Bipolar Vs. Schizophrenia: How To Tell The Difference

Reviewed by Tanya Harrell, PhD, LPC, NCC

Published 01/07/2021

Are you wondering if you or someone in your life has bipolar disorder or schizophrenia? These two mental disorders share some features, but they are also different in several ways. It can be hard for someone who isn’t a mental health professional to distinguish between schizophrenia and bipolar.

No matter which mental illness you or they have, it’s vital that you seek help from a psychiatrist or therapist for diagnosis and treatment. In the meantime, here’s what to look for if you suspect one of these two conditions is affecting your life.

Who Is Most Likely To Have These Conditions?

Bipolar disorder affects about 2.6% of adults in the U.S., while schizophrenia affects as few as a tenth of that number, somewhere between 0.25% and 0.64% of the U.S. adult population. But who is most likely to have these disorders?

First, consider the age of onset. People with schizophrenia are usually diagnosed sometime between late adolescence and the early twenties for men and between the early twenties and early thirties for women. They may begin to have symptoms years before the diagnosis. The onset of bipolar disorder is usually around 25 years old, although it can start anywhere from early adulthood to the late 40s or 50s.

Anyone can get these conditions, regardless of gender, social status, or ethnic group. If you or your loved one fits neatly into the most common categories, it may give you a clue about whether they might have one condition vs. the other. But if they don’t seem to fit, it’s still important to pay attention to symptoms and get help if you need it.

Screening Tests

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Screening tests can help give you a clue about whether you might have a mental disorder. You can find online tests for bipolar disorder, schizophrenia, and psychosis, any of which can happen if you have bipolar or schizophrenia. All you have to do is click the answer that describes what you’re experiencing. The site gives you a quick response to let you know if you need to explore the possibility further.

Symptoms Of Schizophrenia versus Bipolar

If you take an online test and indicate you might have one of these conditions, the next step is to check your symptoms. If you end up going for diagnosis and treatment, it will be useful to know the common symptoms you’re having. Here is a brief description of the symptoms of schizophrenia and bipolar.

Schizophrenia Symptoms

There are two main types of schizophrenia symptoms: positive and negative symptoms. Positive signs are those that add behaviors, while negative symptoms are those that take away behaviors.

Some of the positive symptoms of schizophrenia include:

  • Hallucinations, including hearing, seeing, smelling, tasting, or feeling things that aren’t there
  • Delusions, including delusions someone is trying to hurt you, that songs or TV shows have a special message for them, that they have a horrible illness, that a celebrity is pursuing them for a love affair, or that they’re a famous or influential person
  • Disorganized speech and confused thoughts
  • Difficulty concentrating
  • Movement problems like jumpiness or sitting still for hours.
  • Inappropriate laughter or angry outbursts
  • Being especially sensitive to smells, tastes, sounds, and touch sensations
  • Unusual behavior
  • Moodiness
  • Self-harm

Negative symptoms are about what you don’t do when you have schizophrenia. They include:

  • Not experiencing pleasure
  • Not being able to speak much or show feelings
  • Flat voice or lack of emotions
  • Withdrawing from social contact
  • Having trouble functioning in daily life or completing everyday activities and chores
  • Not being able to stay on schedule or finish what you start

Another symptom of schizophrenia is a change in your sleep patterns. You may sleep too much or too little. Or you might sleep enough but at inconvenient times or not all at once.

Bipolar Symptoms

In bipolar disorder, you have at least one episode of depression and at least one episode of mania or hypomania. These three types of episodes are described below.

  • Manic episodes – periods of increased activity, boundless energy, and happy or elated emotions.
  • Hypomanic episodes – like manic episodes but less severe.
  • Depressive episodes –like in major depressive disorder, you may feel sad, lose interest in things you once enjoyed, and have physical changes like sleeping or eating too much or too little.

If you have bipolar disorder, your behavior might change in other ways, too. Examples include:

  • Restlessness
  • Tiredness
  • Trouble focusing
  • Irritability

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  • Impulsive or risky behaviors
  • Suicidal thoughts
  • Exaggerated confidence or self-image
  • Psychotic features during depressed or manic episodes.

What About Psychosis?

Psychosis can happen with either schizophrenia or bipolar. There’s a misconception that psychosis always involves violent behavior. Yet, although the symptoms of psychosis are usually troublesome, they aren’t always dangerous. Psychiatrists and therapists often refer to psychosis as “a break with reality.” Here are some of the symptoms you might experience if you have bipolar with psychotic features. Notice that many of them are similar to symptoms of schizophrenia.

  • Being overly suspicious
  • Hearing voices
  • Seeing people or things that aren’t there

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  • Having strange or unexplained sensations or emotions
  • Thinking someone is controlling you
  • Looking for personal messages in things you hear others around you saying or events that are happening around you
  • Believing you have superpowers or are a famous or powerful person

So how can you tell if the psychosis is related to schizophrenia or bipolar disorder? It’s best to leave the diagnosis to a professional. But here are a few distinctions you might be able to recognize.

  • In schizophrenia, psychosis tends to be an ongoing part of the disorder. In bipolar disorder, it’s more likely to come and go depending on what phase of the condition you’re experiencing at the moment.
  • Auditory hallucinations and paranoia are more common in schizophrenia.
  • Mood changes are the primary factor in bipolar, while the main features of schizophrenia are excitement and grandiosity.

Current scientific thinking has gone beyond the idea that psychotic symptoms clearly indicate one disorder or the other. The accepted belief is that psychotic symptoms are on a continuum on which those with schizophrenia have more severe symptoms, while those with bipolar have less severe ones.

Mood Elements In Schizophrenia Vs. Bipolar

People with both disorders may have mood problems. However, mood fluctuations in bipolar are the primary feature. People with schizophrenia often become depressed, but it seems to be secondary or arising from their other symptoms of schizophrenia.

Are There Distinct Episodes?

Schizophrenia may be more severe at some times than others. However, the changes don’t go in a cycle. With bipolar, you have distinct episodes defined by the symptoms of the manic, hypomanic, and depressed phases.

Severity

As mentioned before, the severity of the symptoms may indicate whether it’s more likely bipolar or schizophrenia. People with schizophrenia typically have more dysfunction due to their symptoms. That doesn’t mean that you can’t have a severe manic or depressed episode. So, relying on an expert is the best way to sort out the two conditions.

Physical Differences In The Brain

You can’t look at the structures of your own or someone else’s brain to determine whether they have schizophrenia or bipolar disorder. Still, it’s interesting to note that there are differences. People with schizophrenia tend to have less gray matter in the frontal, cingulate and insular cortex, temporal, and thalamus. They also have increased gray matter in their basal ganglia. People with bipolar tend to have reductions in gray matter in their anterior cingulate and bilateral insula. The anterior cingulate deficits are present in bipolar but usually not in schizophrenia. So, what does this signify? It means that there are physical differences in the brain, so you can rest assured that the two conditions are different.

How Do the Two Conditions Affect Your Life?

Schizophrenia and bipolar disorder can each have a devastating impact on your life. However, schizophrenia tends to cause the most disruption to everyday activities like work or school. It is among the top causes of disability in the world.

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Many bipolar disorder people can continue to go to work and carry out everyday life tasks, especially when they aren’t in a depressive or manic phase. The people with the most severe bipolar symptoms may have significant problems functioning, but they usually have remission periods.

However, both conditions are treatable with medications and therapy. There is no cure for either, but the right treatments for you can diminish your symptoms, help you manage your illness, and allow you to live a better life than you would without treatment.

Conclusion

There’s nothing wrong with taking a screening test or considering whether you have schizophrenia symptoms vs. bipolar. The most important thing to remember is that if you believe you have either of these types of mental illness, you must seek help from a qualified professional. They can evaluate your symptoms based on standard DSM-5 criteria and accepted mental health diagnosis practices. Then, they can suggest treatments to help you deal with whatever mental health problem you might have.