Is it all bipolar? Differential diagnosis of mood swings in young adulthood
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Date
2026-04-15
Authors
Nieberler, M.
Appel, M.
Klüpfel, C.
Warrings, W.
Kittel-Schneider, S.
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Medizin
Published Version
Abstract
Background: Mood swings can represent a key symptom of various psychiatric disorders in young adulthood. Due to substantial symptom overlap, clinicians often face diagnostic uncertainty, increasing the risk of misdiagnosis and inappropriate treatment. Objectives: Description of qualitative and quantitative characteristics of mood swings in the most relevant psychiatric disorders. Materials and Methods: Narrative review based on the International Classification of Diseases, 11th Revision (ICD-11) and pertinent literature. Results: Bipolar affective disorders exhibit episodic, mostly non-reactive mood swings in clearly defined temporary episodes. In unipolar depression, affective changes are predominantly downward-directed and may show diurnal variation. Emotionally unstable personality disorder is characterized by high-frequency, reactive, and interpersonally triggered affective states, whereas neurodevelopmental disorders typically present with situationally induced, short-lived emotional dysregulation. Conclusions: Differential diagnostic evaluation requires a comprehensive clinical assessment, possibly supported by life charts, mood diaries, or psychometric instruments. Given the frequent comorbidities and symptom overlap, a longitudinal diagnostic approach is recommended in cases of uncertainty.
Description
Keywords
ADHD , Adolescence , Adult , Adulthood , Attention deficit hyperactivity disorder , Bipolar disorder , Borderline state , Circadian rhythm , Clinical assessment , Comorbidity , Controlled study , Depression , Diagnosis , Diagnostic error , Differential diagnosis , Drug therapy , Emotionally unstable personality disorder , Human , ICD-11 , Longitudinal study , Major clinical study , Major depression , Mental disease , Mood , Review , [APCMicrobiome] , [Medicine]
Citation
Nieberler, M, Appel, M, Klüpfel, C, Warrings, W & Kittel-Schneider, S 2026, 'Is it all bipolar? Differential diagnosis of mood swings in young adulthood', Nervenarzt, pp. 1-6. https://doi.org/10.1007/s00115-026-01970-7