Some schizophrenia and bipolar disorder symptoms may overlap or manifest in similar ways. How do you know which one you’re dealing with?
Experiencing constant changes in mood may be a symptom of different mental health disorders. When you add in symptoms of psychosis, that list shrinks — but still leaves you with more than one possibility.
Is it schizophrenia or bipolar disorder? Could it be both or something entirely different? Is bipolar schizophrenia real?
Learning more about these mental health conditions and their other symptoms can help.
Schizophrenia is a mental health condition distinguished primarily by symptoms of psychosis.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), schizophrenia falls under the category of “schizophrenia spectrum and other psychotic disorders.”
To receive a schizophrenia diagnosis, the DSM-5 states these criteria must be met:
- At least two of the following symptoms are present the majority of the time within a 1-month period (or less if there has been successful treatment):
- disorganized speech
- grossly disorganized behavior
At least one of the symptoms present must be hallucinations, delusions, or disorganized speech.
- There has been significant challenges and changes in areas of major functioning.
- Symptoms have persisted for at least 6 months, during which there was at least 1 month when the person had negative symptoms or symptoms of psychosis.
- Other mental health conditions have been ruled out.
- Symptoms are not the result of substance use or injury.
Bipolar disorder is primarily defined by extreme, impairing changes in mood.
These mood changes involve periods of distress known as depressive episodes and periods of agitation or elevated mood known as mania.
In the DSM-5, bipolar disorder is listed under “bipolar and related disorders.” In the clinical setting, it’s often called a mood disorder, or an affective disorder.
More than one type of bipolar disorder exists:
- Bipolar I disorder. Presence of severe manic episodes usually followed by episodes of depression.
- Bipolar II disorder. Depressive periods with less-severe changes of agitated mood known as hypomanic episodes.
- Cyclothymia. Both hypomanic symptoms and depressive symptoms are present for longer than 2 years but are not severe enough to meet other diagnostic criteria.
While the symptoms of bipolar disorder tend to deal with mood, you may experience features of psychosis, too, particularly during episodes of mania. This doesn’t happen to everyone with bipolar disorder, though.
In bipolar disorder, these episodes of psychosis can be mood congruent or mood incongruent.
Mood congruent psychosis matches your current thoughts and feelings. An example can be a delusion of being a movie star while you’re elated and on a shopping spree.
Mood incongruent psychosis doesn’t match your current mood. You may feel on top of the world, for example, but hear voices around you talking about your low self-worth.
Schizophrenia and bipolar disorder can have overlapping features. This sometimes makes a formal diagnosis challenging for everyone, including clinicians.
Differences in symptoms
Bipolar disorder and schizophrenia can share symptoms related to mood, disorganized thinking, and psychosis.
In schizophrenia, however, psychosis is the main diagnostic feature.
In bipolar disorder, the primary symptoms are mood-related, and may (but more often do not) include symptoms of psychosis.
“Sometimes bipolar disorder can have psychotic features,” notes Jessica Eiseman, a clinical counselor in Houston, Texas. “However, these are exclusive to the mood symptoms, whereas with schizophrenia the psychosis is present outside any mood symptoms.”
Dr. Debanjan Banerjee, a psychiatrist at the National Institute of Mental Health and Neuro Sciences in Bangalore, India, explains that bipolar disorder focuses on clinically significant episodes of depression and mania or hypomania.
With schizophrenia, the focus is on a detachment from reality.
“Bipolar disorder is more common than schizophrenia,” says Banerjee. “The gap is not so wide. Symptoms usually manifest during the early 20s, although the range of symptoms for bipolar disorder is wider.”
Differences in causes
The exact causes of bipolar disorder and schizophrenia aren’t yet established.
Similarities and differences between the two conditions have been noted in areas of:
- structural changes in the brain
In a 2013 systematic review, experts noted that, while bipolar disorder and schizophrenia share cognitive impairment profiles, people living with schizophrenia appear to have a more widespread, severe impairment when functioning in the world.
In a specific example, a 2013 study noted people living with schizophrenia had less gray matter in numerous cortical and subcortical regions of the brain. People living with bipolar disorder showed gray matter reduction primarily in the frontotemporal cortex.
The cortical region is the outer layer of the brain. It’s involved in functions like processing information, language, decision making, and memory. These are considered higher-level cognitive functions. The subcortical region is associated with emotional regulation.
The frontal and temporal areas of the brain are linked to behavior, personality, language, and also some higher-level functions like planning and decision making.
Differences in treatments
The primary difference between schizophrenia and bipolar disorder when it comes to medications may be active ingredients, and the addition of mood stabilizers in bipolar disorder treatment.
“Treatments for schizophrenia include antipsychotic medications, which have to be taken every day to prevent symptoms,” notes Banerjee. “Treatments for bipolar disorder include mood stabilizers such as lithium, which are taken usually along with antipsychotic medications.”
Both bipolar disorder and schizophrenia can benefit from psychotherapy and other treatment forms, including electroconvulsive therapy (ECT).
Not all psychotherapy approaches will be the same for both disorders, however.
According to Eiseman, cognitive behavioral therapy (CBT) may have a specific application in bipolar disorder. For schizophrenia, however, challenging someone’s distorted reality with certain forms of CBT could damage the relationship between patient and therapist.
For this reason, CBT for bipolar disorder may be drastically different in approach from CBT for schizophrenia.
Differences in person’s functionality
If you live with bipolar disorder, you may be able to function in the world with and sometimes without treatment. It depends on the severity and type of symptoms.
The outlook for people with schizophrenia may be different.
Some people with schizophrenia see an improvement in their symptoms to the point where they can function independently.
For others, symptoms can improve with daily living supports, such as medications and therapy.
For some, symptoms might not improve.
Yes, you can receive both a diagnosis of schizophrenia and a diagnosis of bipolar disorder — but it’s complicated.
Eiseman says the timing of symptoms would have to be extensively evaluated to determine if two individual disorders are actually present.
She points out it’s not common to receive this type of dual diagnosis. Instead, experts would likely point a finger at another disorder altogether.
“If both schizophrenia symptoms and bipolar symptoms occurred within the same time frames, then a diagnosis of schizoaffective disorder would be considered,” she says.
Schizoaffective disorder typically presents with symptoms of psychosis mixed with mood episodes similar to those seen in bipolar disorder.
Unlike bipolar disorder, though, symptoms of psychosis persist in schizoaffective disorder, even when mood episodes aren’t active.
Some people may refer to mood changes in schizophrenias as “bipolar schizophrenia,” but this isn’t a real diagnosis.
Schizophrenia and bipolar disorder share some similarities. They can have overlapping symptoms and causes, and can respond to similar treatments.
Despite these similarities, schizophrenia and bipolar disorder aren’t the same and rarely coexist.
The main symptoms in schizophrenia involve a detachment from reality known as psychosis.
Bipolar disorder, on the other hand, may have moments of psychosis, but it’s considered primarily a disorder of mood episodes.