Bipolar disorder is a relatively common form of mental illness in individuals with autism. Although the two disorders share certain symptoms and genetic causes, they are not the same.
In this article, we shed light on the co-occurrence of autism and bipolar disorder, their overlapping symptoms, and available treatments.
Understanding Bipolar Disorder
Bipolar disorder is a common psychiatric mood disorder, in the past known as “manic depressive illness.” Approximately 2.3 million Americans are currently diagnosed with bipolar disorder, out of which 1%-3% are adolescents. This disorder is not common in children.
Individuals with bipolar disorder alternate between two extreme emotional states: manic and depressive. Manic and depressive episodes can happen over several days, weeks, or months. Some people have fast and frequent mood swings, called rapid cycling, although this condition is rare.
The dramatic mood shifts typical for bipolar disorder can affect every aspect of a person’s daily life, including behavior, energy levels, judgment ability, sleep, and performing everyday tasks. This is a chronic condition that requires life-long treatment.
Manic episodes are periods of excited behavior that last for a week or more. A milder version, hypomania, lasts for a few days. People who experience manic episodes feel euphoric and full of energy or are extremely irritable.
Symptoms of a manic episode may include:
- Acting unusually upbeat and happy
- High levels of energy
- Inflated self-esteem
- Fast and loud talking
- Excessive pacing
- Repetitive behaviors
- Impulsivity and risk-taking behaviors
- Sleep disturbances.
Depressive episodes are characterized by extreme sadness and the feeling of hopelessness. Most bipolar people experience episodes of mania and depression, but some may have very few depression episodes or none at all.
Symptoms of a depressive episode may include:
- Feeling sad and without hope
- Fatigue and low energy
- Loss of interest in everyday activities
- Dramatic changes in appetite
- Sudden weight loss or weight gain
- Insomnia or excessive sleeping
- Inability to concentrate
- Suicidal thoughts.
Are Autism and Bipolar Disorder Related?
Autism is a neurodevelopmental disorder characterized by socialization and communication difficulties, in addition to repetitive and obsessive behaviors. Bipolar disorder involves mood swings and significant variations in energy levels. Both disorders can interfere with normal daily functioning.
An estimated 27% of individuals with autism also have symptoms of bipolar disorder, compared to only 4% of the general population. Research shows that individuals with autism are at increased risk for bipolar disorder and vice versa.
The connection between the two disorders is not well understood, however, some studies have suggested that autism and bipolar disorder may share underlying genetic risk factors. People who have a close family member with bipolar disorder are at a greater risk of developing autism.
The difference between autism and bipolar disorder is not always clear, as individuals affected by these two conditions may behave in similar ways. Here are some aspects to consider:
- Autism is a neurodevelopmental disorder, while bipolar disorder is a psychiatric illness.
- The main symptoms of bipolar disorder are mood-related issues, while autism is unrelated to mood. Individuals with autism typically don’t experience manic and depressive episodes.
- Most people with autism have difficulties with language, social communication, and sensory processing. People with bipolar disorder who don’t have autism are very unlikely to show these symptoms.
- Stimming or repetitive actions that occur consistently over longer periods of time, such as rocking and hand flapping, are typical of autism. These symptoms are not related to bipolar disorder.
- The first signs of autism are often noticed before the age of 3. However, symptoms of bipolar disorder tend to emerge much later, usually around the age of 25.
Although bipolar disorder and autism are two distinct diagnoses, they have many similarities and overlapping symptoms. Here are the most common ones.
Overlapping Symptoms of Autism and Bipolar Disorder
Overlapping symptoms for autism and bipolar disorder may include:
- Sleep problems
- Difficulty concentrating
- Being prone to accidents
- Behavior issues and tantrums.
Some symptoms of bipolar disorder may appear in individuals with severe autism, for example, hyperactivity, agitation, disturbed sleep, impulsivity, and irritability. However, people with ASD who show these symptoms, don’t necessarily have bipolar disorder. In fact, the symptoms of bipolar disorder in people with autism will usually not appear in the same way that they would in a non-autistic person.
Individuals who are diagnosed with both conditions are likely to present the following symptoms:
- Loud and fast talking
- Constant pacing
- Increased impulsivity
- Aggressive behavior
- Sudden sleep disturbances.
Bipolar disorder is one of the most severe comorbid psychiatric disorders in people with autism. Managing co-occurring autism and bipolar disorder involves a combination of behavioral interventions and medications. It is essential to have an accurate diagnosis for comorbid autism and bipolar disorder, since treatment for each of the disorders may not be effective when they overlap.
Applied Behavioral Analysis (ABA) therapy is the most successful intervention for treating autism. It focuses on teaching communication and social skills, coping with sensory issues, and performing daily tasks through positive reinforcement of desired behaviors.
With intensive early intervention, close to 50% of autistic children who go through ABA therapy see significant improvement in their symptoms and reach a development level where they are indistinguishable from their neurotypical peers. Young children should receive at least 25 hours of ABA therapy per week for maximum effect.
Depending on their level of functioning, individuals with autism may also require supplementary treatments, such as developmental and play therapy, speech therapy, sensory integration therapy, social skills training, and dietary intervention. When medications are used, they include anti-anxiety drugs and second-generation antipsychotics.
Bipolar disorder is treated with a combination of lifestyle changes, cognitive behavioral therapy (CBT), and medications to help control symptoms of manic and depressive episodes. Medications may include antipsychotic drugs, mood stabilizers such as lithium, as well as some anti-seizure drugs. With adequate treatment, most people with bipolar disorder are able to live normal, productive lives and control their illness.