Distinguishing Between Bipolar Disorder And Adhd
There may be an overlap between the symptoms of mania or hypomania associated with bipolar disorder and ADHD. Some of these include talkativeness, distractibility, loss of social functioning, difficulty maintaining attention. Doctors typically use several criteria when they try to determine the difference between bipolar disorder and ADHD or assess if the conditions are co-occurring.
A good indication someone is struggling with ADHD will include the onset of symptoms at a young age, and continuing symptoms will occur in the absence of manic, depressive, or hypomanic episodes. If the symptoms are cyclical, and someone has an increase in goal-directed activity, a decreased need for sleep, or an inflated sense of self, they may be experiencing a hypomanic or manic episode rather than ADHD.
The following examples are questions your doctor might ask to assist them in diagnosing ADHD as well as bipolar disorder, which include:
- Are you experiencing symptoms of impulsivity, hyperactivity, or inattention since childhood?
- Are there environmental stressors that may contribute to the symptoms?
- Do you struggle with impulsivity or inattention when your mood is stable?
- Do you have other psychiatric or medical conditions that may contribute to the symptoms?
- Do these symptoms interfere with relationships, work, or other daily routines?
For a doctor to diagnose ADHD and/or bipolar disorder, they must rule out other potential diagnoses that may contribute to symptoms. Some of these include:
Why Do Bipolar Disorder And Adhd Often Occur Together
Its still not entirely clear why bipolar disorder and ADHD often occur at the same time. One theory is that shared genetic and biological factors may be partially responsible for the association.
In a 2015 study , researchers examined data from 13,532 twins to try to understand the degree to which genetic factors play a role in the development of ADHD in people with bipolar disorder.
They found that genetic factors associated with mania were 25 to 42 percent associated with ADHD symptoms, suggesting that theres some biological connection between the two conditions.
Treatment For People With Both
Treatment for co-occurring bipolar disorder and ADHD is not straightforward. More research is needed to determine best practices.
Currently, healthcare providers may approach each case on an individual basis to identify the patient’s needs. However, treating symptoms to stabilize patients is generally considered the first step of treatment.
Treatment strategies for bipolar disorder include medication, psychotherapy, and lifestyle changes. Medication options may include:
- Mood stabilizers
- Antidepressants
Once bipolar symptoms are managed in patients with comorbid bipolar disorder and ADHD, a healthcare provider may add stimulant or non-stimulant medications to target symptoms of inattention.
Some non-stimulant medications used to treat ADHD include:
Stimulants can trigger manic symptoms in some cases, so regular check-ins with a healthcare provider are essential. Medication management with bipolar disorder and ADHD may involve some trial and error.
Lifestyle changes such as getting regular sleep, eating healthy and balanced meals, and exercise can support people with bipolar disorder and ADHD.
Ultimately, collaboration with a healthcare provider can determine the best treatment plan.
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What Is Bipolar Disorder
Bipolar disorder is a serious mental illness that is characterized by extreme mood swings, abrupt changes in energy levels, and distorted decision making. In most cases, it develops in the late teens or early adulthood though more and more experts now accept the existence of pediatric bipolar disorder. Bipolar disorder affects men and women at virtually equal rates, and the disorder is found among patients of all races, social classes, and ethnic groups.
Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation, which are common in individuals with ADHD.
Manic Episodes: The Other Side Of Bd
1. Severe changes in mood. The hallmark of a manic or hypomanic episode is a severe shift in mood, in which someone becomes extremely irritable or inappropriately elated without any external reason. These mood states last for hours , days, or weeks. With ADHD, irritability is often the result of boredom, sleep deprivation, a stressful situation, or heavy demands on executive functioning. A person having a manic episode feels irritable, regardless of what is going on.
2. Inflated self-esteem and grandiosity. When patients are in the throes of a manic episode, their sense of themselves can become grandiose or narcissistic. Sometimes it is subtle , and other times it can be detached from reality .
3. Increased, revved-up energy. Kathleen, 30, described her manic episodes as a flurry of uncontrolled energy. With ADHD, people can feel excited and energetic manic energy, however, feels scary, uncontrolled, and uncontained.
4. Impulsive or self-destructive behaviors. Hypersexuality, substance abuse, reckless driving, and conflict with others are common in mania. With ADHD, impulsive acts are driven by something someone wants to do. With BD, people having a manic episode feel driven to do acts that, when not manic, they would have no desire to do.
5. Psychosis. Having thoughts that are detached from reality is not a symptom of ADHD, but that is a symptom of a severe depression or mania. Jeff, 36, believed he was Jesus Christ when manic, while Kelly, 14, heard angels talking.
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Diagnosing Adhd And Bipolar Disorder
When making the diagnosis of bipolar disorder in a person with ADHD, a clinician will follow guidelines laid out in the most recent edition of the American Psychiatric Associations Diagnostic and Statistical Manual.
ADHD and bipolar disorder can share symptoms such as hyperactivity, distractibility, and reduced inhibition, which makes diagnosis difficult.
Bipolar disorder is generally episodic, meaning periods of mania and depression are often short-lived.
People with ADHD show relatively constant symptoms. A clinician can use this difference as a clue to which disorder you might be experiencing.
Adhd In Patients With Bipolar Disorder: Genetics Diagnosis And Treatment
David N. Osser, MDPsychiatric Times
Although clinicians and patients may wish otherwise, the comorbidity of ADHD and bipolar disorder needs to be considered.
BIPOLAR UPDATE
Recent study results revealed that children with a diagnosis of attention-deficit/hyperactivity disorder had a 10-fold increase in the incidence of later development of bipolar disorder compared with matched children without ADHD.1 The comorbidity is common, has a more severe course than either diagnosis alone, and is associated with greater risk of suicide attempts.2 Clinicians will have trouble determining which diagnosis best fits the patient, and it could be that the patient has both diagnoses. Often the patient prefers the ADHD diagnosis and the stimulant medications used to treat it. They hope to avoid the BD diagnosis and medications used to treat it, because of the perceived stigma and complexity of treatment. The differential diagnosis is made by recognizing that bipolar manias occur in discrete episodes of at least 4 to 7 days, whereas the hyperactivity and associated symptoms of ADHD are more or less constantly present as features of the individuals temperament.
The bottom line of these data is that it is important to take the time to diagnose bipolar disorder accurately in patients with a history of ADHD or who are presenting with current ADHD. Mood-stabilizing medications such as lithium will usually be indicated for the bipolar condition.
References
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Bipolar Vs Adhd In Children
Bipolar disorder does exist in children, though its commonly misdiagnosed as ADHD. Parents of children with ADHD describe their babies as colicky, always crying, difficult sleepers, or always moving around. Children are born with ADHD symptoms bipolar is a condition that develops and even grows in intensity. A teen with bipolar disorder can rage for hours in a destructive, disturbing way that is described as volcanic emotion or limbic rage. The limbic system is the most primitive, emotional part of the brain. With tantrums caused by ADHD, a child may be upset, but will stop if distracted by something else or when he becomes exhausted. The rage goes on much longer in children with bipolar disorder.
Children who develop bipolar disorder are often precocious, gifted, and have night terrors characterized by gore and mutilation. They have an extreme fear of annihilation, and talk about death, murder, and suicide in an obsessive, matter-of-fact way. Some children with bipolar disorder will harm animals, or experience hallucinations and psychotic symptoms of paranoia from a young age. Children diagnosed with conduct disorder or oppositional defiant disorder are at a higher risk of having bipolar disorder.
Most parents seek diagnosis for bipolar disorder when they feel something is taking over their child, who doesnt seem in his or her right mind.
Lack Of Impulse Control Or Hypomania
According to data from the International Mood Disorders Collaborative Project, nearly one in five individuals with bipolar experience ADHD.
What we really need to be aware of, though, is that we dont have to have a full-blown ADHD diagnosis to complicate our lives. Virtually all of us have attention problems of some sort. Thus, we all need to be paying attention to attention.
Another element of ADHD concerns the lack of ability to rein in impulses.
It works something like this: Attention is a function of the thinking parts of the brain. If youre not thinking right, the front end of your brain is perpetually engaged in a losing battle with the back end of the brain.
The back of your brain may tell you that now would be a good time to belt out Theres No Business Like Show Business in your best Ethel Merman voice. The front end of your brain neglects to remind you that you happen to be in the middle of a business meeting right now.
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Overlap Experiences And How To Spot The Difference
Mood Flux
Neurodivergent Mood fluctuations are common within the context of ADHD, which may look like bipolar mood fluctuations.
How to tell the difference: Neurodivergent mood fluctuations are more likely to be situational and caused by external causes . Bipolar mood fluctuations are more likely to appear to have no cause . It will be more difficult for the person to pinpoint a cause for the low mood as it is more biologically based. Furthermore, the mood shifts that occur in the context of BD tend to be longer than the mood shifts in ADHD. They also tend to be more cyclical and chronic and can be triggered more easily
What to look for : Does the person has a history of experiencing a depressed mood without cause? Does it have a cyclical nature to it? Also, be aware that a person with bipolar can have mixed episodes.
Impulsivity/Risk Behavior
A hallmark of mania is risk-taking behavior . While impulsivity with ADHD can also show up as reckless behavior, it is more likely to be due to not thinking through the consequences of their actions. In mania, a person may behave in ways that are farther from their values baseline.
What to look for : What is the gap between the persons values/baseline and the behavior? In the context of ADHD, reckless behavior is often due to difficulty thinking through the consequences of actions. In the context of mania, there is a disregard for consequences.
Stimming/Excessive Energy/Hyperactivity
Starting Multiple Projects
Executive Functioning
Adhd And Comorbid Psychiatric Disorders
Several studies have found a high prevalence of comorbid psychiatric disorders in adult ADHD . The high comorbidity rates may overshadow ADHD presentation, thus hindering the recognition and diagnosis of ADHD in adults. This is acknowledged as one of the main reasons for the observed under-recognition and undertreatment in the adult population .
The most frequently represented psychiatric comorbidities are mood and anxiety disorders, substance use disorders and personality disorders, with rates for at least one comorbid psychiatric disorder ranging from 57 to 92% . Other authors, adopting a dimensional approach to diagnose ADHD and comorbid disorders, found rates as high as 80% .
Mood disorders are especially common in patients with adult ADHD. A large epidemiological study conducted in 20 countries found a 12-month prevalence of major depression in the 15% of adult subjects diagnosed with ADHD . Clinical studies reported even higher rates of lifetime major depression in adults with ADHD, ranging from 45 to 55% The presence of a depressive disorder reduces the quality of life and overall functioning of patients with ADHD, further increasing the burden of disease . In some cases depression arises as a result of the impairment of functioning in all areas carried by ADHD, eventually bringing about secondary demoralization with associated decreased hedonic ability, sleep disorders and irritability .
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How Common Is Adhd With Bipolar
It’s relatively common for patients to have both ADHD and bipolar disorder. In fact, one in 13 patients with ADHD also had bipolar disorder, while one in six patients with bipolar disorder also had ADHD.
While there is clearly a link between the two conditions, the reasons for the increased likelihood of comorbidity of ADHD and bipolar disorder are unclear. While no one knows what that link is or what might cause someone to develop both conditions, genetic factors may be responsible for the high comorbidity rates. However, environmental factors may also be at play.
Adhd Bipolar Disorder Or Borderline Personality Disorder
Ciro Marangoni, MDPsychiatric Times
ADHD can present with symptoms such as irritability, mood lability, low frustration tolerance and low self-esteem, making it easily confused with mood disorders and personality disorders.
ADHD is defined by early onset of persistent symptoms of inattention and/or hyperactivity and impulsivity that are not consistent with development, causing impairment of normal functioning in at least two settings . It is the most common psychiatric disorder in children, mostly in school-age boys.1
Generally, the diagnosis of ADHD is based on the presentation of impairing levels of attention, hyperactivity, and impulsivity. However, ADHD can present with different symptoms such as irritability, emotional dysregulation, mood lability, low frustration tolerance, low self-esteem, and sleep problems, making the diagnosis difficult because of overlap with mood disorders and personality disorders .
ADHD
Onset and course. ADHD onset is generally before age 12 years, with a prevalence of 1.7% to 16%.2 ADHD follows a chronic and unremitting course, persisting into adulthood in half of the cases.3 The hyperactive-impulsive type is associated with trajectories of improvement while the inattentive type is often associated with negative outcomes. ADHD hyperactive type is more prevalent in males, while ADHD inattentive type is more common in girls. The persistence and severity of ADHD during development are associated with adult antisocial and criminal behaviors.
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How Manic Symptoms Resemble Adhd
One hallmark byproduct of ADHD is hyperfocus, or the ability to focus intently on something of great personal interest for an extended period of time, at times mentally drowning out the world around. This may happen on deadline pressure or when wrapped up in a compelling project, book, or video game. Hyperfocus may cause a decreased need for sleep and may look like increased goal-directed activity, however this is short-lived in people with ADHD, who often feel exhausted once the hyperfocus fades. A manic episode, on the other hand, is independent of external circumstances. People with bipolar disorder often want to go to sleep or relax, but describe feeling as if there is electricity going through their bodies that they cannot stop or dampen, no matter how desperate they are for sleep. This inability to settle the mind and body can go on for a week. Going without sleep for long periods of time can trigger psychotic episodes or hallucinations.
People with ADHD often interrupt or talk too much without noticing because they miss social cues or because they lose focus on the threads of a conversation. Patients experiencing a manic bipolar episode are often aware they are changing topics quickly and sometimes randomly, but they feel powerless to stop or understand their quickly moving thoughts. This type of behavior is uncharacteristic and does not reflect how they would typically converse.
How Often Do They Occur Together
Many studies have set out to determine the frequency of ADHD and bipolar disorder co-morbidity. One such review aimed to analyze rates of ADHD and bipolar disorders in a sample of 646,000 participants. They found that ADHD was comorbid with bipolar disorder in roughly 1 in 13 adults. Conversely, the ratio was 1 in 6 adults for bipolar disorder comorbid with ADHD.
Hence, as research suggests, ADHD and bipolar disorder occur together in a large proportion of individuals. Thus, clinicians and healthcare providers must be cognizant of these statistics while diagnosing patients with either of these conditions.
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Are Bipolar Disorder And Adhd Related
Bipolar disorder is known as a neurological brain disorder that affects 2.3 million Americans today, or one percent of the total adult population. While the condition typically starts in adolescence or early adulthood, there are some cases where individuals develop bipolar disorder in their 40s or 50s.
Bipolar is also labeled as manic-depressive illness, and those who are diagnosed will experience mood swings that alternate from severe highs to extreme lows. Suicide is the number one cause of death among those with bipolar, and 15 percent to 17 percent will take their own lives as a result of the adverse symptoms.
Attention-deficit hyperactivity disorder is a disorder marked by an ongoing pattern of inattention or hyperactivity-impulsivity that will interfere with functioning and development. Unfortunately, some individuals with ADHD are prone to developing other mental health-related disorders once they become adults. These can be major depression, anxiety disorder, or bipolar disorder.
Researchers still have a lot to learn about the neurological interaction between these two disorders. The initial reports show that anywhere from nine percent to 35 percent of adults with bipolar disorder also struggle with ADHD. Many of those with bipolar disorder find that even when their mood is stabilized with the right medication, they will continue to struggle with meeting deadlines, staying focused on a task, and staying organized.
- Unable to cope with stress