Bipolar disorder symptoms overlap with other conditions, such as depression, anxiety disorders, and ADHD. This can lead to misdiagnosis.

Bipolar disorder is a mental health condition marked by severe shifts in mood and energy levels. Mood episodes may involve depression, mania, hypomania, and mixed states.

Whether it’s intense moods, agitation, or impulsivity, some features of bipolar disorder are commonly mistaken for other disorders with similar symptoms — and vice versa.

In fact, a 2018 review reports that up to 40% of people with bipolar disorder are misdiagnosed, most commonly with major depressive disorder.

Sometimes it’s hard to work out the most appropriate diagnosis, even for medical professionals. We look at what conditions might be confused with bipolar disorder and why.

Bipolar disorder can be particularly difficult to diagnose in the early stages or when it arises at a young age (early-onset bipolar disorder). Many people won’t receive a bipolar diagnosis until years after their first mood episode.

In the United States, bipolar disorder is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). There are three main types of bipolar disorder:

  • bipolar I disorder: diagnosed after you have at least one episode of mania
  • bipolar II disorder: diagnosed after you have at least one episode of hypomania and at least one episode of depression
  • cyclothymia: diagnosed if you have mood changes that are less extreme than in bipolar I disorder or bipolar II disorder

The symptoms of bipolar disorder overlap with other conditions, which can lead to misdiagnosis. Misdiagnosis can also happen when a mental health professional does not thoroughly review the person’s medical history or is overly restrictive with the diagnostic criteria.

Conditions that may be confused with bipolar disorder include:

  • depression
  • attention deficit hyperactivity disorder (ADHD)
  • schizophrenia
  • borderline personality disorder (BPD)
  • substance use disorder

Ethnicity may also play a role in misdiagnosis. Research shows that people with African ancestry are more often misdiagnosed with a condition other than bipolar disorder, compared with those of non-African ancestry.

Why is misdiagnosis concerning?

Mental health professionals give people diagnoses in order to work out which treatments will be most suited to helping the person manage their symptoms. Getting an incorrect, incomplete, or late diagnosis can lead to delayed or ineffective treatment.

If you are unsure whether you have received a correct diagnosis, consider talking with a mental health professional about your symptoms and concerns.

The most common misdiagnosis of bipolar disorder is major depressive disorder (MDD). The symptoms of major depression last for at least two weeks and can include:

  • persistent feelings of sadness or low mood
  • a loss of interest in activities you previously enjoyed
  • sleep changes
  • weight changes
  • fatigue

Bipolar disorder may be mistaken for depression partly because depression is often the first mood episode (rather than mania) for many people. It’s also more common for people with bipolar disorder to first seek professional help for their depressive symptoms, since mania feels less problematic.

In fact, according to one study, only 20% of people with bipolar disorder who seek help during a depressive episode receive a confirmed diagnosis within the first year of treatment.

Those with bipolar II disorder may be more likely to be misdiagnosed with depression because hypomania is less prominent than mania, and the depression in bipolar II disorder tends to be more severe.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects your attention and focus. It often begins in childhood.

ADHD shares several symptoms with bipolar disorder, such as:

  • inattention, which may occur in mood episodes, such as racing thoughts or trouble concentrating
  • impulsivity, a feature of mania
  • restlessness or an inability to relax, which may arise in anxious depression and mania

According to the National Institute of Mental Health (NIMH), around 4.4% of adults in the United States experience bipolar disorder in their lifetime. ADHD is more common, with a lifetime prevalence of 8.1% in U.S. adults.

Since ADHD is more common than bipolar disorder, a diagnosing doctor may think someone with bipolar disorder has ADHD instead.

In addition, ADHD and bipolar disorder often occur together, with up to 20% of those with ADHD also having bipolar disorder. In these cases, bipolar disorder symptoms might be “hidden,” or the doctor may think that all of the person’s symptoms are due to ADHD alone.

Importantly, common bipolar features such as hypersexuality and psychosis are not seen in ADHD. In addition, bipolar disorder comes in episodes, so symptoms such as impulsivity, inattention, and hyperactivity fluctuate over time. In contrast, ADHD symptoms are typically stable over time.

Schizophrenia is a mental health condition characterized by psychosis, which includes experiencing delusions and hallucinations.

Though often left out of the conversation, a 2000 study reports that 50% of people with bipolar disorder experience some form of psychosis.

In a 2008 study, 31% of participants with bipolar I disorder with psychotic features were misdiagnosed as having other disorders such as schizophrenia or substance-induced psychotic disorders.

Some other mental health conditions that have overlapping symptoms with bipolar disorder include:

  • Borderline personality disorder (BPD): People with BPD experience intense emotions, impulsive behavior, and suicidal thoughts or actions. A 2019 study reported that 40% of people who met the criteria for BPD, but not for bipolar disorder, were misdiagnosed with bipolar II disorder.
  • Substance use disorder: There is a high comorbidity between bipolar disorder and substance misuse, with 2006 research reporting that 46% of those with bipolar disorder had alcohol misuse and 41% had drug misuse.
  • Generalized anxiety disorder (GAD): Symptoms of GAD include anxiety, restlessness, and agitation. Research from 2021 suggests that they may also have unstable or over-reactive moods that can be misdiagnosed as bipolar disorder.

Various mental health conditions have an element of emotional dysregulation, defined as the inability to regulate or control one’s emotional responses.

Research suggests that emotional dysregulation is particularly common in people with a history of trauma or post-traumatic stress disorder (PTSD).

Extreme mood shifts of this kind can be mistaken for rapid-cycling bipolar II disorder.

Bipolar disorder can be confused with other conditions, such as depression, schizophrenia, BPD, anxiety, and ADHD.

Detecting and diagnosing bipolar disorder may take some time. But getting a correct, early diagnosis often results in better outcomes.

If you believe you have symptoms of bipolar disorder, reach out to a mental health professional. Be sure you share your full medical history and symptoms with your provider to get the most accurate diagnosis.