In fact, it’s not uncommon for those persistent symptoms to signal one or more additional undiagnosed psychological conditions, according to the National Institute of Mental Health (NIMH). Experts aren’t entirely sure why, but genetic factors such as a family history and environmental factors such as childhood adversity likely play a role in the development of co-occurring mental health conditions, according to a review published in the Journal of Affective Disorders. Unfortunately, being told you have multiple mental health issues — called dual diagnosis — can also result from misdiagnosis, since bipolar disorder and related conditions often share symptoms such as changes in mood, energy, and activity levels, NIMH experts explain. Nonetheless, if you have bipolar disorder, knowing the risk and symptoms of those related conditions is vital for improving your overall well-being. That’s because having an untreated co-occurring psychological condition can worsen your bipolar symptoms, making it harder to function day to day, explains psychiatrist Howard Weeks, MD, chief medical officer of Pathlight Mood and Anxiety Center in Salt Lake City. Here are four mental health conditions that research shows frequently coexist with bipolar disorder:
1. Bipolar Disorder and Anxiety Disorders
Anxiety disorders are a group of mental health conditions involving constant, intense, and disproportionate fear or worry about everyday situations. Some examples of anxiety disorders are generalized anxiety disorder, social anxiety disorder, and panic disorder. Symptoms include:
Feeling apprehensive or fearing the worstFrequent diarrhea or urinationIrritabilityNauseaTwitches or tremorsUpset stomach
It’s very common for people with bipolar disorder to have an anxiety disorder, too. A review published in January 2019 in the World Journal of Psychiatry suggested around 50 percent of people with bipolar disorder will develop an anxiety disorder sometime during their lives. Each of these conditions can mimic some symptoms of the other and complicate the course, diagnosis, and treatment of both, according to the Anxiety and Depression Association of America (ADAA). For instance, when someone with bipolar disorder has a manic or depressive episode, it could worsen their anxiety, Dr. Weeks says. And the reverse is true: Some symptoms of anxiety, such as difficulty sleeping, could trigger or deepen bipolar manic and depressive symptoms. RELATED: Are You Just Feeling Anxious, or Do You Have an Anxiety Disorder?
Engaging in risky activities while under the influence, such as drivingFeeling that you need to drink or use a drug every day or multiple times a day, often accompanied by urges that supersede all other thoughtsHaving strained relationships with others or not meeting normal responsibilities due to drug or alcohol useNeeding more alcohol or drugs over time to achieve the same effectNot being able to stop drinking or using drugs, or experiencing withdrawal symptoms when you try to stopPutting significant effort into obtaining drugs or alcohol, including spending money you don’t have to get them
An estimated 30 to 50 percent of people with bipolar disorder (bipolar 1 or bipolar 2) will develop an SUD at some point in their lifetime, according to an advisory published in 2016 by the Substance Abuse and Mental Health Services Administration (PDF). There are several reasons why the co-occurrence of these disorders is so common. In some cases, people turn to substances to “self-medicate” their bipolar symptoms and then, over time, their substance use evolves into a disorder, explains Weeks. Gregory Jantz, PhD, the founder of The Center: A Place of Hope, a mental and behavioral health practice in Edmonds, Washington, agrees. “For many, using a substance is a way of emotion regulation. It’s a way of balancing highs and lows. They may use alcohol to bring them down from a manic state and up from depression,” he explains. “Another possibility is that when patients are depressed or manic, they may begin using substances when they normally would not,” notes Weeks. “Again, over time this can trigger a substance use disorder.” Genetics may also play a role. One large study, published in September 2021 in Addiction, suggested that alcohol use disorder, bipolar disorder, and schizophrenia may be linked across many different genes.
3. Bipolar Disorder and Borderline Personality Disorder
Borderline personality disorder (BPD) is a mental health condition involving difficulty regulating emotions, low self-worth, and extreme concern about how others treat and view them. People with BPD often experience frequent and intense mood swings lasting from hours to days, as well as an acute fear of abandonment and being alone. This routinely leads them to take extreme measures to avoid feeling rejected or neglected. Their actions and reactions to people and situations often results in explosive and unstable relationships, impulsive actions such as excessive alcohol or drug use and risky sex, and severe self-esteem problems. Approximately 20 percent of people with bipolar disorder also have BPD, and vice versa, according to research published in Dialogues in Clinical Neuroscience . However, while it’s certainly possible for someone to have both disorders, accidental misdiagnosis can happen, especially for BPD. As many as 40 percent of people who have BPD were initially misdiagnosed with bipolar 2, a study published in the Journal of Psychiatric Research found. Why is BPD so often confused with bipolar disorder even by medical professionals? Largely because their symptoms often overlap, explains Weeks. Those symptoms include:
Drastic mood changesImpulsive or risky behaviors, including unsafe sex, substance use, or gamblingSeeking mental health help frequentlySevere self-esteem issuesWorsened daily functioningSuicidal thoughts or behaviors
RELATED: Is ‘Borderpolar’ a Real Diagnosis?
4. Bipolar Disorder and ADHD
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder involving patterns of inattentive, hyperactive, or impulsive behavior. Common symptoms are:
Constant movement or significant feelings of restlessnessExcessive talking or interrupting othersFidgeting or feeling unable to sit stillFrequent daydreamingHaving difficulty staying organized and completing tasksImpatienceMaking careless mistakes at school or workMaking impulsive decisions without considering the consequences first
As many as 10 to 20 percent of people with bipolar disorder also have ADHD, according to a review published in May 2021 in Medicina . In addition, youths with ADHD have a 7 to 21 percent increased risk of developing bipolar disorder in early adulthood, the review showed. Although bipolar disorder primarily affects mood and ADHD primarily affects attention and behavior, both conditions can share some symptoms, such as irritability and impulsivity, making differentiating between the two challenging. “If someone with ADHD is not using medication, it can look similar to a manic phase of bipolar where they may be talking or moving fast, attention is distracted, and they can’t concentrate,” Jantz explains. However, “one difference with ADHD is that they don’t have a crash. They may exhaust themselves, but they don’t have the deep dark depression that someone with bipolar disorder would,” Jantz adds. Having both bipolar disorder and ADHD can worsen the course of each condition, per the Medicina review, which is why it’s critical for people with these two conditions to be properly treated for both.
