PTSD and bipolar disorder have several overlapping symptoms and many people have both. Here’s how to tell the difference.

Diagnosing post-traumatic stress disorder (PTSD), bipolar disorder, or both can be trickier than it seems.

The two conditions have overlapping symptoms, making it more difficult to get the right diagnosis and best treatment. It’s also possible — and quite common — to have both conditions.

While even the most seasoned doctor might not find the right diagnosis immediately, each condition has distinct characteristics.

Understanding the key differences between PTSD and bipolar disorder can help doctors find the best diagnosis so you receive the most helpful professional support.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), PTSD is classified as a trauma-related disorder and bipolar is a mood disorder.

PTSD begins after a traumatic or highly stressful event.People with PTSD can reexperience the event, avoid situations that remind them of the event, and experience a hypervigilant state when facing reminders of the event.

Sometimes they may sense danger when it’s not there, which can also prompt a stressful response.

Bipolar disorder is a mental health condition involving extreme mood shifts that last at least 4 days. People living with bipolar disorder might experience energy moods (mania or hypomania), low-energy moods (depression), or both.

PTSD doesn’t share key symptoms of mania, which include high energy, heightened self-esteem, and feel rejuvenated even after not getting enough sleep.

But some PTSD symptoms overlap with mania, including irritable moods and engaging in behaviors that may lead to harmful consequences.

Both bipolar disorder and PTSD can co-occur with depression. Specific signs and features of these conditions can overlap, including:

  • low mood
  • difficulty feeling positive, optimistic, or joyful
  • trouble sleeping
  • losing interest in things you once enjoyed
  • isolating from friends and family
  • suicidal thoughts

Unlike bipolar disorder, PTSD symptoms are related to trauma:

  • intrusive memories of the traumatic event
  • avoidance of reminders
  • cognition and mood changes related to a specific event or trigger
  • feelings of hypervigilance when reminded of the traumatic event
  • nightmares
  • trouble recalling the traumatic incident
  • experiencing an intense physical response when reminded of the trauma

Bipolar disorder is not associated with trauma, but traumatic experiences may prompt a bipolar disorder episode.

PTSD and bipolar disorder can involve insomnia and sleep disturbances that can impact your ability to get a good night’s sleep but in different ways.

For example, someone with bipolar disorder might experience mania (high energy and restlessness), keeping them up at night. People with PTSD don’t typically experience bouts of mania but may still experience insomnia.

It’s possible to have PTSD and bipolar disorder. Living with both conditions is fairly common.

According to a 2020 study of people with bipolar disorder, 72.3% of participants reported experiencing a traumatic event. Around 37% of people in the study also reported a PTSD diagnosis.

A 2017 review of published research found:

  • 4% to 40% of people with bipolar disorder also have PTSD
  • Women with bipolar I disorder compared to bipolar II disorder are more likely to have PTSD
  • 6% to 55% of people with PTSD had bipolar disorder
  • People living with both conditions have more or higher-intensity symptoms

Research hasn’t shown PTSD causes bipolar disorder, which is typically genetic. But trauma may be a risk factor. According to 2020 research, experiencing a traumatic event in childhood can increase the risk of developing bipolar disorder.

Trauma can certainly induce enough stress to set off a bipolar disorder episode, but only in someone predisposed to bipolar disorder, explains Dr. Alex Dimitriu, founder of Menlo Park Psychiatry & Sleep Medicine in California and BrainfoodMD.

People with relatives with bipolar disorder or a personal history of bipolar disorder can start having mood cycles because of significant trauma, stress, substance use, or sleep deprivation.

Bipolar disorder is one of the most misused terms in mental health.

People use the term “bipolar” to describe typical swings from good to bad days, “so it’s no surprise that PTSD with its intense moods and anxiety can be lumped into this category as well,” says Dimitriu.

“I emphasize to all my patients that a true bipolar diagnosis involves mood states that last for days and involve changes in sleep and energy. Clusters of regrettable behavior are another marker worth exploring for bipolar. Mood tracking helps here,” he suggests.

Also, it can be difficult for those who have experienced trauma to talk about it.

If a medical professional isn’t aware of someone’s trauma background — a key distinction of PTSD versus bipolar disorder — then the several overlapping symptoms could steer a diagnosis in the wrong direction.

There are options for treating PTSD, which include:

  • individual psychotherapy
  • group psychotherapy
  • medication, primarily antidepressants

Individual psychotherapy can include:

Treatment options for bipolar disorder almost always include medication, namely mood stabilizers. Mood stabilizers target areas of the brain responsible for mood disruption.

Psychotherapy is often an important component of treatment because it can be challenging living with frequent mood disruptions. Psychotherapy can help a person with bipolar disorder learn to manage their symptoms, maintain a lifestyle that promotes mood stabilization, and prevent the recurrence of mood episodes.

At first glance, PTSD and bipolar disorder may seem similar, but these conditions have many differences. Knowing them may help you fully share your symptoms and possible trauma history with your healthcare professional.

It’s common for individuals to have both conditions. It’s also possible for these conditions to trigger the other.

Treatment approaches for bipolar disorder and PTSD typically include psychotherapy and medication. However, therapy methods may differ for each condition, and medication is far less prescribed for PTSD as an effective treatment than bipolar disorder.

That makes finding the right diagnosis critical to receiving the most effective care. Whatever your individual experience or diagnosis, you don’t have to try to get better on your own. Help is out there for both conditions.