Some comments by Carolina Estevez, Psy.D.
A diagnostic evaluation is a very different process from a screening test that you take online. Screening tests are excellent tools and oftentimes are what alert people to understanding that they might have Bipolar Disorder and should seek an evaluation with a professional.
A psychiatrist can conduct a diagnostic evaluation; however, psychologists, who hold a doctorate degree (i.e., a Ph.D. or Psy.D.) or mental health counselors or social workers, which are Master’s level mental health professionals, can also conduct a diagnostic evaluation. Psychiatrists usually do not conduct psychotherapy, so they will typically diagnose you and if you are diagnosed with Bipolar Disorder, the psychiatrist will recommend a medication plan and likely refer you to therapy. If you undergo a diagnostic evaluation with a psychologist, counselor, or social worker, these professionals can provide therapy and will also refer you to a psychiatrist so that you can receive a medication evaluation. Not all people take medication for Bipolar Disorder, but many people do since symptoms can be very severe, debilitating, and endanger your safety and wellbeing.
During a diagnostic evaluation, the clinician sits with you for a session (typically lasting about one hour, or more in some cases) and asks you questions about your current symptoms, history of symptoms, and numerous background history questions. These background questions include your medical history, any current medical problems, or any medications you are currently prescribed; employment history and highest level of education achieved; marital status, whether you have children, and your current living situation; any current stressors or significant life changes (e.g., death of a loved one, recently moved or changed jobs); your activities of daily living (e.g., what you do during an average day, your hobbies); any family history of mental health problems; and even some brief history about any significant childhood experiences and your academic history.
The diagnostic evaluation also includes a Mental Status Examination, which assesses several aspects of your current emotional, cognitive, behavioral, and social functioning, as well as behavioral observations, which are observations the clinician makes of your ability to communicate, your interactions during the session, and your behaviors during the evaluation. In addition to this process, sometimes the clinician will provide you with a paper-and-pencil (or computerized) assessment similar to Bipolar screening tests you can take online. This helps to support information gathered during the diagnostic evaluation and also helps to confirm the accuracy or consistency of your responses during the face-to-face evaluation with the clinician. For example, if you tell the clinician in your face-to-face interview that you have never had suicidal thoughts, but then you endorse that you have had these thoughts on a screening test, the clinician will ask you about your response and investigate this information further.
Hence, an online screening test provides questions that require a ‘yes or no’ answer is a good indication of the presence of symptoms. A diagnostic evaluation with a mental health professional is the next step where the clinician evaluates you by combining not just your ‘yes or no’ responses to symptom-related questions, but also an assessment of you as a whole person: Your emotions, actions, reactions, thought process, insight, judgment, reasoning, verbal abilities, and attention along with details about your life history and current functioning. It is the combination of all of these factors that an accurate and definitive diagnosis can be made.