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Can adhd and ocd coexist? Is it in the same way mania and depression can coexist (in bipolar disorder)?

Can adhd and ocd coexist? Is it in the same way mania and depression can coexist (in bipolar disorder)?



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Is it really possible for someone to have both ADHD and OCD?

I was thinking that ADHD is the opposite of OCD: 1 2

from 1:

alexThePotato:

With ADHD you may be forgetful, distracted, make careless mistakes, daydream, etc. With OCD, my impression is that you'd be very focused on details, a bit perfectionist, and generally meticulous. So how do they coexist, and what kind of behaviors do you attribute to each?

kukienboks:

Seems to me that OCD is about putting a lot of focus and energy into unimportant things, something which Adhd-ers also can tend to do. The main difference is probably that OCD-ers are driven by anxiety rather than suffering from inability to prioritize tasks.

from 2:

There are also those who believe that OCD and ADHD often occur together. This site on ADHD states, “It is not uncommon for someone to have both ADHD and OCD.” I find this statement baffling, as the basic symptoms of ADHD (listed below), in my opinion, seem to be in direct contrast to those of OCD:

Inattention: Having a short attention span and easily distracted. (Most people with OCD would love to be able to not pay attention to their thoughts.)

Impulsivity: Causes a person to do dangerous or unwise things without thinking about the consequences. (Those with OCD do the exact opposite. They play it safe and obsess about the consequences.)

Hyperactivity: Inappropriate or excessive activity. (Those with OCD often go out of their way to do what they feel is appropriate. Also, in Dan's case, he often had very low energy as he was “wiped out” from struggling with his OCD.)

However I read here that:

Some research has suggested that OCD and Obsessive Compulsive Spectrum Disorders fall upon a compulsive-impulsive continuum. In other words there exists a gradient of disorders ranging from behavioral impulsivity to compulsivity. OCD appears to lie at one end of this spectrum, while ADHD exists at the other.

That reminds of this picture (taken from here):

Does this then mean that ADHD and OCD together is like mania and depression together? Is there a term for the former just like the latter has bipolar disorder?


There's someone in 1 who says

"ADHD makes my mind wander but then my OCD latches onto things I get so focused that nothing else exists."

and someone else who says

"The OCD part of is killing me on the inside on how messy my room is. I hate messy rooms.",

but there seem to be contesting comments such as

"Actual clinical OCD is so very far from the perfectionism you're describing."

and

"You are confusing Obsessive Compulsive Disorder with Obsessive Compulsive Personality Disorder… I don't know if OCPD and be comorbid with ADHD, but I agree that intuitively they don't seem compatible. OCD on the other hand is sometimes misdiagnosed as ADHD (and vice versa) as they both involve problems with impulse control."

There's another comment which might explain how ADHD and OCD are not opposites, but I'm not quite sure I understand (assuming it is right):

they aren't opposites. OCD is when you have strong anxious compulsions that you can't resist. ADHD is when you are unable to resist even weak impulses. They harm the patient in a devilishly sinergistic manner - let's take someone who already has difficulty resisting impulses, and give her compulsions to do useless things!

Is it right? What exactly does that mean?


Yes, they can coexist. No, they aren't opposites. How could they be? Both ADHD and OCD affect a variety of different brain regions, and its effects are not consistent in every person. Maybe if OCD and all its symptoms were always caused by an excess of dopamine in one specific pathway in the reward system, whereas ADHD and all its symptoms was always caused by an decrease of dopamine in that same system, then they wouldn't be compatible. But this isn't the case, and it could never be the case, because the brain is more complex than that.

If mental disorders were diagnosed strictly on oppositional behaviors, then we could easily make the assertion that the opposite of being inattentive would be being hyperfocused. Therefore, nobody who has an attention deficit disorder could achieve hyperfocus, right? But we know to attribute both of these behaviors to ADHD. How can this be?

It is important to remember that mental disorders are not behaviors. OCD is marked by obsessions and compulsions, and any behaviors that may arise do so in the context of mental symptoms. It certainly follows that someone with OCD who has an obsessional focus on staying clean and organized will stay clean and organized -- in general, it is hard to not act on things that you are constantly thinking about and uncomfortable by. This is different from the child with ADHD, who may or may not have trouble staying clean and organized, because to someone who doesn't have some sort of incentive (or 'motivation'), staying clean and organized is really hard to force yourself to do on your own terms. And with ADHD, it can be all the more difficult to achieve that motivation, given the lack of dopamine and/or norepinephrine activity in certain parts of the brain.

That being said, ADHD is not a 'messiness' disorder. The behavior of an ADHD sufferer arises from a complex set of symptoms, usually related to executive dysfunction. As the name may reveal, executive functioning is an abstract yet measurable concept that encompasses a variety of higher-level processes, including regulation of focus, self-management (including keeping oneself organized), and one's capacity for paying attention to detail. Any messiness that arises from this is just an effect from the cause-and-effect relationship that is ADHD.

Likewise, OCD is not a 'neatness' disorder. OCD is marked by obsessions and compulsions. A child with ADHD may have OCD and never feel any compulsion to clean a messy room. There are many different ways that obsessions and compulsions can be demonstrated. A person with OCD may perform rituals, engage in lengthy routines, avoid certain foods, or pick at their skin. They may fear or avoid strange things for no reason at all. Many people with OCD have phobias, and these phobias may interfere with normal life, such as a fear of blood leading someone to never step foot in a doctor's office. Perfectionism and OCD are not the same thing, though perfectionism can be a quality in both.


Is Autism a Psychological Disorder?

Fig 2: Psychological disorder vs Autism – There is only a minor overlap! Download Image

While some symptoms and effects may overlap, Autism and Psychological disorders are a different kettle of fish. Here is a quick comparison:

Table 1: Typical Characteristics present in Psychological Disorder but NOT in Autism

Table 2: Typical Characteristics present in Autism but NOT in Psychological Disorder

Note: While it is 4 times more likely for boys to be diagnosed with Autism, girls identified with Autism are almost twice as likely to be diagnosed with co-existing mental disorders. Please refer to the article on autism in girls vs boys for more details.


When You’re Married to Someone with Bipolar Disorder

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Learn more about bipolar disorder and relationships by reading our relationship blogs.

Bipolar disorder wears many faces. There are as many experiences with bipolar disorder as there are people with bipolar. These experiences run the gamut from wonderful and exciting to confusing, disappointing and devastating. This article addresses some of the issues that can arise when dealing with a spouse with bipolar disorder.

Like all individuals, people with bipolar disorder have many good attributes, but at times, they also display less desirable qualities, such as being withdrawn, irritable, moody, and depressed. They may be affectionate and loving sometimes and then cold and distant at other times. The person may welcome and enjoy sex one day, while rejecting affection the next day. These erratic behaviors can be quite challenging for all concerned, especially spouses.

At times the person with bipolar disorder may experience manic or hypomanic episodes (manic but more controlled and less extreme) during which they can be fun, interesting, talkative, upbeat and full of energy. At other times, the person may experience depression that effects them physically, spiritually and soulfully. The spouse might feel confused, not knowing how to deal with certain behaviors.

The tricky part comes up when neither you nor your spouse knows bipolar disorder may be behind the tension and trouble between the two of you. Often the individual doesn’t even know she has bipolar disorder. People can go years and even decades without a diagnosis or treatment. It might take you to get them in for a diagnosis.

If your spouse has experienced debilitating periods of sadness, followed by periods of high excitement and activity, he or she may have bipolar disorder. Below, you’ll find a list of typical behaviors exhibited by those with bipolar disorder. If your spouse or significant other has been unusually excited or active for a week at a time and displays three of the symptoms listed below, talk with your healthcare provider about bipolar disorder.

  • Racing thoughts, rapid speech
  • Easily distracted, can’t concentrate well
  • Exaggerated optimism and self-confidence
  • An inflated perspective about abilities and qualities
  • Impulsive and reckless behavior
  • Poor decision making, rash business decisions
  • Shopping sprees, excessive money-spending
  • Irresponsible driving choices
  • Sexual promiscuity
  • Delusions (holding untrue beliefs)
  • Hallucinations (seeing and/or hearing things that aren’t there)

Another way to determine if a person has bipolar disorder is to consider his or her childhood. The lives of teens struggling with mood disorders can be marred by poor decisions and/or ineffective, misguided attempts to cope. Teens with mood disorders may experience the following symptoms and/or behaviors:

  • Academic struggles
  • School suspension or expulsion
  • Destruction of property
  • Social isolation
  • Drug and alcohol use
  • Frequent misunderstandings
  • Inability to finish projects
  • Reckless behavior (speeding, unprotected sex, over-spending)
  • Extreme defiance
  • Poor social skills
  • Disconnection
  • Controlling behaviors
  • Suicidal thoughts or attempts

Keep in mind that adults with bipolar disorder may have experienced a childhood in which they were aware that their moods and behaviors were different from their peers, resulting in a sense of being different, disconnected, or outcast. As a result they are likely to develop poor coping skills that do them an injustice as adults. Some of these coping mechanisms include:

Disconnection: When young people with bipolar can’t understand or predict others’ moods and behaviors, they may cope with feeling disconnected by withdrawing, usually interacting with one or very few people who can meet their needs.

Controlling Behaviors: When you can’t predict someone else’s behavior, one way to feel safe is to learn to control others. Control is a subtle art, and often controlling people have been practicing it for decades. A portion of the bipolar population becomes “controlling.” This at first can show up as a talkative and outgoing, but soon suggestions and discussions become manipulative. Examples of controlling statements include:

  • “Why would you do that?”
  • “Does that really make sense?”
  • “Only an insecure person would think that way.”

These habits can be so ingrained that they are difficult to change without professional help.

Drug/Alcohol Abuse: The feelings someone with bipolar disorder experiences can be so overwhelming, they might think the only way out is with street drugs. A significant proportion of those who abuse alcohol and narcotics have an underlying mood disorder, particularly bipolar disorder and depression.

Overspending: During mania or hypomania, someone with bipolar disorder can find all sorts of reasons to rationalize spending gobs of money on whatever their hearts desire. Some people who know they struggle with this choose to let their spouses control the money, particularly when they recognize a manic episode coming on. This may involve the other spouse keeping the credit cards or even the car keys.

Irritability: People with bipolar disorder and even those with depression can experience uncontrollable irritability. A spouse often serves as an outlet for their overwhelming anger, but so can children, other drivers and other family members.

Grandiosity: The imbalance of chemicals in the brain can cause those with bipolar disorder to have an inflated images of themselves. They may feel they’re more talented or more psychic than most. They may think that they’re needed take care of governmental or world-wide problems.

Try to remember that the person suffering from bipolar disorder does not directly control most of these behaviors (although they can learn to work on them in therapy). They are influenced by the balance or imbalance of chemicals in their brain.

What Does It Mean for Our Marriage if My Spouse Has Bipolar Disorder?

There are two answers to this question. If you spouse fully accepts the diagnosis and resolves to get treatment, you could begin working together and make the marriage stronger than ever. Many people with bipolar disorder have happy, successful marriages.

If, on the other hand, your spouse refuses treatment, you must learn to protect yourself from abuse. Abuse can take the form of

  • Verbal abuse (rampant blaming)
  • Financial abuse (spending money taking on massive debt)
  • Emotional abuse (controlling, cruel behavior)
  • Physical abuse (when irritability spins out of control)

Read our article on Encouraging a Loved One to Get Help for tips on discussing bipolar with your spouse. And see our article on Finding a Good Therapist for when they are ready to take that step.

We offer a variety of resources to help those with bipolar disorder and their loved ones. One of these is our free e-book, Healthy Living with Bipolar Disorder, which covers all of the basic information you need to know about bipolar. View a list of the rest of our programs here.


Conclusions

Because DMDD has just entered the nosology, only approximate recommendations are feasible. It is unknown whether use of this diagnosis will reduce diagnoses of pediatric bipolar disorder. If so, it will at the very least preclude communicating to parents that their child potentially has a lifelong illness, which is often the case for individuals with true bipolar disorder. It is further hoped that use of the diagnosis will lead to the identification of a group of highly impaired children for whom targeted interventions can be established.


The Connection Between OCD & Psychosis

When my son Dan&rsquos obsessive-compulsive disorder (OCD) became severe, he was in college, fifteen hundred miles away from home. My husband and I arranged for him to see a psychiatrist near his school, who telephoned us (with our son&rsquos permission) after he met with Dan. The doctor certainly didn&rsquot sugarcoat anything. &ldquoYour son is suffering from severe OCD, and he is borderline psychotic.&rdquo

I knew very little about OCD at that time, but I knew what psychotic meant: out of touch with reality. I was terrified. Psychosis made me think of schizophrenia, though that illness was never mentioned. In fact, after I united with Dan and we met with the psychiatrist together, there was no more reference to psychosis.

So what was going on? What my son was experiencing was OCD with poor insight. In many instances, OCD sufferers are aware that their obsessions and compulsions are irrational or illogical. They know, for example, that tapping the wall a certain number of times will not prevent bad things from happening. And they know their compulsive tapping is interfering with their lives. But they can&rsquot control their compulsions, and so they tap away.

Those who have OCD with poor insight do not clearly believe their thoughts and behaviors are unreasonable, and might see their obsessions and compulsions as normal behavior a way to stay safe. It is interesting to note that the recently published DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) specifies that OCD may be seen with: good or fair insight, poor insight, or absent insight/delusional beliefs.

In all previous editions of the DSM, the criteria for the diagnosis of obsessive-compulsive disorder included the sufferer&rsquos realization that their obsessions and compulsions are irrational or illogical. Now, absent insight/delusional beliefs can be part of an OCD diagnosis. In addition, the statement, &ldquoAt some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable,&rdquo has been removed.

Another important aspect of the disorder to be aware of is the fact that OCD sufferers&rsquo levels of insight can fluctuate, depending on the circumstances. When Dan was initially diagnosed with OCD, he did indeed have good insight. He knew his obsessions and compulsions made no sense. But by the time he met with the psychiatrist mentioned earlier, his OCD had gotten so severe that he had poor, or possibly even absent, insight. This is when the doctor used the term &ldquoborderline psychosis.&rdquo

In some cases, OCD sufferers&rsquo levels of insight can change quickly. For example, while calmly discussing a particular obsession and compulsion, those with OCD might acknowledge their thoughts and behaviors are unreasonable. But an hour later, when they are panic-stricken and in the middle of what they perceive as imminent danger, they might totally believe what they had previously described as nonsensical. This is the nature of obsessive-compulsive disorder.

It is crucial to differentiate between OCD and a psychotic disorder, because drugs that are prescribed for psychosis (antipsychotics) have been known to induce or exacerbate symptoms of OCD. In addition, research has shown that these antipsychotics often do not help those with severe OCD. In Dan&rsquos case, the antipsychotics he was prescribed did indeed exacerbate his OCD, in addition to causing a host of serious side effects, both physical and mental.

OCD sufferers and their caregivers need to be aware that things are not always what they seem. A misdiagnosis of psychosis in those with OCD is just one example. A comorbid diagnosis of depression or ADHD are others. Because the DSM-5 categorizes certain behaviors as belonging to specific illnesses, we really need to be careful not to jump to conclusions in reference to diagnoses and subsequent treatments.

In the case of obsessive-compulsive disorder, maybe the best way to proceed is by treating the OCD first, and then reassessing the situation. Once OCD has been reined in, we might be surprised to find that symptoms typically associated with other disorders have fallen by the wayside as well.


How are bipolar disorder and ADHD different?

Bipolar disorder and attention deficit hyperactivity disorder (ADHD) are two distinct health conditions. They share some similar symptoms but have several key differences.

ADHD is more common than bipolar disorder. As the two conditions can coexist, misdiagnosis can occur.

In this article, we compare bipolar disorder and ADHD. Read on to learn about the symptoms of each and how they can overlap. We also explain treatments and when to see a doctor.

Share on Pinterest Bipolar disorder affects mood, while ADHD affects behavior.

Bipolar disorder is a long-term mental health condition that can cause unusual shifts between high and low moods.

Symptoms occur in episodes rather than being ongoing. In addition to affecting how a person thinks and feels, bipolar disorder can influence their behavior.

In contrast, ADHD is a condition that affects a person’s attention, activity, and impulse control. It primarily affects behavior, not mood. Symptoms are ongoing rather than occurring in episodes.

Bipolar disorder and ADHD can share some similar symptoms, especially in relation to manic episodes.

If a person has bipolar disorder, manic episodes may cause them to feel happy and confident and to have excessive energy. During a manic episode, a person might be:

  • moving about a lot
  • talking often, quickly, or loudly
  • interrupting people
  • becoming distracted easily
  • acting impulsively

Manic episodes are not a symptom of ADHD, but a person with ADHD may experience some of the symptoms of a hypomanic episode.

Although there may be some symptom similarities, the underlying causes of bipolar disorder and ADHD are different.

Manic episode symptoms happen because of a mood state, while ADHD symptoms tend to be more consistent.

Sometimes, people think that ADHD is synonymous with “hyperactive” or “impulsive” behaviors, and while this may be the case for some people, this is not universally true. Some children and adults with ADHD have symptoms of inattention.

  • inattention to detail
  • trouble focusing
  • daydreaming
  • not listening when people speak to them
  • avoiding mental exertion
  • losing belongings frequently
  • forgetting to complete tasks

The symptoms of inattentive ADHD are not typical of bipolar disorder.

If a person has bipolar disorder and experiences a depressive episode, it may make them feel sad, hopeless, and low in energy. They may also withdraw socially.

Depressive episodes are not a symptom of ADHD, but some people with ADHD may also experience depression.


Eating Disorders and Bipolar Disorder

Some bipolar patients may also have eating issues like anorexia and bulimia.

Patients with bipolar disorder must work to control mood swings that range from manic to depressive. Evidence is mounting that many bipolar patients also must struggle to control their appetite, as they are likely to have some sort of eating disorder.

Research has found that many people with bioplar disorder have eating issues like bulimia nervosa, anorexia nervosa, and binge-eating disorder. A recent study found one in five bipolar patients in its group of participants met the criteria for a lifetime eating disorder.

These studies are far from conclusive, as they often focus on small samples, or groups of patients. However, evidence does suggest that bipolar patients are more likely than the general public to have an eating disorder. Researchers are also trying to identify the links between bipolar disorder and eating disorders.

At Risk: Eating Disorders Among Bipolar Patients

The eating disorders most closely associated with bipolar disorder are:

  • Bulimia nervosa. People with bulimia tend to gorge themselves on food, then immediately “purge” or rid their bodies of the food by vomiting or using laxatives or diuretics. Bulimia is the eating disorder most closely associated with bipolar disorder, as current research firmly supports a connection between the two.
  • Anorexia nervosa. People with anorexia tend to develop an adversarial relationship with food. They generally avoid eating and skip meals. When they do eat, they may obsessively weigh their food and count calories or eat small amounts of a few, carefully chosen "acceptable" foods. Anorexics also tend to exercise obsessively. Anorexia is not as closely associated with bipolar disorder, although some studies have found a link between the two.
  • Binge-eating disorder. Binge eaters tend to compulsively overeat, but unlike bulimics, they do not purge afterward. They tend to feel shame or guilt over their eating and often eat by themselves and very quickly. Many bipolar patients report periods of binge eating, although whether they have a full-fledged disorder is not certain. Some medications for bipolar disorder promote binge eating.

The Bipolar-Eating Disorders Connection

Researchers aren't yet sure why bipolar disorder seems to be linked with eating disorders. However, the two problems share many characteristics, including:

  • Eating irregularities
  • Weight problems
  • A tendency to act impulsively and rashly
  • Behaving in a compulsive manner, repeating purposeless acts or following odd but well-established sets of rules
  • A tendency to "cycle" — with eating disorders, it’s between bulimia and anorexia with bipolar disorder, it’s between depression and mania

The severity of a person's bipolar disorder may influence the development and severity of an eating disorder. One study found that people with worse bipolar symptoms and deeper mood swings were more apt to develop either bulimia or bulimia combined with anorexia.

Treating Both Bipolar and Eating Disorders

Managing both a bipolar disorder and an eating disorder can be challenging. For example, antidepressants are often used to treat eating disorders, but these medications are not recommended for bipolar patients, as they can prompt a manic mood swing. Doctors also need to be careful about prescribing mood stabilizers or anti-psychotics to bipolar patients who are either obese or binge eaters, as these drugs have been known to trigger binge-eating episodes.

Therapy can be helpful for coping with eating disorders. Psychotherapy, family therapy, and behavioral therapy are known to be beneficial in treating anorexia, bulimia, and binge eating.


Autism spectrum disorder, or ASD, includes what used to be called Autistic Disorder, Asperger syndrome, or Pervasive Developmental Disorder – Not Otherwise Specified, all of which affect a person’s social and emotional skills and nonverbal communication. ASD has many similarities to ADHD, but there are also differences between the two.

Can a person be diagnosed with both ADHD and ASD?

More than half of all individuals who have been diagnosed with ASD also have signs of ADHD. In fact, ADHD is the most common coexisting condition in children with ASD. On the flip side, up to a quarter of children with ADHD have low-level signs of ASD, which might include having difficulty with social skills or being very sensitive to clothing textures, for example.

Why do ADHD and ASD coexist so often and what are the similarities between them?

Both ADHD and ASD are neurodevelopmental disorders (brain development has been affected in some way). That means both conditions/disorders affect the central nervous system, which is responsible for movement, language, memory, and social and focusing skills. A number of scientific studies have shown that the two conditions often coexist, but researchers have not yet figured out why they do.

With ADHD or ASD, brain development has been affected in some way. Most importantly, that includes the brain’s executive functioning, which is responsible for decision making, impulse control, time management, focus, and organization skills. For many children, social skills are also affected. Both ADHD and ASD are more common in boys.

Although adults can have both ADHD and ASD, the combination is not as common as it is in children. While ASD is considered a lifelong disorder, long-term studies have shown that in one-third to two-thirds of children with ADHD, symptoms last into adulthood.

What are the differences between ADHD and ASD?

Many children are first diagnosed with ADHD around the time they start preschool or kindergarten because their behavior contrasts with that of their classmates. ADHD can cause children to be restless all the time, act impulsively, and have a hard time paying attention. But some children with ADHD have different signs—focusing all their attention on one toy, for instance, and not wanting to play with anything else.

For some children with ASD, the signs are noticeable before they reach their second birthday. For others, signs of ASD may not be clear until they are school-aged and their social behaviors are clearly different from their classmates’. Children with ASD often avoid eye contact and don’t seem interested in playing or engaging with others. Their ability to speak may develop slowly or not at all. They may be preoccupied with sameness in textures of food or in making repetitive movements, especially with their hands and fingers.

ADHD- and ASD-specific behaviors

Often, children with ADHD have difficulty focusing on one activity or task. When they are engaged in their daily activities they may be easily distracted. It is challenging for children with ADHD to complete one task before jumping to another, and they are often physically unable to sit still. But some children with ADHD may be so interested in a topic or activity that they fixate on it, or hyperfocus. Although focusing on one thing can be positive, it may mean that children have difficulty moving their attention to other activities when they are asked to do so.

Children with ASD are most likely to be overfocused, unable to shift their attention to the next task. They are often inflexible when it comes to their routines, with low tolerance for change. That may mean taking the same route and eating the same things every day. Many are highly sensitive or insensitive to light, noise, touch, pain, smell, or taste or have a strong interest in them. They may have set food preferences based on color or texture and may make gestures such as repeated hand flapping. Their intense focus means people with ASD are often able to remember detailed facts for a long time and may be particularly good at math, science, art, and music.

Treatment overview

The best medical provider for someone who has been diagnosed with both ADHD and ASD is a doctor who has experience treating both conditions.

Treatment for ADHD usually includes medication. On the other hand, because the medication options for ASD are still limited, children with ASD may respond better to non-medication alternatives. Those might include behavior therapy to help manage symptoms and skills training to help cope with daily life. For a child with ASD, paying attention to diet is essential, because sensory-based food restriction can result in nutritional gaps. For someone with ADHD, stimulant medications can cause a loss of appetite.

While the symptoms of ADHD generally respond well to the most commonly prescribed medications, ASD symptoms are less likely to do so. Symptoms of ASD that often overlap with ADHD, such as hyperactivity, impulsiveness, and inattention, may respond to the medications used to treat ADHD, if not as well. Medications to treat ASD are now being developed, and irritability, aggression, and self-injury that are related to ASD usually respond to antipsychotic medications.

Medication is frequently part of the treatment plan for children with ADHD because it helps reduce some of the major symptoms, including hyperactivity and impulsivity. The most commonly prescribed medications are methylphenidate (Ritalin, Concerta, Metadate, Quillivant), amphetamine (Adderall, Dexedrine, Vyvanse, Dyanavel), atomoxetine (Strattera), and guanfacine (Intuniv, Tenex). However, when they are used to treat patients with both ADHD and ASD, the stimulants—methylphenidate and amphetamine—seem less effective and cause more side effects, including social withdrawal, depression, and irritability, than when they are used to treat ADHD alone.

For more information

  • Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2005). Randomized, Controlled, Crossover Trial of Methylphenidate in Pervasive Developmental Disorders with Hyperactivity. Archives of General Psychiatry, 62(11):1266-1274.
  • Handen, B.L. et al. (2015). Atomoxetine, Parent Training, and Their Combination in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(11), 905-915.
  • The MTA Cooperative Group. (Dec 1999). A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Archives of General Psychiatry, 56(12):1073-1086.
  • Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2002). Randomized clinical trial of risperidone for irritability in autism. New England Journal of Medicine, 347(5):314-321.
  • Rommelse, Nanda et al. (May 2018). Differentiating between ADHD and ASD in childhood: some directions for practitioners.European Child & Adolescent Psychiatry, pp 1–3.

The information provided by CHADD’s National Resource Center on ADHD is supported by Cooperative Agreement Number NU38DD005376 funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Department of Health and Human Services (HHS).


Bipolar and schizophrenia symptoms

Bipolar disorder and schizophrenia are psychiatric conditions that have some common traits, but also key differences. Bipolar disorder causes shifts in mood, energy levels, and thinking. Schizophrenia causes a person to appear to lose touch with reality.

People with bipolar disorder may experience episodes of mania and depression, often separated by periods of relative stability.

Individuals with schizophrenia experience symptoms of psychosis, such as hallucinations or delusions. Some people with bipolar disorder also experience psychotic symptoms.

Because of some overlap in symptoms, getting the right diagnosis can be challenging. Also, a person can have both schizophrenia and bipolar disorder, which can complicate diagnosis.

Some people have schizoaffective disorder, which involves a combination of schizophrenia symptoms and those of a mood disorder.

In this article, we look at the similarities and differences between bipolar disorder and schizophrenia. We also discuss methods of diagnosis and treatment options.

Share on Pinterest People with bipolar disorder experience extreme changes in mood.

Symptoms of bipolar disorder and schizophrenia vary and can differ in type and severity.

They may get worse, then significantly improve or go away for a period, which some doctors call remission.

People with bipolar disorder experience extremes in mood. Doctors may classify “highs” as mania or hypomania, while “lows” involve a decrease in mood and often depression.

In some types of bipolar disorder, people experience a less severe form of mania, known as hypomania. The symptoms are the same, but in hypomania, they are less severe. Nonetheless, they affect a person’s life and relationships.

A manic episode is all that is necessary for a diagnosis of bipolar I, while hypomania preceding or following a major depressive episode is necessary for a diagnosis of bipolar II. A person often experiences periods of relative stability in between.

Symptoms of mania

  • anger or irritability
  • difficulty sleeping or less need for sleep
  • excessive energy and restlessness
  • high self-esteem
  • inability to concentrate or make decisions
  • increased engagement in pleasurable activities, such as sexual activity or drug use
  • intense excitement
  • racing thoughts
  • reckless behavior, such as overspending

In a person with bipolar disorder, depressive symptoms are the same as those in major depressive disorder.

Symptoms of depression

The primary symptom is a feeling of sadness or hopelessness that persists for 2 weeks or longer.

  • changes in appetite
  • changes in sleep habits and low energy
  • a loss of interest in things once enjoyed
  • low self-esteem
  • physical aches and pains without an apparent cause or behaviors

Bipolar disorder can also cause anxiety and psychotic episodes, during which a person loses touch with reality.

Approximately half of all people with a bipolar disorder diagnosis experience psychotic hallucinations or delusions.

When people display psychotic symptoms, doctors may be unsure whether they have bipolar disorder or schizophrenia.

Schizophrenia symptoms affect a person’s thoughts, emotions, and behaviors. They include:

Delusions

These are false beliefs, and most people with schizophrenia experience them.

People may think, for example, that they are famous or special in a certain way, that they are being harassed or stalked, or that something terrible is about to happen.

Hallucinations

During a hallucination, people see, hear, or smell things that are not there. The most common type involves hearing voices.

Disorganized thinking and speech

People may not make sense when communicating with others. They may give unrelated answers to questions, or their sentences may seem meaningless to the people around them.

Abnormal behavior

People with schizophrenia may demonstrate unpredictable behavior, for example, by making childlike actions, strange postures, or excessive movements.

Inability to function regularly

Schizophrenia can affect a person’s ability to take care of their personal hygiene, engage with others in socially acceptable ways, or perform everyday activities.

The following symptoms can occur with bipolar disorder or schizophrenia:

Psychotic episodes

For some people with bipolar disorder, these hallucinations or delusions arise during severe episodes of mania or depression.

Disorganized thinking

This is common among people with schizophrenia, but people with bipolar disorder may seem to have disorganized thoughts during episodes of mania. They may struggle to concentrate on a single idea or task at a time.

Symptoms of depression

During periods of depression, people with either condition may demonstrate a loss of interest in things they once enjoyed. Some people feel unable to experience pleasure or have trouble concentrating or making decisions.

Some researchers report high rates of drug and alcohol misuse among people with schizophrenia, bipolar disorder, or depression.

If a person has significant symptom overlap, they may receive a diagnosis of schizoaffective disorder, a related but separate mental health condition.

Bipolar disorder is more common than schizophrenia.

According to the National Institute of Mental Health, approximately 2.8 percent of adults in the United States experience bipolar disorder in a given year, and 4.4 percent experience it at some point in their lives.

Among them, 82.9 percent have serious impairment due to their symptoms, and 17.1 percent have moderate impairment.

On average, the disorder develops at 25 years of age, and it occurs at an equal rate in males and females.

According to a study in American Family Physician, 0.3–0.7 percent of people worldwide have schizophrenia, making it the most common psychotic illness.

It is marginally more common among males, and symptoms tend to first appear between late adolescence and a person’s mid-30s.

Diagnosis of both conditions involves the same procedures. A doctor or mental health professional will likely perform:

A physical examination

This helps determine if medical problems are causing psychological symptoms. A doctor may also request specific tests, such as:

A psychological evaluation

A doctor, most likely a psychiatrist, will explore a person’s signs and symptoms, including those that affect thoughts, emotions, and behaviors.

They will also ask about family and personal mental health histories, and they may have the person complete a psychological self-assessment form.

During this evaluation, the doctor will also observe the person’s appearance and actions to look for signs of schizophrenia and bipolar disorder.

In addition, they will compare the person’s symptoms with the criteria set out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, commonly called the DSM-5.

Diary of symptoms and moods

It may help to keep a daily diary of thoughts, moods, and sleep patterns. The doctor may examine this to identify patterns in behavior and other clues that can inform diagnosis and treatment.

Both conditions require lifelong treatment to manage symptoms.

Treatment for bipolar disorder

Many people with bipolar disorder require medications to stabilize their moods.

  • lithium, a mood stabilizer that may significantly help prevent relapse in the long term
  • antipsychotic drugs
  • sleeping pills

Psychotherapy is an important part of bipolar disorder management. It may take place individually or with a group or the person’s family.

Therapy can help people manage their thoughts and emotions, establish a routine, and identify triggers.

Those who do not respond to medications or psychotherapy may benefit from electroconvulsive therapy (ECT). The goal is to alter the brain’s chemistry by sending electrical currents through the brain, causing a seizure.

Other strategies that can help people with bipolar disorder include:

  • avoiding alcohol and drugs
  • eating a balanced diet
  • establishing a daily routine
  • exercising regularly
  • getting enough sleep
  • identifying triggers and taking steps to prevent or lessen manic or depressive episodes
  • managing stress
  • seeking help and support from family, friends, and others

Treatment for schizophrenia

Antipsychotic medications are a vital part of treatment for most people with schizophrenia. Doctors believe that they alter the brain’s chemistry and reduce symptoms such as hallucinations and delusions.

Some individuals also require other medicines, such as antidepressants or anti-anxiety drugs. For people who do not respond to medications, a doctor may recommend ECT, which can improve psychotic symptoms.

When the symptoms of psychosis are under control, people with schizophrenia typically benefit from psychological and social interventions. These may include:

  • psychotherapy, both in individual and family settings
  • social skills training, to improve interactions with others
  • employment support, to help a person secure or perform a job more easily
  • daily living support, to help people find housing and manage daily responsibilities

Other coping strategies include:

  • avoiding alcohol and drug use
  • joining a support group
  • learning about schizophrenia
  • making certain healthful lifestyle choices, such as eating a balanced diet, exercising, and maintaining a sleep schedule
  • managing stress through meditation, exercise, and yoga
  • seeking help from family and friends

Although there are similarities between bipolar disorder and schizophrenia, there are also key differences, particularly relating to symptom severity and treatment.

People with bipolar disorder generally alternate between periods of low and high moods, while people with schizophrenia typically lose touch with reality as they experience hallucinations and delusions.

With treatment, a person who has either condition can manage their symptoms and reduce the impact that it has on their life.

Bipolar disorder is typically more manageable after a person receives appropriate treatment. Schizophrenia is more challenging to treat, and people who have it tend to require greater support.


Is It Bipolar Disorder or Something Else?

At the peak of mania, bipolar symptoms may look like schizophrenia. At a deep low, it's hard to distinguish between depression and bipolar disorder. How can you tell the difference?

The first step to successfully managing bipolar disorder? Getting an accurate diagnosis.

But because symptoms of other mental health conditions — such as depression and ADHD — can mimic bipolar disorder, getting to that diagnosis can be tricky. Even experienced mental health professionals can find it hard to diagnose bipolar disorder, especially if all they have to work with is a person in crisis or the statements of the bipolar patients themselves.

“When someone with bipolar disorder goes for treatment, they fairly naturally will downplay their hypomanic or manic episodes,” explains Michael Otto, PhD, professor of psychology at Boston University and author of Living with Bipolar Disorder. That’s why it works best when friends and family are involved, he says. People with bipolar disorder may not recall how bad their episode was or may try to minimize it because they are embarrassed. Yet it is those extremes and overall patterns that ultimately distinguish bipolar disorder from other conditions.

Here’s a look at six other mental health conditions that often get mistaken for bipolar disorder — and how you can tell the difference.