In this article, we discuss the connection between autism and bipolar disorder and autistic people’s experiences of bipolar disorder.
The Connection Between Autism and Bipolar Disorder
Autistic people can have bipolar disorder, and they can experience their symptoms differently as a result. Megan is autistic and has bipolar disorder, and she shared her experience with bipolar disorder as an autistic person. “Bipolar symptoms already come with risky behavior,” she explained, “but I think I ended up in more dangerous situations than maybe I would have if I weren’t autistic because I didn’t recognize the different social innuendos.” In addition, she noted that her mood symptoms can be “exacerbated by my sensory issues, both external and internal sensory triggers.” In addition to bipolar disorder manifesting differently for autistic people, the autistic community is at higher risk for developing bipolar disorder than non-autistic people. Some studies have found that there are shared genetic connections between autism and bipolar disorder. One study found that bipolar disorder and autism share global gene expression patterns, which may explain why they sometimes occur together.
Shared Risk Factors
Some factors that appear to be more common in autistic people with bipolar disorder compared to non-autistic people with bipolar disorder include:
Being easily distracted Comorbid attention-deficit hyperactivity disorder (ADHD) Comorbid obsessive-compulsive disorder (OCD) Depressed moods Experiencing mood symptoms earlier in life Racing thoughts Social withdrawal
Complications of Autism and Bipolar Disorder
Autistic people with bipolar disorder can experience significant effects in many different domains. Evidence suggests that young autistic people who have bipolar disorder experience greater impairments when it comes to their social relationships compared to those who do not have bipolar disorder. Autistic people who develop bipolar disorder tend to develop bipolar symptoms at a younger age than non-autistic people with bipolar disorder. This can lead to disruptions in a person’s life and their ability to function in relationships, school, self-care, and other important life areas. Bipolar disorder can also present with an intense focus on a goal or activity. Megan shared, “I have to be mindful of how focused I get on my [autistic] special interests and prioritize routine, especially around sleep because I used to forgo sleep in order to learn more or create projects which could and has pushed me into mania.”
Diagnosis of Autism and Bipolar Disorder
Because much research around bipolar disorder focuses on the symptoms of non-autistic people, it can be more difficult for autistic people to get an accurate diagnosis. Some symptoms that autistic people experience when they have bipolar disorder include: For more mental health resources, see our National Helpline Database.
Aggression Depressed or elevated moods Distractibility Engaging in repetitive behaviors Impulsivity Irritability Racing thoughts Rapid speech or excessive talking Sleep difficulties
When an autistic person has intellectual impairments or communication challenges, accurately assessing bipolar symptoms can be even more difficult. Having comorbid ADHD or OCD can further complicate the diagnostic process due to symptom overlap.
Autism vs. Bipolar Disorder
Healthcare practitioners conduct routine screenings for autism. The American Academy of Pediatrics (AAP) recommends that these screenings should occur at ages 9, 18, and 30 months of age. Doctors may also administer a physical exam, perform lab tests, and conduct other tests to help rule out other conditions that might be causing or contributing to symptoms. People with bipolar disorder are also more likely to experience other comorbid conditions such as ADHD, substance use, and post-traumatic stress disorder (PTSD). In order to differentiate between autism and bipolar disorder, a doctor may look at the nature, duration, expression, age of onset, and severity of symptoms.
Autistic people and those with bipolar disorder can exhibit impulsive behavior, but this symptom will cycle with bipolar disorder and not with autism. Autism is a neurodevelopmental difference with early childhood onset, whereas the typical age of onset for bipolar disorder is adolescence or young adulthood.Autistic people may experience problems with social communication and awareness, speech differences, sensory issues, and intellectual disabilities. Such symptoms are not typically associated with bipolar disorder.Bipolar disorder causes severe depression and may cause suicidal thoughts. While autistic people may also experience depression, these mood episodes are not considered a symptom of their condition.
Doctors and mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to diagnose mental health conditions and neurodevelopmental differences including autism.
Treatment and Support for Autism and Bipolar Disorder
Autism and bipolar disorder are both lifelong. Treatments for bipolar disorder are focused on helping people manage symptoms and strengthening their ability to function in their daily life. Although autism is not an illness, many autistic people benefit from supportive services to help them function in a world that is not designed to meet their needs.
Medications
Treatment for bipolar disorder typically involves the use of medications to help stabilize mood. Megan told us that medication was “the most important thing to get back on track” after she experienced her first manic episode. Medications that may be prescribed include:
Mood stabilizers such as lithium or Depakote (sodium valproate) Anti-psychotics such as Risperidal (risperidone), Seroquel (quetiapine), Abilify (aripiprazole), Zyprexa (olanzapine), and Geodon (ziprasidone) Antidepressants such as Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram)
It is important to note that it is not recommended to take antidepressants on their own for bipolar disorder. These medications may trigger the onset of a manic or hypomanic episode or contribute to the rapid cycling of mood episodes. When autistic people experience bipolar disorder, mood stabilizers are sometimes used along with low-dose antipsychotics. Antiseizure medications that stabilize mood, such as valproic acid, may be preferred. Atypical antipsychotics such as aripiprazole and risperidone can help control symptoms of irritability in children.
Psychotherapy
Frequently-used interventions typically focus on improving skills and may include:
Cognitive-behavioral therapy (CBT) focuses on helping people change negative thought patterns. Specifically, a therapist who is neurodiversity-affirming can connect with and support autistic people with their mental health. Family therapy can help family members learn more about their loved one’s condition and what they can do to help. Support groups can help individuals connect with other people who are going through similar experiences. Megan said, " I joined a living with psychosis group which focused on building skills really around executive function, socialization, and symptom management, which inadvertently gave me more perspective and support with my autism."
Such approaches can help improve existing strengths, increase communication abilities, improve social skills, and promote adaptive skills needed for independent living. Support for autism can begin in early childhood, while treatment for bipolar disorder often begins when the condition is first diagnosed in adolescence or young adulthood.
Coping With Autism and Bipolar Disorder
In addition to seeking the appropriate treatment, there are also strategies that may help autistic people better cope when they have bipolar disorder.
Lifestyle Changes
Self-care strategies can be an important part of living well with autism and bipolar disorder. Some strategies that can help include:
Getting regular physical exercise Following a healthy diet Getting plenty of sleep Monitoring mood changes Learning to recognize triggers that affect mood Utilizing relaxation techniques to manage stress Following a daily routine Seeking social support Avoiding alcohol and substance use Having a suicide safety plan
Megan said that she uses a routine to help her notice if she is starting to experience bipolar symptoms as well. Such strategies can improve daily living, but they are not a replacement for professional treatment. Lifestyle changes combined with effective, proven treatments for autism and bipolar disorder can maximize your strengths and ensure your well-being.
Support Groups
Support groups for autism and bipolar disorder can also be a source of valuable information, support, and encouragement. Megan told us, “Finding support through online communities helps me feel connected and less alone.” Autism Resources
Autistic Self Advocacy Network (ASAN) Asperger/Autism Network (AANE) Color of Autism Neuroclastic
Bipolar Resources
bphope The Depression and Bipolar Support Alliance (DBSA) National Alliance on Mental Illness (NAMI)
A Word From Verywell
Autistic people experience unique challenges and difficulties when they experience symptoms of bipolar disorder. It can be more difficult for autistic clients to get an accurate diagnosis compared to non-autistic peers, but effective treatments and interventions are available for these lifelong conditions. Experiencing symptoms of autism and bipolar disorder can make diagnosis more complicated, particularly when an autistic person has difficulty communicating their emotions, moods, and behaviors. The presence of both conditions may affect how they are treated, so it is important to get an accurate diagnosis. If you or someone you love is experiencing symptoms of autism or bipolar disorder, talk to a doctor or mental health professional.
