Is It ASD Or Something Else: Autism And Bipolar's Unexpected Ties

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/09/2020

Autism Spectrum Disorder is an increasingly common neurodevelopmental disorder characterized by delays in speech, difficulty in social situations, and difficulty with sensory integration and intake, leading to tics or stimming behavior designed to regulate sensory overload. Bipolar Disorder, conversely, is a mood disorder, most well-known for its intense shifts in mood and behavior, alternating between manic and depressive episodes. It may be surprisingto find that Autism Spectrum Disorder (ASD) and Bipolar Disorder may have a common point of intersection.

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Autism Spectrum Disorder: A Short Guide

Autism Spectrum Disorder is a neurodevelopmental disorder typically identified in early childhood. There are many different sets of symptoms within ASD, and people with the disorder have often been likened to puzzle pieces due to the overwhelming differences among diagnosed individuals. The hallmark symptoms of Autism Spectrum Disorder include delayed speech, sensory issues, impaired social skills, and compulsive behavior. ASD may also show other symptoms, such as difficulty concentrating, difficulty making eye contact, verbal or physical tics, and mood or anxiety disorders. People with ASD typically exhibit very rigid behaviors and may express great distress in crying, screaming, or melting down when plans are changed, routines are rearranged, or objects are not arranged in a specific order.

Autism Spectrum Disorder is often associated with nonverbal communication, but people with ASD may learn how to communicate effectively. Some will continue to have unique speech patterns, including emotionless or monotone-laden speaking habits, while others may be able to pass as neurotypical in their speech. Although having Autism Spectrum Disorder was once considered tantamount to assisted living and a life full of struggle, this is no longer the case; many people with ASD live relatively independent, self-sufficient lives. While this is, in part, a wonderful advancement for the acceptance of neurodiversity, some people with high functioning autism may be overlooked and not get all of the services they need—an experience shared by some people with Bipolar Disorder.

Bipolar Disorder: A Short Guide

Bipolar Disorder is so named because it is characterized by large shifts in experiences and behavior; people with Bipolar Disorder experience periods of mania and periods of depression, alternately, with periods of normalcy or baseline behavior in between.

There are four different types of Bipolar Disorder recognized by mental health professionals. These include Bipolar Disorder 1, Bipolar Disorder 2, Cyclothymic Disorder, and Bipolar Disorder-Not Otherwise Specified. All of these may be identified by the same swing from mania to depression. However, each is identified by a different severity level, with Cyclothymic Disorder being the least severe. Determining whether or not someone has Bipolar Disorder is the work of dedicated mental health professionals. Still, people who suspect they might be exhibiting Bipolar Disorder symptoms might find some solace in taking an online Bipolar Disorder quiz that can quickly examine the likelihood of symptoms pointing to Bipolar Disorder.

Bipolar Disorder is typically identified and diagnosed when someone is a teenager or young adult, though it has been diagnosed earlier and later than this. Depending on the intensity of symptoms, people with Bipolar Disorder may initially seek mental health assistance under the assumption that they are exhibiting depression symptoms, not recognizing mania signs. Bipolar Disorder is considered a treatable disorder, though the rates of symptom relapse are often high, due largely to the loss of adherence to a strict treatment regimen, including psychotherapy and medications, such as anti-depressants.

The Crossover of Symptoms

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Although Bipolar Disorder and ASD are two very different disorders, they do possess many similarities and crossover in their symptomatology, making it difficult to determine whether someone is exhibiting symptoms of both ASD and Bipolar Disorder or symptoms that can be explained by ASD alone. The most common symptoms the two conditions have in common include:

  • Emotional outbursts. Both ASD and Bipolar Disorder are known for emotional outbursts, though the source is often different. In ASD, emotional outbursts can come in the form of anger or frustration at witnessing an unexpected change or feeling unable to complete a task. In Bipolar Disorder, emotional outbursts might be due primarily to the emotional changes during periods of mania and depression.
  • Swings in emotional states. In ASD, emotional swings are frequently observed; people with ASD are more likely to experience swings in emotional states quickly and easily daily. Conversely, people with Bipolar Disorder experience emotional swings in much larger swaths, with significant changes occurring over days or weeks, rather than moments or hours.
  • ASD and Bipolar Disorder are known for showing symptoms of hyperactivity. However, ASD’s hyperactivity may come more in the form of stimming than in Bipolar Disorder, wherein hyperactivity might present more as an overwhelming need to deeply dive into an interest or area of focus.
  • Altered sleeping patterns. People with ASD often have lifelong difficulties with sleep, whether that means difficulty falling or staying asleep or difficulty getting up each morning. People with Bipolar Disorder exhibit similar sleeping patterns and may struggle to consistently secure a healthy, restful night of sleep.
  • Agitation or irritability. Agitation and irritability are present in ASD and Bipolar Disorder and can be seen in periods of depression and mania.
  • Sudden spikes in attention or ability. ASD and Bipolar Disorder are also both prone to periods of “popping up” or seeming to leap into a space of clarity and coherence. In Bipolar Disorder, this could signal a return to baseline or a period of mania, while the exact reason for this type of behavior in ASD remains unknown.

ASD Vs. Bipolar Disorder

Diagnosis of ASD and Bipolar Disorder typically come at very different times in life. While ASD is more often diagnosed in early childhood, Bipolar Disorder is typically diagnosed in late adolescence, in an individual’s teenage years, or in adulthood. The symptoms associated with each of these disorders can be similar and have some very distinct differences, including the source of behaviors, dispositions, and experiences. At the same time, ASD is a disorder affecting normal neurological development. Bipolar Disorder is a disorder affecting emotional experience and expression, often partially rooted in hormonal changes or deficiencies.

Autism Spectrum Disorder is not typically considered unless speech and social difficulty are present, while Bipolar Disorder does not typically require these same parameters for a diagnosis. However, someone with Bipolar Disorder may struggle with relationships and social situations, but the specific social difficulties seen in ASD are not usually found with Bipolar Disorder alone.

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High functioning ASD and high functioning Bipolar Disorder can present unique diagnostic challenges, as both can be difficult to diagnose, especially as time wears on. Having both high functioning ASD and high functioning Bipolar Disorder could further obfuscate the likelihood of someone having one or both conditions. Seeking evaluation from a mental health professional for any symptoms that negatively impact daily functioning is the best way to determine what disorder or condition might be at play, as both ASD and Bipolar Disorder can be diagnosed late in life. Both can be managed prior to diagnosis and with difficulty, with potentially unhealthy or strained coping mechanisms to obscure the severity of symptoms.

ASD And Bipolar Disorder: Common Co-Morbidities

While ASD and Bipolar Disorder are similar in some of their symptoms, they are not the same disorder—they stem from different brain areas and are treated in vastly different ways. Nevertheless, having Autism Spectrum Disorder may serve as an increased risk factor in developing Bipolar Disorder, with some estimates suggesting an up to a 9-times-higher rate of Bipolar Disorder in people with ASD than the general population. Because many of the symptoms of ASD coincide with Bipolar Disorder symptoms, Bipolar Disorder in people with autism might go unnoticed or undiagnosed. This is problematic because the treatments utilized for these conditions do not typically have a great deal of crossover. People with both autism and Bipolar Disorder may not get the help they need.

Working with a therapist, psychologist, or doctor who is familiar with Bipolar Disorder and ASD may be the most effective way to determine whether one or the other is at play—or a combination of the two. Autism can frequently shield other disorders from view, which can make comorbid diagnosis difficult for people with ASD. Depression, anxiety, ADHD (Attention Deficit Hyperactive Disorder), and ODD (Oppositional Defiant Disorder) are all conditions that are frequently found in conjunction with ASD—and may all go unnoticed for far longer in people with ASD than in the general population due to the standard signs of ASD. While it may seem like chasing a rabbit down a rabbit hole to chip away at all of the potential diagnoses to be found in a person with ASD, identifying any and all co-morbid conditions makes all the difference in getting someone with ASD and other disorders such as Bipolar Disorder the help they need to feel safe and at peace.