A Guide To The Difference Of PTSD From Bipolar Disorder

What are bipolar disorder and PTSD?

Bipolar disorder is a mental health condition where you experience episodes of mania or hypomania and, in some cases, episodes of depression. Hypomania is a lesser form of mania where you’ll experience the same symptoms to a lesser degree.

These episodes cause dramatic shifts in mood, energy, or activity and are much more severe than the typical emotional ups and downs most people feel from time to time. 

Bipolar disorder is a severe illness that significantly impacts your life. It is present in about 4.4%¹ of the population at some point in their lives. The disorder severely impairs most people with bipolar disorder (about 83%). 

PTSD is a trauma- and stressor-related disorder that can occur after a traumatic event. This could include a dangerous or otherwise shocking event that either happens to you or that you witness. 

Although going through a traumatic event happens to about 60% of men and 51% of women² in their lives, most people don’t develop PTSD. PTSD is more likely to occur if you have direct exposure to trauma or injury. PTSD occurs in roughly 5-6% of men and 10-12% of women.³ 

Similarities and differences between PTSD and bipolar disorder

There are several types of bipolar disorder, depending on your symptoms. 

To be diagnosed with bipolar I disorder, you must have at least one manic episode, and a major depressive episode might follow. For some people, the manic episode could involve a detachment from reality (i.e., psychosis). 

If you experience at least one major depressive episode and at least one hypomanic episode but never a manic episode, you might be diagnosed with bipolar II disorder. 

Cyclothymic disorder can occur when you’ve experienced many periods of hypomania and depressive episodes over two years (one year for children or teenagers). 

This is a form of bipolar disorder whereby symptoms are present over a long period. Other types of bipolar disorder can occur due to drugs, alcohol, or certain medical conditions. 

PTSD can occur due to a single traumatic event that leads to problems with sleep and emotional, physical, or behavioral issues over at least one month. 

For experiences with chronic traumatic events (e.g., domestic violence, child abuse), the current PTSD diagnostic criteria may not capture all of the psychological impacts. Instead, you might be diagnosed with complex PTSD, particularly if the trauma repeats for months or even years. 

Symptoms of bipolar disorder and PTSD

Symptoms of bipolar disorder include a manic or hypomanic episode and, in some cases, a depressive episode. Manic episodes have three or more of the following symptoms:

• Excess energy, feeling jumpy or wired

• Increased levels of activity or agitation

• A sudden increase in self-confidence

• Lack of need for sleep

• Being easily distracted

• Being overly talkative

• Poor decision-making

• Racing thoughts

A major depressive episode, which can occur in both bipolar I and bipolar II disorder, has five or more of the following symptoms:

• Depressed mood (feeling sad, hopeless)

• Lack of interest in activities that previously brought joy

• A significant change in weight with little effort

• Either too little or too much sleep

• Either being restless or lethargic

• Being tired and having no energy

• Feeling excessively guilty or worthless

• Inability to make decisions

• Planning or committing self-harm, including suicide

Complex PTSD includes some of the following symptoms: 

• Behavioral issues: Alcohol misuse, impulsivity, and sexual risk-taking

• Emotional difficulties: Dysregulation, shame, rage, depression, or panic

• Cognitive challenges: Dissociation or feeling like you’ve lost personal identity

• Interpersonal problems: Sudden changes to personal relationships and distrust

• Somatic issues: Many visits to the doctor due to various physical ailments

Complex PTSD and bipolar disorder: misdiagnosis and how to tell them apart

As we can see from the symptoms described above, complex PTSD and bipolar disorder could look similar depending on your symptoms. 

To make it more difficult, PTSD and bipolar disorder are commonly found in tandem,⁴ as those with bipolar disorder can be more exposed to trauma. They may also have lower levels of support to help them deal with the traumatic events they are exposed to, thus increasing the likelihood of developing PTSD. 

As a result, mental health professionals often misdiagnose someone with complex PTSD, diagnosing them with bipolar disorder instead. This can occur because of the occasional lack of understanding of complex PTSD among healthcare providers. 

In addition, mental health providers might be more reluctant to diagnose someone with complex PTSD over bipolar disorder. This is partly due to the extensive research on bipolar disorder. 

Unfortunately, it’s also due to how mental health providers in the U.S. bill managed care companies for services. They must use a diagnostic code from the DSM-5 to receive payment. Since complex PTSD isn’t in the DSM-5, they will likely be unwilling to diagnose someone with this condition.

The insurance company will not reimburse the mental health professional for their services, and the patient will often not have coverage for services unless they receive a DSM-5 diagnosis.

Getting help for bipolar disorder and PTSD

Mental health recovery includes participating in healthy activities that help you live a meaningful life. 

One method in veterans' mental health recovery is video games.⁵ Playing these games manages mood and stress levels. It also provides a distraction, increases confidence, and a support network of other players. 

Another method is eye-movement desensitization reprocessing⁶ (EMDR) therapy. This therapy treated PTSD in four randomized controlled trials and reduced PTSD symptoms. It could also help with other trauma-related symptoms. 

While EMDR studies proved it an effective therapy, these results came from a small set of studies; therefore, we need more research on the effectiveness of EMDR therapy for PTSD. 

The lowdown

PTSD and bipolar disorder are mental health disorders that can significantly affect your well-being and quality of life. PTSD is characterized by experiencing a traumatic event that leads to various emotional, behavioral, and physical problems.

In contrast, bipolar disorder is a mood disorder characterized by depressive, manic, or hypomanic episodes. 

The two disorders can be hard to distinguish, and receiving an accurate diagnosis can be challenging. Luckily, treatment for both conditions includes a strong support network and participating in activities that provide joy.

If you feel like you or someone you know might have PTSD or bipolar disorder, please consult a medical or mental health professional.