Selena Gomez disclosed a bipolar diagnosis publicly in 2020 and described the information as a relief, saying she wanted to know everything about it and that learning about it took the fear away. [rollingstone-2022-gomez] She has also said she was misdiagnosed before receiving it, which is the ordinary route to this diagnosis rather than an unusual one.
Why it is so often missed first
The delay is structural rather than a matter of clinicians being careless, and it comes down to which half of the illness presents itself.
People seek help when they are depressed. Depression is painful, it impairs everything, and it makes you want assistance. Hypomania rarely does any of that: it frequently feels good, productive, energetic and creative, and almost nobody books an appointment because they have been getting a great deal done on four hours of sleep. So a clinician assessing someone in a depressive episode is looking at a genuinely depressive picture, and the elevated periods are invisible unless specifically asked about and recognised in retrospect.
The result is that a depression diagnosis is often a reasonable reading of the evidence available at the time, and still wrong. That is why so many people describe years of treatment for depression before a fuller picture emerges.
Why the delay carries a specific risk
This is not only an administrative problem, and the reason is worth knowing before an appointment. Antidepressant treatment given without a mood stabiliser, in someone who has bipolar disorder, can precipitate a switch into mania or hypomania. [grande-2016-bipolar]
That is the clinical reason a careful assessment asks about past periods of elevated mood, reduced need for sleep and out-of-character spending or activity, even when the person in front of them has come in describing low mood alone. It is also the strongest argument for volunteering that history yourself rather than waiting to be asked, since the elevated periods are the ones least likely to be reported spontaneously and most likely to change the treatment.
The half that usually goes unreported
Not about how you feel now. About whether you have ever had a distinct period, lasting days, that was clearly out of character.
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Several distinct features here, particularly reduced need for sleep alongside out-of-character activity, are exactly what a bipolar assessment turns on. If you are being treated for depression and have never been asked about these, say so directly.
Some of this is the half of the history clinicians most often do not hear, because people rarely volunteer it. It is worth bringing to an appointment deliberately rather than waiting for the right question.
This pattern of distinct elevated periods does not seem to be part of your picture, which is useful information for an assessment in itself.
A reflection prompt, not a diagnosis. No screener on this site assesses bipolar disorder.
Relief and burden, usually together
Gomez’s public description of the diagnosis as something that took fear away is a common reaction and it is not the only one. People frequently describe relief and dread arriving together: relief because a long-standing pattern that looked like a series of unrelated personal failures turns out to have a name and a treatment, and dread because the name is permanent.
Neither reaction is the correct one and neither predicts how treatment goes. What the diagnosis actually does is practical: it routes you to treatment that fits the condition, and away from treatment that carries the switch risk described above.
What treatment involves
Medication is central, usually a mood stabiliser or an atypical antipsychotic, chosen on presentation and history. Structured psychological therapy is used alongside rather than instead, and approaches focused on recognising early warning signs and holding sleep and daily routine steady have evidence behind them. [geddes-2013-treatment]
The goal is stability and relapse prevention over the long term rather than a course of treatment that finishes. That is a different shape from most therapy, and it is worth knowing at the outset rather than discovering it as a disappointment later.
When to seek help
Speak to a doctor if you have had distinct periods of elevated mood, reduced need for sleep or out-of-character activity, particularly if you are already being treated for depression and have never been asked about them. Bring what other people noticed as well as what you remember, since the elevated periods are the ones hardest to assess from the inside. If you are having thoughts of harming yourself, treat that as urgent and contact your local emergency services or a crisis helpline.
How MyFreud can help
Daily mood tracking is more useful in bipolar disorder than in most conditions, because the question an assessment turns on is whether shifts last hours or weeks, and that is precisely what memory reconstructs badly and a record settles. Our bipolar disorder guide covers the condition in depth, including hypomania, which is the part that most often goes unreported.
Download MyFreud and start today: App Store or Google Play.