Diagnosing bipolar disorders requires therapists to carefully consider a client's symptoms, history, and overall clinical presentation. Although specific subtypes like Bipolar I and II have clear criteria, some cases may not fit neatly into these categories.

In these situations, therapists may use the ICD-10 diagnosis F31.9, Bipolar Disorder, Unspecified. This article explains when and how to apply this diagnosis effectively and ethically.

Understanding the indications, limitations, and best practices around F31.9 helps therapists provide accurate diagnoses, guide treatment decisions, and ensure proper care for clients with bipolar spectrum disorders.

Bipolar Disorder Overview: Core Features Across Subtypes

Bipolar spectrum disorders, including Bipolar I, Bipolar II, and Cyclothymia, share several core features. These include mood instability, episodes of elevated or irritable mood, changes in energy, activity, or sleep, and periods of depression.

While each subtype has unique characteristics and diagnostic criteria, they all involve significant shifts in mood and functioning. The diagnosis of Bipolar Disorder, Unspecified  may act as a placeholder or initial diagnosis when the full clinical picture is still emerging or incomplete.

Recognizing the common threads across bipolar disorders enables therapists to better identify when a client's symptoms suggest a bipolar spectrum condition, even if the specific subtype remains unclear.

When to Use F31.9: Indications and Limitations

Bipolar Disorder, Unspecified serves as a suitable diagnosis in various clinical scenarios where a bipolar spectrum disorder is present, but the specific subtype remains uncertain or the symptoms are unusual. Some typical indications for using this diagnosis include:

• Mixed or atypical symptoms: The client shows mood disturbances typical of bipolar disorders but with mixed features, brief episodes, or symptoms that don't fully align with the criteria for a specific subtype.
• Early stage of assessment: When a client is in the beginning phase of evaluation and a complete diagnostic picture is still forming, this diagnosis helps document the presence of a bipolar disorder while additional information is gathered.
• Incomplete documentation: In situations where external records (e.g., previous hospitalization or treatment notes) are delayed or missing, F31.9 acts as a temporary label until a more definitive diagnosis is possible.

When determining if Bipolar Disorder, Unspecified is the appropriate diagnosis for a client, therapists should document their reasoning, noting the particular symptoms and factors that suggest a bipolar spectrum disorder but prevent a more specific diagnosis. It is also beneficial to outline a plan for ongoing assessment and diagnostic clarification to ensure that clients receive suitable care and support tailored to their individual needs.

Differential Diagnosis: Distinguishing Bipolar Disorder from Similar Presentations

Diagnosing bipolar disorder accurately involves distinguishing it from other conditions with similar features. Some similar diagnostic presentations  include:

• Unipolar depression with irritability: Irritability during depressive episodes can resemble the mixed features of bipolar disorder. However, the presence of manic or hypomanic episodes is a key differentiator. Assessing for manic or hypomanic episodes helps differentiate between unipolar and bipolar depression.
• Borderline Personality Disorder (BPD): BPD often involves emotional instability, impulsivity, and relationship difficulties that can look like bipolar mood swings. However, BPD mood shifts are typically shorter, reactive to interpersonal stressors, and come with identity disturbances and fear of abandonment. In contrast, bipolar disorder is characterized by more prolonged mood episodes with periods of stability in between.
• Substance-induced mood disorders: Substance use can trigger symptoms that mimic mania or depression. A thorough history of substance use and the timing of mood episodes in relation to substance use patterns help clarify the diagnosis.
• ADHD or trauma-related dysregulation: Hyperactivity, impulsivity, and emotional reactivity in ADHD or complex trauma can be mistaken for bipolar disorder. Evaluating the pervasiveness and episodic nature of symptoms aids in differentiation.ADHD symptoms are typically chronic and consistent, whereas bipolar disorder involves distinct mood episodes.

Therapists can use several strategies to improve diagnostic accuracy:

1. Mood charting: Having clients track their daily mood symptoms, sleep patterns, and energy levels over time provides valuable data for identifying episodic patterns characteristic of bipolar disorders.
2. Collateral interviews: Gathering information from family members, partners, or close friends about observed mood states and behaviors can offer important insights, especially regarding manic or hypomanic episodes that clients might not fully recall or report.
3. Longitudinal history of episodes: Constructing a timeline of mood episodes, their duration, and severity helps distinguish bipolar disorders from more chronic or situationally-bound mood issues.
4. Structured diagnostic tools: Instruments like the Mood Disorder Questionnaire (MDQ) or the Structured Clinical Interview for DSM-5 (SCID-5) Structured Clinical Interview for DSM-5 (SCID-5)  guide systematic assessment of bipolar disorder criteria and differential diagnosis.

Treatment Considerations and Therapist Role

While therapists cannot prescribe medication for clients with bipolar disorder, they play a vital role in supporting treatment and promoting overall well-being. When working with clients diagnosed with F31.9, Bipolar Disorder, Unspecified, therapists should focus on several key areas:

• Psychoeducation: Help clients understand bipolar disorders, common symptoms, and the importance of consistent treatment. Explain the purpose and limitations of the F31.9 diagnosis, and emphasize the need for ongoing assessment and diagnostic clarity.
• Symptom monitoring: Encourage clients to keep track of their moods, energy levels, sleep patterns, and other relevant symptoms. Regularly assess for signs of manic, hypomanic, or depressive episodes, and assist clients in identifying potential triggers or warning signs.
• Treatment adherence: Therapists play a vital role in supporting clients to maintain consistent engagement with therapy and medication management. Address any barriers to adherence, such as side effects, stigma, or lack of insight.
• Behavioral strategies: Teach clients practical skills for managing symptoms, regulating emotions, and maintaining stable routines. This may include techniques from cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT) , or other evidence-based approaches.
• Collaboration with prescribers: Maintain open communication with clients' psychiatric providers or primary care physicians. Share relevant information about symptom patterns, treatment response, and any concerns that arise in therapy. These therapies have been shown to be effective in managing bipolar disorder. 

Therapists should pay close attention during high-risk periods, such as the onset of manic episodes or periods of rapid cycling. Assess for safety concerns, including suicidal thoughts, self-harm, or risky behaviors. Develop a comprehensive safety plan in collaboration with the client and their support system.

Throughout treatment, address issues related to insight, stigma, and self-esteem. Help clients understand that a bipolar disorder diagnosis does not define them and that effective treatment can lead to an improved quality of life. Provide a non-judgmental, supportive space for clients to process their experiences and work towards recovery.

By providing skilled psychotherapy, monitoring symptoms, and collaborating with prescribers, therapists can greatly improve outcomes for clients with bipolar disorder, even when the specific subtype remains unspecified. Effective therapeutic support helps clients build resilience, maintain stability, and work towards a fulfilling life not limited by their diagnosis. .

Documentation and Ethical Use of F31.9

When documenting, therapists should focus on clarity, accuracy, and ethical principles. The ICD-10 code F31.9 is used when a client's symptoms suggest a bipolar spectrum disorder but do not yet meet the criteria for a more specific subtype. Here are some helpful tips for charting and maintaining ethical standards:

Tips for charting:

• Clearly document presenting symptoms: Provide a detailed description of the client's current mood symptoms, behavioral patterns, and any other relevant clinical observations that support the use of the F31.9 diagnosis.
• Include relevant client history: Briefly summarize the client's mental health history, including previous diagnoses, treatments, and hospitalizations, to provide context for the current diagnosis. For more on best practices, consider documenting intake assessments.
• Explain rationale for F31.9: Clearly articulate the reasons for using F31.9, such as mixed or atypical symptoms, early stage of assessment, or incomplete diagnostic information.
• Note plans for diagnostic clarification: Document when the diagnosis will be reviewed and what steps will be taken to gather additional information or reassess symptoms over time.

Ethical principles:

• Avoid pathologizing non-clinical behavior: Ensure that the use of F31.9 is based on clinically significant symptoms and not merely on individual differences or non-pathological behaviors.
• Refrain from using F31.9 for billing convenience: Diagnose based on clinical judgment and available evidence, not on reimbursement or administrative factors.
• Ensure client understanding: Explain the meaning and implications of F31.9 to the client, emphasizing its provisional nature and the importance of ongoing assessment.
• Maintain privacy and confidentiality: Protect client confidentiality by sharing diagnostic information only with those directly involved in the client's care and with the client's informed consent.

Therapists must also consider how diagnostic labels might affect clients' self-perception and social stigma. Clinicians can frame the diagnosis as a working hypothesis rather than a definitive label as well as emphasize the individual nature of each client's experiences and the unique factors contributing to their symptoms.

Thoughtful documentation of the current diagnostic presentation while using the code F31.9  and adherence to ethical guidelines allows therapists to maintain diagnostic integrity, support client well-being, and prepare for individualized, evidence-based care as the clinical picture becomes clearer.

Working with Clients Diagnosed with Bipolar Disorder, Unspecified

When working with clients with this diagnosis, therapists play a vital role in normalizing the changing nature of the diagnostic process, especially in the early stages of treatment. It's important to emphasize that an unspecified diagnosis is not uncommon and that the clinical picture often becomes clearer over time as more information is gathered and symptoms are closely monitored.

Therapists should focus on helping clients build practical coping strategies and emotional regulation tools to manage their symptoms effectively, as well as strengthening the therapeutic alliance early on in treatment to support ongoing client-therapist collaboration and trust. This may include:

• Psychoeducation: Provide information about bipolar disorders, common symptoms, and the importance of consistent treatment engagement. Mood tracking: Encourage clients to keep a daily record of their moods, sleep patterns, energy levels, and any other relevant symptoms. This can help identify triggers, patterns, and early warning signs of mood episodes.
• Skill-building: Teach clients evidence-based techniques for managing stress, regulating emotions, and maintaining a balanced lifestyle. This may include cognitive-behavioral strategies, mindfulness practices, or interpersonal effectiveness skills.
• Rapport-building: Developing a genuine connection by learning about the client’s values, goals, and what matters most to them in their healing journey.

Developing a strong support network is also important for clients with bipolar disorder. Therapists can provide resources and guidance on connecting with local or online support groups, engaging family and friends in the treatment process, and building a team of healthcare providers who can offer comprehensive care.

It's important to encourage consistent engagement in treatment across all mood states, including during euthymic or stable periods. Clients with bipolar disorder may be tempted to discontinue therapy or medication when they are feeling well, but ongoing care is important for maintaining stability and preventing relapse. Therapists should educate clients about the risks of treatment dropout and work collaboratively to develop a long-term care plan that feels manageable and sustainable.

Key Takeaways

Bipolar Disorder, Unspecified, serves as a valuable diagnostic tool when applied carefully and with a commitment to ongoing clinical assessment. This diagnosis provides a starting point for treatment and support when a client's symptoms suggest a bipolar spectrum disorder but do not yet meet the criteria for a more specific subtype.

Therapists should regard F31.9 as a temporary label, bridging the gap between diagnostic uncertainty and a clearer understanding of the client's specific needs. Key strategies for using this diagnosis effectively include:

• Thorough documentation: Clearly record the presenting symptoms, client history, and clinical reasoning, along with plans for further diagnostic clarification.
• Regular reassessment: Continuously gather information through clinical interviews, collateral reports, and symptom tracking to refine the diagnosis over time.
• Collaboration with clients: Involve clients in the diagnostic process, educating them about bipolar disorders and the importance of ongoing assessment and treatment.
• Evidence-based treatment: Provide targeted interventions and support tailored to the client's current needs, while remaining adaptable as the clinical picture evolves.

Thoughtful use of the Bipolar Disorder, Unspecified diagnosis allows therapists to validate a client's experiences, initiate appropriate care, and maintain diagnostic integrity. It reflects a commitment to understanding each client's unique challenges and working collaboratively towards stability and well-being.

Ultimately clinical diagnoses  are a tool for empowerment and healing when applied with clinical precision, ethical care, and compassion. It opens the door to a therapeutic journey that can lead to greater self-understanding, symptom management, and a fulfilling life for clients living with bipolar spectrum disorders.