They don't know. I have two brothers who were diagnosed as BP. I was in treatment for bulimia and my parents were over it. It was embarrassing and disgusting and I needed to grow up. Yet, every thing my brothers do (fights in public, spending money, getting fired from jobs for temper) is all related to their bipolar. Neither are on meds and the only one who doesn't function is my oldest brother. I truly believe he is BP.
Don't get me started on my ILs...