6 Conditions That Can Go Hand-in-Hand With Bipolar Disorder

Last Updated: 10 Jul 2019

Co-occurring psychiatric conditions––like anxiety and addiction––often go hand-in-hand with bipolar disorder. What we need to remember is that these conditions require separate diagnoses and each have different treatment plans that manage symptoms and improve your quality of life. Here are six disorders that commonly accompany bipolar diagnoses:

#1 Anxiety Disorders

Anxiety as a symptom occurs during the course of illness for most people living with bipolar disorder and can resolve as part of the standard treatment. However, studies report that anxiety disorders are three to four times more common in bipolar with obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder most consistent. Since anxiety disorders can worsen the course of bipolar, they generally require additional treatment.

#2 Attention Deficit Hyperactivity Disorder (ADHD)

About one-third of adults with bipolar disorder have co-occurring ADHD, as do up to 80 percent of children and adolescents, notes Stephen M. Strakowski MD, Chair of Psychiatry at Dell Medical School in Texas. “The decrease with aging in rates of co-occurring ADHD may be due to ADHD symptoms resolving over time. Alternatively, this decline in rates with age may represent a complex interplay between cognitive and brain development…”

#3 Personality Disorders

Studies have reported high rates of co-occurring personality disorder with bipolar. “Elevated rates of borderline, narcissistic, histrionic, obsessive-compulsive, and avoidant personality disorders are particularly common and occur in up to half of bipolar individuals,” Strakowski points out in his book Bipolar Disorder (Oxford University Press 2014). Personality disorders, he explains, generally require long-term and focused psychotherapies to gain improvement, in addition to treating the primary bipolar disorder.

#4 Alcohol Use Disorders

Studies show that up to half of people with bipolar consume alcohol excessively at some point in their life. Alcohol abuse is associated with impaired treatment response, increased time in depression, increased risk of suicide, and worse functional outcome,” explains Strakowski. Therefore, health professionals would be wise to watch for evidence of alcohol abuse in their patients with bipolar disorder.

#5 Nicotine Use Disorders

Smoking seems to share common ground with bipolar, affecting up to 80 percent of individuals. This is concerning since cigarette use is associated with increased anxiety, as well as heart disease, stroke and cancer. Studies also show that people living with bipolar who smoke are less successful at quitting. Consequently, it’s extremely important for doctors to address nicotine use in the management of bipolar disorder.

#6 Other drug use disorders

In addition to the excess use of nicotine and alcohol, there is also an elevated abuse of illicit and prescription drug use associated with bipolar disorder. As Strakowski notes, the lifetime predominance of drug abuse in bipolar is three to six times greater than in people without bipolar disorder. Drug abuse significantly worsens the course of the disorder, adding to increased affective episodes and poor psychosocial recovery.

  1. I think many of us in this community have experiences of trauma – trauma that may have led to the onset or activation of our genetic predisposition to bipolar and trauma associated with the lived experience of bipolar. For me anyway the continued identity crisis, instability and chaos, emotional anguish, isolation, consequences of mood episodes (on relationships, work and to reputation), utter confusion about what was happening to me, attempts to cope and survive and negative experiences of help-seeking and finding appropriate and non-harmful treatment CAUSED further trauma and PTSD. And the. Adjusting to the diagnosis of bipolar and it’s impacts on your identity, life goals and dreams, your understanding of your past, the grief for the lost years, stigma from society, the experience of trying to find adequate and appropriate treatment that is not psychologically or physically harmful and all round adjustment to life with bipolar is further traumatising. I believe we need focused and compassionate trauma care and treatment to help restore and heal ourselves. Bipolar treatment is just not enough. Once I had received my diagnosis and was treated for bipolar my illness and anguish continued – despite my bipolar being well controlled. It wasn’t until I received specialised trauma reprocessing that my suffering began to diminish and I began to get better and restore some stability, relief, improvement and reduction in my symptoms. I thought that bipolar depression was my problem but it turned out that complex trauma was the real problem.

  2. I do believe that eating disorders should be added to the list. Before I was diagnosed I went through several periods of eating to less and now I eat too much and am overweight. I do believe that antipsychotics are to blame. They are weight gainers plus I crave carbs and sugars. Not a good combination which has led to my having type 2 diabetes and high blood pressure. The battle is never ending with mental and physical health when it comes to bipolar disorder.

  3. Tracy and Diane;
    I think you are reading accusations into this article that were neither stated nor implied. The author was discussing some of the co-morbid disorders that often accompany bipolar disorder. It may be that none of us (or most) have professional experience with treating bipolar, OCD, anxiety, ADHD, etc. but the authors of many of the bpHope columns are non-professionals but have had enough experience with their, and others’ disorders that s/he has more knowledge and experience than many of us who read the columns. The author wasn’t accusing anyone of having any co-morbid disorders or addictions; just says that often-times these and other disorders/personality traits often crop up in people who are dealing with bipolar disorder. The author also doesn’t say that all people with bipolar have addiction issues; just that they occur at a higher rate than so-called “normal” people. Believe me, we are not all alcoholics and addicts, and the author doesn’t say so! I, for one, am well aware that alcohol and drugs – prescription or illicit – can and do interact with our own psych meds and moods (Cocaine can damage the brain and can and does actually cause bipolar disorder.) and will affect how our meds work or not. For myself, I occasionally have a few sips of a liqueur but detest getting drunk or high (I swore off marijuana nearly forty years ago; long before anything was diagnosed) and strictly limit myself to one aperitif each time and probably imbibe only once or twice a month. That can hardly be called alcoholism or addiction. Please don’t be defensive and read into our articles and responses things that aren’t there.

  4. Use of cortisone may not be discussed often in these bpHope columns but my pain doctor certainly knows that the steroid can have a deleterious effect on those with bipolar disorder. He warns me every time I have a nerve block that cortisone can trigger a manic episode. I keep telling him that that’s usually with bipolar 1 and I have bipolar 2. I remember having what were probably hypomania episodes as a teenager, but was not diagnosed correctly until I was 58. I over-spent a very few times before the diagnosis but never missed paying rent or any other payment. I don’t believe I ever got completely out of control, just careless; not keeping track of what I was spending on E-Bay. As I said, I have bipolar 2 and since it’s only hypomania. Since I have learned my lesson I have kept strict control of my spending (Have even managed to save some money.) and don’t have episodes much anymore. The mood-stabilizer seems to keep me from depressive episodes. Thank heavens for the psychiatrist who spotted the hypomanic episode and for the meds that keep me so stable!
    It’s important to remember that while psychiatry did diagnose manic-depressive illnesses back in 1949, little was known about it and cortisone, also being new, little was known about it either. It has only been since the 70’s that lithium became more frequently used to treat mood swings. The medical world had a lot of catching up to do before it was well-known that cortisone could trigger a manic episode. I even knew one woman who, in the 80’s, was still being medicated improperly with alprazolam for the mania and another drug (I’ve forgotten which, but neither was lithium or lamotrigine, and since I’ve become more aware, was also inappropriate. The woman refused to try any other drugs insisting on staying on those two; I suspect she was addicted to the alprazolam. Really, the wider knowledge of bipolar disorder is fairly new and our columnists either are unaware of the interaction or don’t think to mention it. Remember, many of these columnists are lay-persons, not all are professionals in the psychiatric or psychological fields.

  5. You left out a huge one — sex addiction. As I’ve learned, this apparently is more prevalent in bipolar women than bipolar men. This is what finally lead to my diagnosis.

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