How Often Does ADHD Co-Occur with Bipolar Disorder?

Reports claim attention deficit hyperactivity disorder (ADHD) may co-occur with bipolar disorder (BD). In a study of over 650,000 participants, researchers found one in thirteen adults with ADHD also had bipolar disorder. They also found that one in six adults with bipolar disorder had ADHD.

Another study suggests up to 80% of children with bipolar disorder also have ADHD. Statistics prove that when someone is diagnosed with bipolar disorder, they should also be evaluated for ADHD and vice versa.

To better understand how often they co-occur, you must learn more about each condition separately.

What is ADHD?

Attention deficit hyperactivity disorder was once diagnosable as either attention deficit disorder (ADD), with or without hyperactivity. Today, they are listed as one condition in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM5). There are three subtypes of ADHD, including:

  • Primarily Inattentive
  • Primarily Hyperactive and Impulsive
  • Combined

ADHD is a neurodevelopmental disorder, a brain disorder that impacts a person’s ability to sit still, pay attention, delay impulses, focus, and manage behavior. More children are diagnosed with ADHD than adults. Some people may grow out of their symptoms, while others may have them for the rest of their lives.

There is controversy among doctors, some claiming ADHD is over-diagnosed in school-aged children. Some disagree that children should be given stimulants, the primary treatment. Researchers also differ on the causes of ADHD, some thinking it is genetic and others blaming it on their environment.

Controversies exist due to the lack of adequate testing. Doctors have only a symptoms checklist and documentation for guidance. But for those with true ADHD, medications and behavioral therapies help them succeed in school, at work, and socially.

What is Bipolar Disorder?

Bipolar disorder was once called manic-depressive disorder, referring to someone cycling between depression and mania. It is a brain disorder that causes a person to have extreme or mild shifts in mood, behavior, sleep, thinking, and energy levels. The shifts go beyond ordinary changes due to outside circumstances. Some people experience rapid shifts between depression and mania, while others spend weeks or months in the highs and lows.

Three types of bipolar disorder describe the intensity and frequency of mood changes:

  • Bipolar I 
  • Bipolar II 
  • Cyclothymic 

Research shows bipolar disorder has a strong genetic link. When one person has it, someone else in their family likely has it, too. One report claims the average age of bipolar disorder onset is 25 for men and women. The same report claims 7 million people experience symptoms of bipolar every year.

When Do ADHD and Bipolar Disorder Occur Together?

Diagnosing ADHD and bipolar disorder together must be done by a licensed Psychiatrist or mental health professional with education and experience in both conditions. They use the DSM5 criteria, which gives them specific symptoms for each since there are no blood tests or brain scans to administer. 

A person with ADHD and BD must meet the criteria of both disorders. The general criteria for the three subtypes of ADHD include:

  • Primarily, Inattentive applies to a person with five or more symptoms related to inattention for at least six months and less than five symptoms of hyperactivity and impulsiveness. A few examples include trouble listening, focusing, completing tasks, staying organized, and forgetfulness.
  • Primarily, Hyperactivity and Impulsiveness apply to a person with five or more symptoms of hyperactivity and impulsiveness and fewer than five symptoms of inattention in at least six consecutive months. Symptoms may include the inability to stay seated, interrupting others, excessive talking, fidgeting, and can’t wait their turn.
  • Combined-type applies to someone with at least five inattentive and five hyperactivity and impulsive symptoms in the last six months.

The general criteria for bipolar disorder include:

  • Bipolar I applies to someone with at least one severe manic episode lasting at least seven days. Depression may or may not be present. Three or more symptoms must be evident, such as inflated ego, lack of a need for sleep, increased talking, and participating in behaviors with risks and consequences.
  • Bipolar II applies to someone with severe depression lasting at least two weeks and one or more mild manic episodes. A person may lose interest in activities, feel worthless, have suicidal ideation, and isolate themselves from family and friends.
  • Cyclothymic applies to a person with mild shifts between depression and mania, but neither is extreme. Symptoms must occur over two years, and the other two types of bipolar and other mental and medical conditions are ruled out. 

Overlapping Symptoms of ADHD and Bipolar Disorder

Finding the right professional to diagnose you is crucial, especially because symptoms of ADHD may overlap with BD, such as:

  • Irritability
  • Hyperactivity
  • Restlessness 
  • Agitation
  • Distractibility
  • Impulsivity
  • Poor judgment
  • Lack of motivation
  • Forgetfulness
  • Paranoia
  • Self-harming thoughts
  • Mood swings
  • Defiant or oppositional behavior

ADHD symptoms are chronic and persistent, whereas BD symptoms occur in cycles. Specifically, increased energy, speech, impulsiveness, and restlessness are constant with ADHD but not with BD. Someone who engages in risky behaviors does so much of the time with ADHD but only during mania associated with BD.

Some differences help mental health professionals distinguish between the two disorders. Someone with ADHD is likely to consistently have low self-esteem, whereas someone with bipolar will have low self-esteem when in depression but high self-esteem during mania. While both disorders impact behavior, ADHD also affects attention, and BD impacts mood.

Why Do ADHD and Bipolar Disorder Co-Occur?

Why one person gets ADHD and another develops ADHD and bipolar is a research topic in the mental health industry. Researchers seem to agree there is not one specific reason for the difference but rather multiple. Known as risk factors, certain factors make it more likely someone will have a comorbid disorder.

Risk factors include genetics, brain structure, alcohol and drug use, brain injury, childhood trauma, medical comorbidities, and issues during or after pregnancy.

To learn more about ADHD and bipolar disorder or to talk to someone about symptoms you or someone you know is having, contact the Mental Health Center.