May 10th 2023
Bipolar and PTSD are distinct mental health conditions, yet there is enough symptom overlap that the two disorders can be mistaken for one another. In some cases, bipolar and PTSD might occur together. Fortunately, both conditions are highly treatable with therapy, medication, or both.
Post-traumatic stress disorder, or PTSD, is a potentially debilitating trauma-based disorder. Though PTSD is most commonly associated with veterans of the armed forces who have been in combat, it’s also common among people who have experienced trauma like assault, natural disasters, and acts of terrorism.
PTSD has many symptoms, including intrusive memories, avoidance of anything associated with the trauma, self-blame, and an exaggerated startle response. These symptoms can last for months, years, or sometimes for the remainder of a person’s life. Complicating matters is that some people with PTSD have a comorbid condition, such as a substance abuse disorder.
Bipolar disorder is a severe mood disorder characterized by an unstable mood that cycles between mania and depression. There are two main types of bipolar disorder – bipolar 1 and bipolar 2. Full mania is only experienced by people with bipolar 1, while those with bipolar 2 experience a state called hypomania. When someone with bipolar disorder is in a manic phase, they exhibit symptoms like delusions, participating in risky behaviors, and having seemingly untapped energy.
But, when a person with bipolar disorder is in a depressive phase, they exhibit typical symptoms of depression: withdrawal from activities, changes in sleep patterns, and feelings of hopelessness. The cycle between mania and depression typically lasts several days to more than a week. However, some people have a type of bipolar called cyclothymic disorder, which involves rapid mood changes, though the severity of the changes is less extreme.
As noted above, bipolar and PTSD have some similar symptoms. However, PTSD and bipolar also have distinct characteristics that enable clinicians to differentiate between the two. Below is an overview of the similarities and differences in symptomatology.
In severe cases, both PTSD and bipolar patients may have suicidal ideation or engage in self-harm.
PTSD and bipolar disorder can be more easily differentiated because of significant symptom differences.
Emotional dysregulation is common with PTSD. However, extreme swings between mania and depression are not present as they are in bipolar disorder. Likewise, the flight of ideas, grandiosity, and extreme talkativeness that commonly occur with manic phases of bipolar disorder typically do not occur with PTSD.
Another significant difference between the symptoms of these disorders is that PTSD patients experience intrusive dreams, flashbacks, and extreme psychological distress in the face of traumatic memories. In contrast, bipolar disorder doesn’t include these symptoms. Moreover, PTSD patients are prone to hypervigilance, an inability to experience positive emotions, and persistent negative beliefs about the world. These symptoms are not usually associated with bipolar disorder.
A quick examination of the diagnostic criteria for these disorders further differentiates between their symptoms. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the following criteria for diagnosing PTSD:
The DSM-5 criteria for bipolar 1 disorder are markedly different:
Note that bipolar 2 disorder has different diagnostic criteria than bipolar 1 and involves having at least one hypomanic and one major depressive episode but no manic episodes. In any case, the DSM lays out the differences between these disorders, which makes a proper diagnosis more likely.
One of the most significant differences between these disorders is their etiology.
As noted earlier, PTSD is directly related to experiencing trauma. Common traumas that might trigger the development of PTSD include:
And while childhood trauma might be a risk factor for the development of bipolar disorder in some patients, it’s likely caused by many factors, including genetics, brain structure, and brain function.
However, research indicates that stress might serve as a trigger for a bipolar episode and PTSD. And while stress differs from trauma, traumatic events can be stressful.
For example, the death of a loved one is stressful and traumatic. On the one hand, the trauma of such an event could trigger PTSD. On the other hand, the stress associated with such an event could lead someone with a genetic predisposition for bipolar disorder to experience symptoms.
Again, these are complex mental health issues with no specific known cause. While some people might experience extreme trauma, they might not develop PTSD. Likewise, not everyone with the biological markers associated with bipolar disorder will develop the condition.
Bipolar and PTSD are severe mental health conditions. However, many highly effective treatments exist, including various therapies and medications.
Both PTSD and bipolar can be treated with cognitive-behavioral therapy (CBT), a type of talk therapy that hones in on maladaptive thinking patterns and relearning those patterns to affect different outcomes. CBT is a front-line treatment for PTSD. It is also effective for treating depressive symptoms in bipolar patients.
This is the only mainstream treatment option shared between these disorders. There are far more treatment options specific to each condition.
For example, PTSD is often treated with:
Bipolar disorder is often treated with the following:
Again, though the bulk of treatments for these disorders are different, they offer effective ways of minimizing symptoms and improving day-to-day life for people with one or both disorders.
PTSD and bipolar can occur together. Research suggests that anywhere from 4 percent to 40 percent of people with bipolar also have PTSD. The incidence of bipolar among people with PTSD is even higher, ranging from 5 percent to 55 percent.
Interestingly, bipolar with PTSD is more likely among women. Likewise, bipolar with PTSD is more common among patients with bipolar 1 disorder than bipolar 2 disorder.