Understanding Differential Diagnosis in Bipolar Disorder and ADHD

ADHD, which is often first diagnosed in school-aged children, is more common than bipolar disorder. It affects an estimated eleven percent of children in the United States and four percent of adults, while 2.6 percent of American adults suffer from the symptoms of bipolar disorder. Boys are three times more likely to be diagnosed with ADHD than girls, whereas bipolar disorder affects men and women at equal rates across all races and social classes.

Symptoms common to both bipolar disorder and ADHD include the following:

• Unexpected shifts in mood
• Sudden bursts of energy
• Restlessness and impatience
• Talkativeness

Because of the symptoms shared between ADHD and bipolar disorder, attaining a differential diagnosis can be complicated. Indeed, bipolar disorder is frequently misdiagnosed: A survey from the National Depressive and Manic-Depressive Association (DMDA) suggests that 69 percent of those with the condition are initially misdiagnosed, with over a third remaining undiagnosed ten years later. If you’re suffering from the serious effects of bipolar disorder, it’s crucial to have your condition properly diagnosed and treated to make sure you receive the best possible care and have the best chance of recovery.

If you have bipolar disorder, your mood will cycle dramatically between the two poles of mania and depression. You’ll experience periods of intense happiness followed by periods of equally intense sadness; these shifts aren’t sparked by any particular event and don’t seem to occur for any apparent reason. These mood shifts last a significant amount of time and can be debilitating and destructive—or even violent. Delusional or bizarre thinking may take place while you’re in the grip of one of these swings. When you’re not immersed in either a manic or a depressive state, your mood is very different—in fact, you almost seem like an entirely different person.

ADHD, on the other hand, most likely occurs when your brain produces too little dopamine, creating a craving for more. Dopamine, a compound that acts as a neurotransmitter, is charged with triggering the reward center in your brain. Without enough dopamine produced to satiate it, your brain will demand more, leading to possible depression, inattention, and a lack of focus. If you have ADHD, you may be easily distracted, hyperactive, fidgety, and forgetful.

If you’re experiencing the symptoms of either ADHD or bipolar disorder, or if you’re experiencing symptoms common to both conditions, a mental health professional will be able to assess your condition and give you a diagnosis. The following criteria may be useful in making an accurate diagnosis:

Age of onset

Bipolar disorder is rarely diagnosed in children. Most people with bipolar disorder experience their first manic or depressive episode after age nineteen. ADHD usually first occurs in adolescence or earlier, with symptoms appearing by age twelve.

Lack of triggers

With bipolar disorder, your mood swings aren’t connected to anything happening in your life at the time of the shift. You can suffer a depressive mood swing during a time of success, or experience intense manic happiness in the middle of turmoil. The mood swings associated with ADHD, however, are triggered by life events: Happy events result in a happy mood, and vice-versa.

Speed and duration of mood swings

When you’re affected by bipolar disorder, it can take hours or days for your mood to shift to either a manic or depressive state; the mood will then be sustained for at least two weeks. With ADHD, your mood shifts up or down instantly, then shifts back in a matter of hours.

Family history

While exact causes aren’t known, bipolar disorder may be caused by genetics, environmental factors such as stress or trauma, chemical imbalances in your brain, or hormonal imbalances. Heredity appears to be a key factor in your odds of developing this condition: About sixty to eighty percent of cases of bipolar disorder have a hereditary link. A mental health professional looking to make a diagnosis would look for the existence of a family history of the disorder, as well as a family history of suicide. ADHD also likely has a genetic component, so a family history of that condition would be taken into consideration when making a diagnosis.

Response to medication

Your response to various medications can help determine whether you have bipolar disorder or ADHD. Bipolar disorder can often be managed through the use of mood stabilizers, whereas people with ADHD are often prescribed stimulants such as Adderall and Ritalin designed to increase dopamine production in the brain.

Complicating the issue of diagnosis still further is that ADHD and bipolar disorder have been known to co-occur. Studies have shown that up to twenty percent of children with ADHD also have bipolar disorder, while around two-thirds of children with bipolar disorder also have ADHD. The combination of the two conditions can bring about an increased intensity of symptoms and a higher risk of health threats, including suicide. If you were diagnosed with ADHD as a child, you should be assessed for the possible appearance of bipolar disorder as an adult. In the case of co-occurring conditions, the bipolar disorder should be brought under control first. Treatment for both conditions will be independent, but aligned.