It is possible for someone to meet the diagnostic criteria for both ADHD and bipolar disorder, but sometimes it can be difficult to determine which diagnosis best fits someone’s presenting symptoms.
What Is ADHD?
To meet the diagnostic criteria for ADHD, an individual must exhibit six or more inattentive symptoms, six or more hyperactive-impulsive symptoms, or both. The inattentive symptoms of ADHD are:
Making careless mistakesHaving difficulty maintaining focus in tasksHaving difficulty listening when spoken toFailing to follow through on instructionsHaving difficulty staying organizedAvoiding tasks that require a lot of mental effort and focusLosing thingsBecoming distracted easilyBeing forgetful
The hyperactive-impulsive symptoms of ADHD are:
Fidgeting, tapping, or squirmingLeaving one’s seat at inappropriate timesRunning or climbing at inappropriate timesMaking noise while engaging in activitiesBeing “On the go,” as if “driven by a motor”Talking excessivelyBlurting or speaking out at inappropriate timesBeing unable to wait one’s turnInterrupting in conversations
What Is Bipolar Disorder?
Individuals with bipolar I disorder have a history of at least one full manic episode, which includes elevated or irritable mood and increased energy as well as at least three of the following symptoms:
Feelings of grandiosity or inflated self-esteemSignificantly reduced need for sleep; for example, feeling rested after only two hours of sleep per night or staying up all nightMore talkative than normal“Flight of ideas,” or racing thoughts that are disconnectedDistractibilityAgitated movementsHigh-risk activities, such as physically dangerous choices, impulsive spending, drug use, or unsafe sexual behavior
Symptoms must be present most of the day or all day for a minimum of one week to meet criteria for a manic episode. Manic episodes might include psychotic symptoms. A person must have had at least one full manic episode to be diagnosed with bipolar I disorder. Individuals with bipolar II disorder must have a history of at least one major depressive episode and a hypomanic episode. To meet criteria for a hypomanic episode, an individual must experience the period of elevated mood and at least three manic symptoms lasting at least four consecutive days. Hypomanic episodes typically do not include psychotic symptoms.
ADHD and Bipolar Disorder: Symptom Overlap and Differences
Some symptoms appear under the diagnostic criteria for both ADHD and bipolar disorder. Providers must distinguish which diagnosis best accounts the client’s symptoms, or if both diagnoses are present. The following symptoms can be present in individuals with ADHD and those with bipolar disorder.
Distractibility
Distractibility can have many causes, including fatigue, substance intoxication, or stress. Both people with ADHD and those with bipolar disorder can exhibit distractibility as well. A person with ADHD may be easily distracted by extraneous things, like other activities or visually interesting objects. They may also struggle with focus due to disorganization or forgetfulness. ADHD distractibility comes from the inability to regulate focus. The effect of ADHD prevents the brain from being able to filter out what is important or what is a priority. Similarly, in bipolar disorder, a manic or hypomanic episode may cause someone to be distracted by their own thoughts or the cycle of their moods.
Racing Thoughts
Both people with ADHD and people with bipolar disorder report “racing thoughts.” However, the experience of racing thoughts is different for ADHD and bipolar disorder. People with ADHD experience thoughts that jump from topic to topic following a thread. The thread might jump between topics based on loose associations or memories; for example, a food might remind a person of a film where someone ate that food, which could bring up a memory from when they saw that film. To an outside observer, the connections might not be immediately apparent, but the connection exists. Racing thoughts caused by manic or hypomanic symptoms follow a “flight of ideas” pattern, where the individual jumps between topics without a connection or thread connecting the ideas. The individual might perceive a connection between these topics, but those connections may be peripheral.
Impulsive or Reckless Behavior
Both ADHD and bipolar disorder can cause impulsive, reckless, or dangerous behavior, including over-spending, unsafe sexual activity, driving recklessly, or making big, life-changing decisions. People with ADHD who exhibit impulsive behavior tend to show a consistent pattern of behavior over time. Although they might develop skills to better manage these impulses or follow a medication regimen that helps manage their symptoms, the impulsivity tends to be consistent over time. People with ADHD don’t always act on their impulsive behaviors—they may have thoughts about doing something impulsive without actually acting on it. (Undergoing treatment and learning coping skills can help with this.) People with bipolar disorder tend to display impulsive or reckless behavior during manic or hypomanic episodes. The behavior abates when they are not in the midst of an episode, and they might not understand why the behavior seemed like a good choice at the time.
Periods of Hyperfocus
People with ADHD often struggle less with sustaining attention and more with choosing what their attention will focus on. This can lead to hyperfocus on preferred activities, areas of interest, or things that are interesting to them. The hyperfocus can cause the individual to forget to eat, use the bathroom, or engage in other self-care activities due to their focus. During manic or hypomanic episodes, people with bipolar disorder may engage in “increased goal-directed activity” and restlessness. This can be due to feelings of grandiosity or delusions that they can accomplish unrealistic goals.
ADHD and Bipolar Disorder: Treatment Options
Effective treatment options are available for both ADHD and bipolar disorder, though an accurate diagnosis is essential for appropriate treatment. Individuals with bipolar disorder may benefit from medication, including mood stabilizers such as lithium, or certain anticonvulsants, antipsychotics and antidepressant medications. Depending on individual needs and symptoms, an individual might need a combination of medications to stabilize their moods. Ongoing therapy services can help individuals develop appropriate coping skills and learn to identify when they might be entering an episode. Those with ADHD are often prescribed stimulant or non-stimulant ADHD medication. They may require support in building skills to manage their symptoms or accommodations in work or academic settings to help with performance and functioning. As with bipolar disorder, people with ADHD might benefit from therapy services to manage stress and cope with anxiety related to their diagnosis.
A Word From Verywell
If you suspect that you might have bipolar disorder or ADHD, your primary physician can help you get a referral for testing. Getting a correct diagnosis is a key first step in determining which treatments and interventions will be most helpful to you.
