Stress or Bipolar Anxiety? How to Tell the Difference

Last Updated: 15 Mar 2020

Learning to tell the difference between stress from a specific source and anxiety from bipolar disorder can help you manage both.

First, I should clarify the role anxiety plays in bipolar disorder.

Bipolar is a mood disorder that has two mood swings: mania and depression. All of our symptoms will either show up in a depression episode, a manic episode or a mixed episode where we are manic and depressed at the same time. The is also called dysphoric mania. Many of these episodes will include anxiety. But, and this is a big but, people with bipolar disorder generally do NOT have anxiety when they are not manic or depressed, in my experience.

If a person with bipolar disorder has anxiety when there is not a mania or a depression, I’ve found this is often considered a separate diagnosis.

When I say bipolar anxiety, it means an anxiety that is with depression or a part of mixed mania (also called dysphoric mania).

How can you tell the difference between stress and bipolar anxiety? Here are a few clues:

  1. Stress is the effect of a cause.  This means that you can relate the stress to something specific, such as trouble in a relationship or trouble at work. Stress is the body’s response to a stimulus. You will be able to identify why you are stressed.
  2. Bipolar anxiety is episodic and can exist for no reason at all. It simply shows up, and you have no idea why on earth you are so upset and obsessive and worried and have so much trouble breathing. You will either be depressed while this anxiety is around or in a dysphoric episode.  You can have low-energy anxiety and high-energy anxiety, but the symptoms will still be the same.

Bipolar anxiety can be triggered, but it many cases it exists in what I call “free-form.” This means it’s just there, and you can’t pinpoint exactly why it happens.  If you don’t like your job and feel upset every time you get to the office, this is stress. It’s a cause and an effect. If you like your job, but for some reason, on the way to work you feel something is wrong and you don’t want to go inside and then you have trouble breathing, this describes anxiety.

In my experience, anxiety always affects the breath; stress doesn’t always affect the breath. Thus, one of the main treatments for anxiety is breathing in a way that balances your oxygen and carbon dioxide. This can be achieved by staying calm and breathing slowly and deliberately.

Do you have bipolar anxiety?

Learn more:
How to Get Through a Bipolar Disorder “Nervous Breakdown”
Why Can Bipolar Disorder Make Me Mean and Nasty?

About the author
Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get It Done When You’re Depressed, and The Health Cards Treatment System for Bipolar Disorder. She is a columnist and blogger for bp Magazine, and she won the Mental Health America journalism award for the best mental health column in the US. Julie was also the recipient of the Eli Lilly Reintegration Achievement Award for her work in bipolar disorder advocacy. Julie is a bipolar disorder expert for ShareCare, a site created by Dr. Oz and Oprah. Julie is CEU certified and regularly trains health care professionals, including psychiatric residents, social workers, therapists, and general practitioners, on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People magazine. She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called "Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis, and Depression." You can find more about her work at and
  1. I just realized once again how there’s so much more to learn about the stuff which affects me regularly. It also makes me a smartass in the eyes of my parent, since she hates how I act like I know much more than doctors, but I only know what happens to me, and that a lot of them aren’t able to recognize that stuff when it’s happening to me. It all just leaves me constantly confused, while I try to figure out the causes, like today when I’m just guessing it’s the weird weather… Plus my other conditions make it even more confusing.

  2. I think this is a very well thought out and informative article. I also think it hits the nail on the head and holds true for me. I now know that my anxiety is usually stress caused by work. I don’t have any anxiety when I’m not at work or thinking about work. Thank you Julie!

  3. Can anyone help me. I have had high anxiety formthe last few years. Psychiatrists have tried to use anti depresssants which make me worse so i am left with a benzo. My anxiety is so high, i can hardly go out or shop, or even concentrate to read a book. I do not get high moods, only low, then i sometimes feel my brain is going mad as i cant concentrate. Can anyone help me finding if this is just anxiety or if its got bp traits. Psychiatrist says its anxiety and i have ro control it but it feels more to me. Do you have romhave highs tomhave bp?

    1. Bipolar by definition, must have had at least one serious manic episode and at least one serious depressive episode. If you feel like your psychiatrist is incorrect, get a second opinion. In my experience psychiatrists don’t give as much of an in detail analysis as psychologists do (obviously this is not completely true for every psychiatrist, just in my experience). What you are describing, sounds a lot like things that I personally deal with during hypomanic and manic episodes. I am not a mental healthcare professional so the only advice I’ll give you is go see someone who is and ask to be evaluated. Find a different psychiatrist/psychologist that specializes in mood disorders and ask for an evaluation.

  4. I have Bipolar !. First, I find myself compelled to make clear there are not only “two mood swings.” How can anyone diagnosed, let alone, an experienced author on the subject, leave out the “HYPO MANIC” state? I have anxiety along with my Bipolar. My anxiety is a part of me, sometimes spurred on by stress. I have spent “far too many months,” in paralyzing isolation. With “great” difficulty I force myself to do very simple chores in my small town. I’m at ease to some extent when out with a family members while in these deep depressions. I’ll I do thank God for my husband, 2 daughters, & extended family who live 3,000 miles for being my table legs. Whatever I encounter, I always see my Dr. & never give up. Reading all these comments one thing is abundantly clear; – our own experiences with same illness vary tremendously.

  5. It is truly frightening to me that a person so obviously uninformed is allowed to present an article of this kind on this forum.

    1. JR;
      What?! Seriously?! This discussion column fits my anxiety attacks to a tee. Luckily, I am retired and alone at home much of the time so I don’t stress much. Your attacks and stress may be a little different from Julie’s descriptions, but there’s no call to run down someone who IS an expert on bipolar disorder, knowing it inside-out! Believe me, she KNOWS bipolar and is speaking from experience. Sure, there are some people whose experiences, and you may be one of them differ, but it’s foolish to call an expert, as she is, frightening/nonsense. Julie is very well-informed and your reaction is over-the-top! Try reading the column again and this time think carefully about every single description. Study it and realize that everybody’s experiences are disparate and widely vary. Really, read her bio before you go off on her.

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