortable with its use. It is in fact, better for diagnosing bipolar one disorder than bipolar two." 

While people looking for answers and reassurance by using the scale may come to feel better about their situation because they feel they can now put a name to what has been troubling them, that won’t necessarily help them if the diagnosis turns out to be flawed. In fact, it can hurt.


A Word From Verywell

Bipolar disorder can be a difficult condition to diagnose, and an even more challenging condition to live with. However, diagnostic tools like the Bipolar Spectrum Diagnostic Scale are making it easier for mental health professionals to assess, and for individuals to receive proper treatment.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018 Apr 26;8(9):251-269. doi: 10.1177/2045125318769235.

  3. Harrison PJ, Geddes JR, Tunbridge EM. The Emerging Neurobiology of Bipolar Disorder. Trends Neurosci. 2018 Jan;41(1):18-30. doi: 10.1016/j.tins.2017.10.006.

  4. Shen H, Zhang L, Xu C, Zhu J, Chen M, Fang Y. Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting. Shanghai Arch Psychiatry. 2018 Apr 25;30(2):93-101. doi: 10.11919/j.issn.1002-0829.217080

  5. Shabani A, Mirzaei Khoshalani M, Mahdavi S, Ahmadzad-Asl M. Screening bipolar disorders in a general hospital: Psychometric findings for the Persian version of mood disorder questionnaire and bipolar spectrum diagnostic scale. Med J Islam Repub Iran. 2019 May 28;33:48. doi: 10.34171/mjiri.33.48.

By Brina Patel
Brina Patel is a freelance writer from Sacramento, California. Prior to writing full-time, she worked as an applied behavior analysis therapist for children on the autism spectrum. She leverages her own experiences researching emotions, as well as her personal challenges with chronic illness and anxiety, in her storytelling, with the hope of inspiring others to take better charge of their overall wellness and understand themselves on a deeper level.