Bipolar Disorder and ADHD

If you have been diagnosed with one of these conditions but still feel like something is being missed, you are not alone. Bipolar disorder and ADHD share overlapping symptoms, are frequently mistaken for one another, and often genuinely co-occur. An ADHD assessment can help bring clarity to a picture that has long felt incomplete.

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Is There a Link Between Bipolar Disorder and ADHD?

Bipolar disorder and ADHD are distinct conditions, but they share significant symptom overlap and a higher-than-expected rate of co-occurrence. Research suggests that approximately 1 in 13 adults with ADHD is also diagnosed with bipolar disorder, and around 1 in 6 adults with bipolar disorder has ADHD.¹ Both conditions are frequently misdiagnosed as the other, and when they co-occur, the combination tends to produce more severe symptoms and greater functional impairment than either condition alone.

Where ADHD involves persistent difficulties with attention, impulse control, and activity regulation, bipolar disorder is characterised by episodic shifts in mood between periods of elevated energy or mania and depression. Understanding the pattern and timing of symptoms is central to distinguishing the two, and to ensuring neither is missed.

Bipolar Disorder and ADHD Symptoms

Symptoms vary significantly depending on a person’s age, gender, and the current phase of bipolar disorder. While ADHD involves persistent, trait-like difficulties, bipolar disorder presents in distinct episodes that shift over time.

Note: Every person’s experience of bipolar disorder and ADHD is different. The patterns below are meant to help you recognise and name what you may be going through, not to replace a professional assessment.

What does Bipolar Disorder Feel like?

During a manic or hypomanic episode:

Significantly reduced need for sleep without feeling tired.
Unusually elevated, expansive, or irritable mood.
Inflated self-esteem or grandiosity.
Racing thoughts or a sense that the mind will not slow down.
Increased goal-directed activity or physical energy.
Impulsive or risky behaviour, such as overspending or reckless decisions.
Rapid or pressured speech.

During a depressive episode:

Persistent low mood, sadness, or emptiness.
Fatigue and loss of energy.
Difficulty concentrating or making decisions.
Loss of interest in previously enjoyed activities.
Changes in sleep and appetite.
Feelings of worthlessness or hopelessness.

What does ADHD feel like?

In children:

Often fidgety or unable to stay seated for expected periods.
Easily distracted by background noise, movement, or thoughts.
Frequently forgets or loses track of instructions and belongings.
Rushes through tasks, leading to careless errors.
Blurts out answers or struggles to wait their turn.

In adults:

Persistent difficulty with organisation, planning, and meeting deadlines.
Frequently losing items like keys, phones, or documents.
Making impulsive decisions without fully considering consequences.
Feeling internally restless even when sitting still.
Trouble sustaining focus during long tasks or conversations.

How to Know If It Is Bipolar Disorder, ADHD, or Both

Mood instability, impulsivity, and difficulty with concentration can arise from ADHD, bipolar disorder, or a combination of both.

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder involving distinct episodes of mania or hypomania and depression. It is not a personality trait or a permanent state; it is a cyclical condition with periods of significant elevation and significant low that come and go, often unconnected to specific life events. With proper treatment, many people with bipolar disorder lead stable and fulfilling lives.

What Is ADHD?

ADHD is a neurodevelopmental condition affecting attention, activity levels, and impulse control. It begins in childhood and frequently continues into adulthood, though how it presents changes with age. ADHD is persistent and trait-like rather than episodic. Its difficulties are present across all areas of life, not confined to specific mood episodes.

Symptom / Behavior

Bipolar Disorder

ADHD

Racing thoughts or a busy mind

Impulsivity or risky behaviour

Difficulty concentrating

Physical restlessness or excess energy

Reduced need for sleep

Elevated or grandiose mood

Persistent low mood or depression

Symptoms present since childhood

Mood fluctuates in distinct episodes

Difficulties consistent across all moods

Emotional reactions triggered by life events

Mood shifts unconnected to external events

Talkativeness and difficulty being interrupted

Seeing overlap in both columns? The similarity between these two conditions is one of the most common sources of misdiagnosis in mental health. An ADHD assessment can be an important step toward understanding your full picture.

Bipolar Disorder and ADHD: Understanding the Overlap

Both conditions affect emotional regulation, impulsivity, and the ability to sustain productive focus. They can look nearly identical from the outside, particularly during a manic or hypomanic episode where energy is high, thoughts are rapid, and behaviour is impulsive. This is why bipolar disorder is one of the most common misdiagnoses in adults who actually have ADHD, and vice versa.

The most reliable differentiating feature is pattern over time. ADHD difficulties are persistent. They were present in childhood, they are present across all moods, and they do not come and go in distinct episodes. Bipolar disorder, by contrast, involves a return to a relatively normal baseline between episodes. A person in a depressive episode of bipolar may have difficulty concentrating, but that difficulty resolves when the episode lifts. In ADHD, the difficulty with focus is always there.

When both conditions genuinely co-occur, individuals tend to have an earlier onset of mood episodes, more frequent cycling between moods, and greater overall impairment.¹ This is why identifying both, rather than assuming one explains the other, matters enormously for treatment and quality of life.

Why Bipolar Disorder and ADHD Are So Often Confused

Understanding why these two conditions are so frequently mistaken for one another helps explain why many people spend years in the wrong treatment pathway.

Commonalities Between Bipolar Disorder and ADHD

Both bipolar disorder and ADHD can involve rapid speech, distractibility, impulsive decisions, emotional intensity, and periods of apparent high energy. During a hypomanic episode especially, the presentation of bipolar disorder can be almost indistinguishable from ADHD. A clinician who sees a highly energised, distractible, fast-talking adult without a detailed childhood history may reasonably conclude ADHD, just as a clinician who focuses on mood may overlook ADHD entirely.

The Cost of a Missed Diagnosis

When bipolar disorder is missed in someone with ADHD, they may receive only stimulant medication, which can in some cases exacerbate manic symptoms. When ADHD is missed in someone with bipolar disorder, the underlying attention and organisation difficulties go unaddressed even when mood is stabilised, leaving the person still struggling despite technically being in remission. Research consistently shows that people with both conditions have poorer outcomes, more hospitalisations, and more co-occurring psychiatric disorders than those with either condition alone.¹

The Role of Childhood History

One of the most important clinical tools for distinguishing ADHD from bipolar disorder is a thorough developmental history. ADHD symptoms must be present from childhood. If difficulties with attention and impulse control began before the age of 12 and have been consistent across all moods and all settings throughout life, ADHD is likely a significant part of the picture. This history is central to any good ADHD assessment.

How Bipolar Disorder and ADHD Are Diagnosed

Because the conditions share so many outward features, diagnosis requires careful attention to timing, pattern, and developmental history. Neither condition should be assumed to explain the other.

How Bipolar Disorder Is Assessed

Bipolar disorder is diagnosed by a psychiatrist following a thorough clinical assessment that explores the pattern, duration, and severity of mood episodes. This includes a detailed history of manic, hypomanic, and depressive periods, their duration and frequency, any impact on functioning, and whether the mood shifts occur in the context of specific life events or seem to arise independently. Family history of mood disorders is also an important factor. A reliable longitudinal picture, often gathered from the individual and from people who know them well, is central to an accurate diagnosis.

What an ADHD Assessment Usually Involves

An ADHD assessment examines patterns of inattention, hyperactivity, and impulsivity across different settings. It includes a detailed developmental and behavioural history, with particular attention to childhood onset, standardised rating scales, and a clinical interview. Because ADHD and bipolar disorder overlap so significantly, a thorough ADHD assessment will explore mood history carefully to build an accurate picture of what is driving the difficulties and when they first appeared.

Support for Bipolar Disorder and ADHD

When both conditions are present, treatment requires careful sequencing and coordination. Medication choices that suit one condition may complicate the other, making specialist oversight essential.

Managing ADHD

ADHD support focuses on reducing the daily impact of attention and impulse difficulties through behavioural strategies, executive function coaching, and structured routines. Environmental adjustments and practical tools, such as planning systems and reminders, can significantly reduce the friction of daily life. Medication, typically stimulants, is commonly used and can be discussed with a qualified clinician as part of a broader plan.

Support for Bipolar Disorder

Bipolar disorder is typically managed with mood stabilisers, which prevent and reduce the severity of mood episodes. Antipsychotic medication may also be recommended in some cases. Psychological support, including therapy focused on understanding mood patterns, building regularity in sleep and daily routines, and recognising early warning signs of episodes, is a core part of ongoing management.

When Both Occur Together

When both conditions are present, mood stabilisation is generally addressed first. Stimulant medication for ADHD may be considered once mood is stable, under close clinical supervision. Research supports this sequencing approach to reduce the risk of stimulants triggering mood episodes.¹ A thorough ADHD assessment is an important first step that contributes essential information to any joint treatment plan.

Ready to Understand Your Full Picture?

If you have a bipolar diagnosis but still feel like your difficulties with focus, organisation, and daily functioning are not fully explained, ADHD may be part of the picture. If you have an ADHD diagnosis but experience significant mood episodes that go beyond emotional dysregulation, bipolar disorder may also be present.

An ADHD assessment is a clear and structured starting point. Understanding whether ADHD is genuinely contributing to your experience gives you and any clinician working with you concrete information to work with.

Ready to Get Clarity on Your Symptoms?

Have Any Questions?

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Can you have both ADHD and bipolar disorder?

Yes. Research suggests approximately 1 in 13 adults with ADHD also has bipolar disorder, and around 1 in 6 adults with bipolar disorder has ADHD.¹ When both are present, symptoms tend to be more severe and more complex to manage, which is why accurate diagnosis of both matters enormously.

How do you tell the difference between ADHD and bipolar disorder?

The most reliable distinction is pattern over time. ADHD is persistent and present across all moods since childhood. Bipolar disorder involves distinct mood episodes that come and go. During a manic episode, bipolar can look almost identical to ADHD, but between episodes, bipolar symptoms typically resolve, whereas ADHD difficulties remain constant.

Can ADHD be misdiagnosed as bipolar disorder?

Yes, and it happens frequently. Emotional intensity, impulsivity, and rapid thoughts in ADHD can resemble a hypomanic episode, particularly in adults without a careful developmental history. Conversely, bipolar is often missed in people diagnosed with ADHD. A thorough assessment with an experienced clinician is the safest route to an accurate diagnosis.

Does having ADHD increase the risk of developing bipolar disorder?

Research suggests that people with ADHD are at a higher risk of developing bipolar disorder than the general population, and that those who develop bipolar tend to do so earlier in life.¹ The shared genetic vulnerabilities between the two conditions are an active area of research.

Can stimulant medication be used if someone has both ADHD and bipolar disorder?

This is a decision that requires careful clinical judgment. Current guidance generally recommends stabilising mood first, then considering stimulant medication for ADHD under close monitoring. In some individuals, stimulants can exacerbate manic symptoms. Working with a specialist who is experienced in both conditions is essential.

Is emotional dysregulation in ADHD the same as bipolar disorder?

No, but it can look similar. People with ADHD often experience intense emotional reactions to life events, a pattern sometimes called rejection sensitive dysphoria. These reactions are triggered and tend to pass relatively quickly. Bipolar mood episodes arise more independently of specific triggers, last longer, and form a distinct pattern over time.

Who should I speak to if I think I might have both ADHD and bipolar disorder?

A psychiatrist with experience in both conditions is the most appropriate clinician. An ADHD assessment is a good structured starting point. The developmental history gathered during a thorough ADHD assessment is directly useful to any subsequent evaluation for bipolar disorder.

References

Schiweck C. et al. (2021) Comorbidity of ADHD and adult bipolar disorder: a systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews.
Salvi V. et al. (2021) ADHD and bipolar disorder in adulthood: clinical and treatment implications. Brain Sciences.
Perugi G. et al. (2022) Differentiation and comorbidity of bipolar disorder and ADHD in children, adolescents, and adults: a clinical and nosological perspective. Frontiers in Psychiatry.
Girard R. et al. (2017) Treatment of ADHD in patients with bipolar disorder. Journal of Psychiatry and Neuroscience.