Is it all bipolar? Differential diagnosis of mood swings in young adulthood

M. Nieberler; M. Appel; C. Klüpfel; W. Warrings; S. Kittel-Schneider

doi:10.1007/s00115-026-01970-7

Is it all bipolar? Differential diagnosis of mood swings in young adulthood

Translated title of the contribution: Alles bipolar oder was? Differenzialdiagnostische Einordnung von Stimmungsschwankungen im jungen Erwachsenenalter

M. Nieberler
, M. Appel
, C. Klüpfel
, W. Warrings
, S. Kittel-Schneider

Research output: Contribution to journal › Article › peer-review

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.

Translated title of the contribution	Alles bipolar oder was? Differenzialdiagnostische Einordnung von Stimmungsschwankungen im jungen Erwachsenenalter
Original language	German
Pages (from-to)	1-6
Number of pages	6
Journal	Nervenarzt
DOIs	https://doi.org/10.1007/s00115-026-01970-7
Publication status	Published - 15 Apr 2026

Keywords

ADHD
Adolescence
Bipolar disorder
Depression
Emotionally unstable personality disorder
[Medicine]
Adult
Adulthood
Attention deficit hyperactivity disorder
Borderline state
Circadian rhythm
Clinical assessment
Comorbidity
Controlled study
Diagnosis
Diagnostic error
Differential diagnosis
Drug therapy
Human
ICD-11
Longitudinal study
Major clinical study
Major depression
Mental disease
Mood
Review
[APCMicrobiome]

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10.1007/s00115-026-01970-7Licence: CC BY

s00115-026-01970-7Final published version, 508 KBLicence: CC BY

https://www.scopus.com/pages/publications/105035908662?origin=resultslist

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title = "Is it all bipolar? Differential diagnosis of mood swings in young adulthood",

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. ",

keywords = "ADHD, Adolescence, Bipolar disorder, Depression, Emotionally unstable personality disorder, [Medicine], Adult, Adulthood, Attention deficit hyperactivity disorder, Borderline state, Circadian rhythm, Clinical assessment, Comorbidity, Controlled study, Diagnosis, Diagnostic error, Differential diagnosis, Drug therapy, Human, ICD-11, Longitudinal study, Major clinical study, Major depression, Mental disease, Mood, Review, [APCMicrobiome]",

author = "M. Nieberler and M. Appel and C. Kl{\"u}pfel and W. Warrings and S. Kittel-Schneider",

note = "{\textcopyright} 2026, the Author(s). Open Access. This article is made available under the CC BY license.",

year = "2026",

month = apr,

day = "15",

doi = "10.1007/s00115-026-01970-7",

language = "German",

pages = "1--6",

journal = "Nervenarzt",

issn = "0028-2804",

publisher = "Springer Medizin",

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T1 - Is it all bipolar? Differential diagnosis of mood swings in young adulthood

AU - Nieberler, M.

AU - Appel, M.

AU - Klüpfel, C.

AU - Warrings, W.

AU - Kittel-Schneider, S.

PY - 2026/4/15

Y1 - 2026/4/15

N2 - 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.

AB - 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.

KW - ADHD

KW - Adolescence

KW - Bipolar disorder

KW - Depression

KW - Emotionally unstable personality disorder

KW - [Medicine]

KW - Adult

KW - Adulthood

KW - Attention deficit hyperactivity disorder

KW - Borderline state

KW - Circadian rhythm

KW - Clinical assessment

KW - Comorbidity

KW - Controlled study

KW - Diagnosis

KW - Diagnostic error

KW - Differential diagnosis

KW - Drug therapy

KW - Human

KW - ICD-11

KW - Longitudinal study

KW - Major clinical study

KW - Major depression

KW - Mental disease

KW - Mood

KW - Review

KW - [APCMicrobiome]

U2 - 10.1007/s00115-026-01970-7

DO - 10.1007/s00115-026-01970-7

M3 - Article

SN - 0028-2804

SP - 1

EP - 6

JO - Nervenarzt

JF - Nervenarzt

ER -

Is it all bipolar? Differential diagnosis of mood swings in young adulthood

Abstract

Keywords

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