Not to come off as dismissive of your concerns but it’s basically a rite of passage for a late-diagnosed ADHDer or autistic person to collect at least one mood disorder before arriving at the correct diagnosis. If you’re AFAB or PoC then you can pretty much expect to run a gauntlet of mood disorders before you reach the finish line.

Try not to invest too much in the label - it’s just a descriptive term but the condition that you have, whatever it happens to be, and the symptoms you experience are the same today as they were yesterday. You could call yourself haunted, you could call yourself bipolar, you could call yourself mad; that doesn’t have a determining effect on what you’re dealing with.

Obviously I’m not saying that you should go collecting diagnoses or that there isn’t a degree of impact that a prior diagnosis may have on the type of treatment you receive but try not to get too caught up in the whole thing.

As a personal example, my psychiatrist has broached the idea of a diagnosis of chronic fatigue with me on multiple occasions. Each time it has been mentioned I have expressed my reticence towards it - I am not in the business of collecting diagnoses, a chronic fatigue diagnosis doesn’t open up opportunities for better management or treatment of what I’m dealing with than what I already have, and I don’t really need clinical validation where it’s basically saying that I’m tired all the time, except it’s Medically-Approved™. For me it seems as though getting diagnosed with chronic fatigue would serve no purpose and so I see no use in it. Whatever it happens to be you can name it, you can choose not to name it, but ultimately if naming it doesn’t create opportunities for you - whether that’s a better way of understanding and managing the condition, more avenues for treatment, access to supports and accommodations, or that sort of thing - then a label is not a useful thing and in that situation I’d seriously consider whether I need to carry it with me at all.

They’re both stigmatized but borderline is more for sure

Get a second opinion. They shouldn’t be giving you a Bipolar I diagnosis without evidence of at least one full-bore manic episode. Bipolar II is harder to diagnose and certainly shouldn’t be diagnosed casually.

For me, hypomania has the following symptoms

• i have too much energy. I need to be in motion, walking around, pacing, playing with things. This goes beyond adhd distraction or stimming. There’s a strong nervous energy and a compulsion to stay on the move.

• pressured speech. I want to talk, constantly, about whatever is on my mind. It’s more than just interest in a topic or excitement. I feel a strong pressure to just keep talking and talking and get agitated if i try to hold it back. Holding back speech requires conscious effort. My excitement and constant flow of speech is usually noticeable to friends and family.

• hypersexuality - i’m thinking about sex constantly in a way that isn’t normal. I have to consciously remind myself not to txt all my friends and invite them in to bed. I think i’m the sexiest person alive. I’m aware that this is abnormal and it requires continual awareness and effort to keep under control. When i’m experiencing hypersexuality i’ll go to bed with almost anyone who asks nicely.

• related to that, but not directly connected, i’ll flirt with everyone. I really enjoy wordplay and clever innuendo and the increased confidence and perceived competence, combined with the broad increased interest in sex and need to speak, brings this out strongly. I use a lot of overwrought speach in general during hypomanic periods.

• lack of perceived need for sleep. I sleep less and perceive myself to be more awake and alert than I am. This often gives way to anxiety as the effects of sleep deprivation catch up. I’m often up all night and well in to the morning

• i feel like the coolest, smartest person in the room. It’s never gone as far as grandiosity or delusion, but i feel very cool, smart, handsome, and capable in a way that is not normal confidence in my abilities or appearance.

• lack of patience and low frustration tolerance. I have adhd so this is a thing normally. Hypomania takes it up several notches. People speak too slowly, loading screens in games are too slow, people move too slowly on the sidewalks. Anything that’s not moving at my too-fast pace feels frustrating.

• impulsive spending. I buy stuff i don’t need, often just things I think are cool or that strike my interest in passing. I buy restaurant food more often. I buy large amounts of groceries thinking i’ll make new dishes, or because I misjudged how much I needed or was appropriate.

• emotional volatility - i’m prone to getting very upset and either crying or writing angry diatribes. I do not become violent, to myself or others, i just feel negative emotions very strongly. It can go the other way, too. Movies and books become totally overwhelming because any emotional response i feel to them is so strong. I write sappy love poetry to my partners.

• an awareness that this is all wrong. It took years to figure out what was happening, but once I understood what a hypomanic episode was I was able to identify episodes that I’d had going back to childhood, and to identify them when they happened. I can tell when my mood is elevated, when the world has too many colors and i’m talking too fast, and i can mostly tell when that trips over to proper hypomania.

My friends can also tell, and will let me know if they think something is off or my mood is too elevated.

Bipolar is different for everyone, and Bipolar I is very different from Bipolar II. But there are a lot of common and typical symptoms most people share.

aripiprazole can be diagnosed to help with bipolar I depression, but the first-line treatment remains lithium. I’m not a medical professional, just a guy with Bipolar II, but immediately giving you abilify without trying you on lithium first does not sound like the usual course of treatment.

Bipolar, adhd, and autism have a huge amount of overlap in the symptoms they present. But a Bipolar I diagnosis, as far as I know, requires at least one confirmed manic episode, while Bipolar II requires pretty solid evidence of hypomania.

A lot of people diagnosed with bipolar struggle with accepting the diagnosis, that’s a real thing. But the diagnosis is weighed heavily on having had identifiable manic or hypomanic episodes. If you can’t define specific episodes of mania or hypomania i’d suggest getting a second opinion. Mania is almost always very obvious, it’s a very extreme state. Hypomania is less drastic, as people usually aren’t delusional or psychotic and have more awareness and control, but it’s still quite different from normal behavior.

Well if people around you haven’t ever noticed any manic or hypomanic episodes in you and you didn’t report having these to the nurse practitioner then I feel like the bipolar diagnosis probably isn’t a good fit.

Atomoxetine

I really shouldn’t gloat by saying that I called it. Suffice it to say that your post set my expectations for this clinic at that level and this tracks.

Sorry you’re having a bad time with it. Go rest up and come back to this post/situation/both of them when you’re feeling up to it - there’s no time pressure.