I think it also very much depends on the person's age and what is going on in their life. Younger people are often misdiagnosed with other things and the bipolar is often missed. When some is living a very chaotic lifestyle with drugs/alcohol or in abusive relationships etc I think it gets more complicated.

If I walked in to just about any pdoc, 46 years old, happily married with a very stable life, and describe my cycles of alternating energy where I re-paint entire houses or reorganize all furniture, or take on huge projects and do lots of art, then describe the crippling depressions where I completely withdraw from my friends and hide in my house till it passes weeks later, it seems pretty obvious.

When I was younger, in terrible relationships and doing drugs etc, they missed it entirely. My GP always thought it was my situation. She didn't even diagnose me with depression until I was in a stable relationship and should have been happy.

It wasn't till much later that I mentioned how great I felt and was telling her about re-painting or re-organizing my entire house that she clued in to that. She diagnosed me with BP then but there was no way to get a referral to a pdoc for anyone who wasn't psychotic in that town and she treated me for years.

Much later I went to a pdoc who diagnosed me with BP 2 depressive type, the next two in a row agreed, and one of them added on GAD. My current doc I've seen for a year, I just asked him if he still agrees with those diagnoses and he didn't hesitate. It was an emphatic yes.

It's a lot simpler for these last docs that I've seen since being in my 30's and 40's than the ones who saw me in my teens and 20's.