Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the

diagnostic process and patient experiences of being newly diagnosed with bipolar disorder.

Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation.

Methods: Medical records (n ¼ 100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar

disorder underwent an in-depth interview.

Findings: Four diagnostic processes were identified during the retrospective record review. Two

patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods

and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a

new diagnosis of bipolar disorder, demonstrated participants’ ways of understanding the diagnosis

and reconciling the diagnosis. Patterns in the interviews corroborated data from the

record review.

Conclusions: The rendering of an appropriate diagnosis is key. Many participants’ lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about

the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a

screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate

meaningful life change in the patient.