Co-occurrence of ADHD and Bipolar Disorder

Prevalence of Co-occurrence in Adults

The prevalence of ADHD in adults with bipolar disorder is also significant. Research suggests that:

• Adults with Bipolar Disorder: Studies indicate that between 10% to 20% of adults with bipolar disorder may also meet the criteria for ADHD (Kessler et al., 2006).
• Adults with ADHD: On the other hand, some studies show that around 15% to 25% of adults diagnosed with ADHD may develop bipolar disorder over the course of their lifetime (Wozniak et al., 1995).

This overlap indicates that both conditions share genetic, neurobiological, and environmental risk factors, which may contribute to their co-occurrence in adults.

Diagnostic Challenges in Adults

Diagnosing both ADHD and bipolar disorder in adults can be more challenging than in children, for several reasons:

Symptom Changes Over Time: The expression of ADHD symptoms in adults often changes. For instance, hyperactivity may become less noticeable, but symptoms like inattention, impulsivity, and organizational difficulties persist. In contrast, in bipolar disorder, manic episodes might be marked by more severe mood instability and energy fluctuations.

Mood Swings vs. Chronic Inattention: Both ADHD and bipolar disorder involve mood dysregulation, but the mood swings in bipolar disorder tend to be more extreme and episodic (lasting days or weeks), while emotional dysregulation in ADHD tends to be more chronic and linked to external stressors.

Comorbidity with Other Conditions: In adults, ADHD and bipolar disorder often co-occur with other psychiatric conditions such as anxiety disorders, substance use disorders, and personality disorders, which can further complicate diagnosis (Kessler et al., 2006).

Mood Episodes in bipolar disorder: The hallmark feature of bipolar disorder in adults is the episodic nature of mood disturbances. Manic or hypomanic episodes are typically distinguished by:

• Increased energy, inflated self-esteem, reduced need for sleep, racing thoughts, and impulsivity.
• Depressive episodes are marked by low mood, loss of interest, fatigue, and feelings of worthlessness.

In contrast, ADHD involves more persistent symptoms of distractibility, impulsivity, and restlessness, but without the drastic mood fluctuations that are central to bipolar disorder.

Symptoms in Adults with ADHD and Bipolar Disorder

When ADHD and bipolar disorder co-occur in adults, the symptoms can overlap in the following ways:

• Impulsivity and Hyperactivity: Both disorders share symptoms of impulsivity and poor decision-making. However, in bipolar disorder, these symptoms are episodic and tied to mood states, while in ADHD, they tend to be chronic and not linked to mood shifts.
• Emotional Dysregulation: Both conditions may involve irritability, but in bipolar disorder, irritability is often associated with mood episodes, whereas in ADHD, it can result from frustration with task completion or attention issues.
• Attention and Focus Issues: Both conditions can lead to distractibility, but in bipolar disorder, inattention tends to occur during depressive or manic episodes. In ADHD, inattention is a persistent feature, regardless of mood state.
• Mood Instability: The key difference between the two is the episodic nature of mood swings in bipolar disorder. These extreme fluctuations between manic and depressive states contrast with the more stable mood in ADHD, which is usually not characterized by extreme highs or lows.

Treatment in Adults with Both ADHD and Bipolar Disorder

Medication

Treating ADHD and bipolar disorder together requires careful management to ensure that medications for one condition don’t exacerbate the other. For example, stimulants used to treat ADHD can trigger a manic episode in individuals with bipolar disorder. Antidepressants can trigger a manic episode in a person with bipolar disorder as well. Learn more about medications for depression and bipolar disorder.

Therapy

Psychotherapy, particularly cognitive-behavioral therapy (CBT) and psychoeducation, can be highly beneficial for both conditions. CBT helps individuals with ADHD manage organizational skills and emotional regulation, while also teaching coping strategies for managing mood episodes in bipolar disorder. Learn more about different types of therapy.

Long-Term Management

Regular monitoring and adjustments in treatment are essential. Lifestyle changes, such as regular sleep patterns, exercise, and stress management, play an important role in the long-term management of both disorders. Visit DBSA’s Wellness Wheel to see how lifestyle changes can help manage mental health.

Key Considerations:

• Risk of Misdiagnosis: Given the symptom overlap, individuals with co-occurring ADHD and bipolar disorder may be at risk of being misdiagnosed. For instance, a person with both disorders might be initially diagnosed with only one (e.g., bipolar disorder) and not receive proper treatment for ADHD.
• Increased Severity of Symptoms: The co-occurrence of ADHD and bipolar disorder in adults is often associated with more severe outcomes, including greater difficulty in managing interpersonal relationships, maintaining employment, and handling emotional challenges (Biederman et al., 2005).

Educational Resources for Bipolar Disorder

DBSA believes that education empowers individuals living with mood disorders to make informed decisions about their treatment. Working closely with your healthcare providers (HCPs) is key to achieving your wellness goals. You and your HCP should form a partnership where both of you contribute and maintain open communication. A great healthcare provider listens to your needs, understands your goals, and considers your background.

Bipolar Disorder Across the Lifespan

Hear from leading experts in the field of bipolar research to talk in detail about what living with bipolar looks like across the lifespan. Learn about the challenges of diagnosing a child with bipolar disorder; how symptoms may be different throughout the lifespan; and current treatment options for bipolar disorder. Watch the Video

Speakers

• Tina R Goldstein, PhD, Associate Professor of Psychiatry and Psychology University of Pittsburgh Department of Psychiatry Pittsburgh, PA
• Andrew A. Nierenberg, MD. Director, Bipolar Clinic and Research Program Bipolar Clinic and Research Program Massachusetts General Hospital Boston, MA

Misdiagnosis and Taking Charge of Your Care

Diagnosis is an integral part of treating a mental health condition, but sometimes finding the correct one can be a challenging process. This video focuses on how mood disorder diagnoses are made, factors that lead to misdiagnosis, and ways peers can take an active role in their mental health care. Watch the Video

Speakers

• Roger McIntyre, MD, FRCPC Professor of Psychiatry and Pharmacology, University of Toronto, Canada Head, Mood Disorders Psychopharmacology Unit Toronto, Canada
• Mark A. Frye, MD Stephen & Shelly Jackson Family Professorship in Individualized Medicine Mayo Clinic Rochester, MN

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References:

• Biederman, J., Faraone, S. V., & Mick, E. (2005). A critical review of the epidemiology of ADHD in adults. Biological Psychiatry, 57(11), 1361-1367.
• Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2006). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
• Wozniak, J., Faraone, S. V., & Biederman, J. (1995). Attention-deficit hyperactivity disorder and manic episodes in children. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 634-642.