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Like bluewave, I think bipolar disorder is a very difficult diagnosis to make --as it can mimic so many other disorders and much of history-taking depends on one's own perception of one's moods, and the issue of situational vs episodic I think depends a good deal on the person's ability to recognize when they are reacting to something in the environment or not, and this can be very difficult. I think the depression aspect of it is relatively easier to figure out (except the issue of situational vs not) but it's the hypomania that is super tricky.
I really respect psychiatrists who take some time to make this determination. It can have huge implications, especially when it comes to medications, and also, I believe, on meaning, self-concept, identity. And at the end of the day, if you're mistakenly diagnosed as bipolar, I think there's the danger of seeing all (or most) moods and behavior as falling out of the sky, and this can prevent exploring the reasons behind mood and behavior and making efforts to change them, cope, etc. (not that people with bipolar disorder couldn't benefit a good deal from doing this as well).
Although I already had a diagnosis from my pdoc in another state, when I moved to the city where I live now, my new pdoc wanted to make his own determination, and only diagnosed me after witnessing a manic episode himself. I really do respect my current pdoc for taking the time to get to know me before making the diagnosis.
It took some time for my pdoc in the other city to make the diagnosis as well. My personal opinion is that this cannot reasonably be diagnosed in one visit. But that's me.
I want to take medications that help me, regardless of diagnosis, but I certainly don't want to be on hugely strong meds with their side effects (short and long-term) without very good reason. It's a risks vs benefits issue, in part, and diagnosis has helped -and least me- make those kinds of decisions for myself (in conjunction with my pdoc).
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