Understanding Autism and Bipolar Disorder

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Autism spectrum disorder (ASD) and bipolar disorder have some common symptoms and may sometimes co-occur. Autism is a neurodevelopmental difference that affects how people communicate, behave, learn, and interact. Bipolar disorder is a mood disorder that causes episodes that impact a person's emotional state, energy levels, and behavior.

While some autistic traits can mimic bipolar symptoms, bipolar disorder and autism are not the same. Estimates suggest that around 5% to 8% of autistic people have bipolar disorder.

In this article, we discuss the connection between autism and bipolar disorder and autistic people's experiences of bipolar disorder.

The Connection Between Autism and Bipolar Disorder

Autistic people can have bipolar disorder, and they can experience their symptoms differently as a result.

Megan is autistic and has bipolar disorder, and she shared her experience with bipolar disorder as an autistic person. "Bipolar symptoms already come with risky behavior," she explained, "but I think I ended up in more dangerous situations than maybe I would have if I weren’t autistic because I didn’t recognize the different social innuendos." In addition, she noted that her mood symptoms can be "exacerbated by my sensory issues, both external and internal sensory triggers."

One study found that around 30% of young people who are diagnosed with bipolar I disorder (which is characterized by significant manic episodes) are autistic. This same study also found that symptoms of bipolar disorder tend to appear earlier when a person is autistic.

In addition to bipolar disorder manifesting differently for autistic people, the autistic community is at higher risk for developing bipolar disorder than non-autistic people. Some studies have found that there are shared genetic connections between autism and bipolar disorder. One study found that bipolar disorder and autism share global gene expression patterns, which may explain why they sometimes occur together. 

Gene expression refers to the way that a gene responds to its environment. It acts as an on/off switch to control the production of proteins, including when and how many are made. Differences in how genes are expressed might explain why certain mental disorders can share similar genetic roots that then produce different symptoms.

Shared Risk Factors

Some factors that appear to be more common in autistic people with bipolar disorder compared to non-autistic people with bipolar disorder include:

Complications of Autism and Bipolar Disorder

Autistic people with bipolar disorder can experience significant effects in many different domains. Evidence suggests that young autistic people who have bipolar disorder experience greater impairments when it comes to their social relationships compared to those who do not have bipolar disorder.

Autistic people who develop bipolar disorder tend to develop bipolar symptoms at a younger age than non-autistic people with bipolar disorder. This can lead to disruptions in a person's life and their ability to function in relationships, school, self-care, and other important life areas.

Bipolar disorder can also present with an intense focus on a goal or activity. Megan shared, "I have to be mindful of how focused I get on my [autistic] special interests and prioritize routine, especially around sleep because I used to forgo sleep in order to learn more or create projects which could and has pushed me into mania."

Get Help Now

People who have bipolar disorder have an increased risk of dying from suicide.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Diagnosis of Autism and Bipolar Disorder

Because much research around bipolar disorder focuses on the symptoms of non-autistic people, it can be more difficult for autistic people to get an accurate diagnosis. Some symptoms that autistic people experience when they have bipolar disorder include:

  • Aggression
  • Depressed or elevated moods
  • Distractibility
  • Engaging in repetitive behaviors
  • Impulsivity
  • Irritability
  • Racing thoughts
  • Rapid speech or excessive talking
  • Sleep difficulties

When an autistic person has intellectual impairments or communication challenges, accurately assessing bipolar symptoms can be even more difficult. Having comorbid ADHD or OCD can further complicate the diagnostic process due to symptom overlap.

Autism vs. Bipolar Disorder

Healthcare practitioners conduct routine screenings for autism. The American Academy of Pediatrics (AAP) recommends that these screenings should occur at ages 9, 18, and 30 months of age.

In order to diagnose autism or bipolar disorder, a provider may administer screenings or mental health evaluations and ask questions about symptoms, history, and behaviors. A diagnosis is typically made by considering the results of these screenings and then asking caregivers or other people about the individual's activities and behaviors. 

Doctors may also administer a physical exam, perform lab tests, and conduct other tests to help rule out other conditions that might be causing or contributing to symptoms. People with bipolar disorder are also more likely to experience other comorbid conditions such as ADHD, substance use, and post-traumatic stress disorder (PTSD).

In order to differentiate between autism and bipolar disorder, a doctor may look at the nature, duration, expression, age of onset, and severity of symptoms. 

  • Autistic people and those with bipolar disorder can exhibit impulsive behavior, but this symptom will cycle with bipolar disorder and not with autism. 
  • Autism is a neurodevelopmental difference with early childhood onset, whereas the typical age of onset for bipolar disorder is adolescence or young adulthood.
  • Autistic people may experience problems with social communication and awareness, speech differences, sensory issues, and intellectual disabilities. Such symptoms are not typically associated with bipolar disorder.
  • Bipolar disorder causes severe depression and may cause suicidal thoughts. While autistic people may also experience depression, these mood episodes are not considered a symptom of their condition.

Doctors and mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to diagnose mental health conditions and neurodevelopmental differences including autism.

Treatment and Support for Autism and Bipolar Disorder

Autism and bipolar disorder are both lifelong. Treatments for bipolar disorder are focused on helping people manage symptoms and strengthening their ability to function in their daily life. Although autism is not an illness, many autistic people benefit from supportive services to help them function in a world that is not designed to meet their needs.

There is no single approach to treatment that is right for everyone, and every person has different needs in terms of the level of support they require to thrive.

Medications

Treatment for bipolar disorder typically involves the use of medications to help stabilize mood. Megan told us that medication was "the most important thing to get back on track" after she experienced her first manic episode. Medications that may be prescribed include:

It is important to note that it is not recommended to take antidepressants on their own for bipolar disorder. These medications may trigger the onset of a manic or hypomanic episode or contribute to the rapid cycling of mood episodes.

When autistic people experience bipolar disorder, mood stabilizers are sometimes used along with low-dose antipsychotics. Antiseizure medications that stabilize mood, such as valproic acid, may be preferred. Atypical antipsychotics such as aripiprazole and risperidone can help control symptoms of irritability in children.

Psychotherapy

Frequently-used interventions typically focus on improving skills and may include:

  • Cognitive-behavioral therapy (CBT) focuses on helping people change negative thought patterns. Specifically, a therapist who is neurodiversity-affirming can connect with and support autistic people with their mental health.
  • Family therapy can help family members learn more about their loved one’s condition and what they can do to help.
  • Support groups can help individuals connect with other people who are going through similar experiences. Megan said, " I joined a living with psychosis group which focused on building skills really around executive function, socialization, and symptom management, which inadvertently gave me more perspective and support with my autism."

Such approaches can help improve existing strengths, increase communication abilities, improve social skills, and promote adaptive skills needed for independent living. Support for autism can begin in early childhood, while treatment for bipolar disorder often begins when the condition is first diagnosed in adolescence or young adulthood.

Coping With Autism and Bipolar Disorder

In addition to seeking the appropriate treatment, there are also strategies that may help autistic people better cope when they have bipolar disorder. 

Lifestyle Changes 

Self-care strategies can be an important part of living well with autism and bipolar disorder. Some strategies that can help include:

  • Getting regular physical exercise
  • Following a healthy diet
  • Getting plenty of sleep 
  • Monitoring mood changes
  • Learning to recognize triggers that affect mood
  • Utilizing relaxation techniques to manage stress
  • Following a daily routine
  • Seeking social support
  • Avoiding alcohol and substance use
  • Having a suicide safety plan

Megan said that she uses a routine to help her notice if she is starting to experience bipolar symptoms as well.

Such strategies can improve daily living, but they are not a replacement for professional treatment. Lifestyle changes combined with effective, proven treatments for autism and bipolar disorder can maximize your strengths and ensure your well-being.

Support Groups

Support groups for autism and bipolar disorder can also be a source of valuable information, support, and encouragement. Megan told us, "Finding support through online communities helps me feel connected and less alone."

Autism Resources

Bipolar Resources

A Word From Verywell

Autistic people experience unique challenges and difficulties when they experience symptoms of bipolar disorder. It can be more difficult for autistic clients to get an accurate diagnosis compared to non-autistic peers, but effective treatments and interventions are available for these lifelong conditions.

Experiencing symptoms of autism and bipolar disorder can make diagnosis more complicated, particularly when an autistic person has difficulty communicating their emotions, moods, and behaviors. The presence of both conditions may affect how they are treated, so it is important to get an accurate diagnosis. If you or someone you love is experiencing symptoms of autism or bipolar disorder, talk to a doctor or mental health professional.

12 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dunalska A, Rzeszutek M, Dębowska Z, Bryńska A. Comorbidity of bipolar disorder and autism spectrum disorder - review paper. Psychiatr Pol. 2021;55(6):1421-1431. doi:10.12740/PP/OnlineFirst/122350

  2. Joshi G, Biederman J, Petty C, Goldin RL, Furtak SL, Wozniak J. Examining the comorbidity of bipolar disorder and autism spectrum disorders: a large controlled analysis of phenotypic and familial correlates in a referred population of youth with bipolar I disorder with and without autism spectrum disorders. J Clin Psychiatry. 2013;74(6):578-586. doi:10.4088/JCP.12m07392

  3. Goes FS, Pirooznia M, Parla JS, et al. Exome sequencing of familial bipolar disorder. JAMA Psychiatry. 2016;73(6):590–597. doi:10.1001/jamapsychiatry.2016.0251)

  4. Gandal MJ, Haney JR, Parikshak NN, et al. Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap. Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469

  5. National Human Genome Research Institute. Gene expression.

  6. Akula N, Marenco S, Johnson K, et al. Deep transcriptome sequencing of subgenual anterior cingulate cortex reveals cross-diagnostic and diagnosis-specific RNA expression changes in major psychiatric disorders. Neuropsychopharmacol. 2021;46(7):1364-1372. doi:10.1038/s41386-020-00949-5

  7. Borue X, Mazefsky C, Rooks BT, Strober M, Keller MB, Hower H, Yen S, Gill MK, Diler RS, Axelson DA, Goldstein BI, Goldstein TR, Ryan N, Liao F, Hunt JI, Dickstein DP, Birmaher B. Longitudinal course of bipolar disorder in youth with high-functioning autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2016 Dec;55(12):1064-1072.e6. doi:10.1016/j.jaac.2016.08.011

  8. Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: A brief review. Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403

  9. American Academy of Pediatrics. Autism spectrum disorder.

  10. Baldessarini RJ, Tondo L, Vazquez GH, Undurraga J, Bolzani L, Yildiz A, Khalsa HM, Lai M, Lepri B, Lolich M, Maffei PM, Salvatore P, Faedda GL, Vieta E, Tohen M. Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry. 2012;11(1):40-6. doi:10.1016/j.wpsyc.201.01.006

  11. Hollander E, Chaplin W, Soorya L, Wasserman S, Novotny S, Rusoff J, Feirsen N, Pepa L, Anagnostou E. Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders. Neuropsychopharmacology. 2010;35(4):990-8. doi:10.1038/npp.2009.202)

  12. Fallah MS, Shaikh MR, Neupane B, Rusiecki D, Bennett TA, Beyene J. Atypical antipsychotics for irritability in pediatric autism: A systematic review and network meta-analysis. J Child Adolesc Psychopharmacol. 2019;29(3):168-180. doi:10.1089/cap.2018.0115

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Originally written by
Kendra Cherry
Kendra Cherry

Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.

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