Bipolar Disorder and Anxious Distress Symptoms

A woman with bipolar disorder.
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Many people who are diagnosed with bipolar disorder also have other psychiatric conditions, including anxiety disorders. But when your anxiety doesn't quite fit into the definition of a specific, well-defined anxiety disorder, your psychiatrist might instead diagnose you as having "bipolar disorder with anxious distress."

Having bipolar disorder with anxious distress simply means you have bipolar disorder, plus anxiety that interferes with your life. Your condition, however, doesn't meet the diagnostic criteria for an anxiety disorder.


Psychiatrists and other mental health professionals use the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to attach an official diagnosis to your condition.

In this case, bipolar disorder is the diagnosis, and "with anxious distress" is what's called a specifier. A specifier is an add-on to a diagnosis that clarifies it or elaborates on it.

The specifier "with anxious distress" is actually new to the DSM with the publication of the fifth edition in 2013. This anxious distress specifier was added because mental health professionals thought it was needed in a variety of cases.


Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder in both primary care and specialty mental health settings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment.

— DSM-5

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.


For a psychiatrist to add the specifier "with anxious distress," a patient's condition needs to include at least two of the following symptoms:

  • Fearing that something terrible may happen
  • Feeling like you might lose control of yourself
  • Feeling tense, nervous, and/or excited
  • Unusual restlessness
  • Worry that makes it difficult to concentrate

In order for bipolar disorder with anxious distress to be diagnosed, the anxious distress symptoms must be present most days of the current or most recent bipolar episode—regardless of whether the episode involved manic, hypomanic or depressive symptoms.

With anxious distress, the severity of the condition is determined by the number of symptoms present. For instance, having two symptoms means the condition is mild, three symptoms means it is moderate, four to five symptoms means it is moderate to severe, and four to five symptoms with ​psychomotor agitation means it is severe.​

It is possible for someone to have bipolar I, bipolar II, or cyclothymia with anxious distress.

Anxiety Disorders Are Also Possible

Even if you have bipolar disorder with anxious distress, you also can be diagnosed with another anxiety disorder. If you get panic attacks, you can be diagnosed with panic disorder, and if you're acutely afraid of a specific object or situation (spiders or flying, for example), then you could be diagnosed with a phobia.

When two or more illnesses not related to each other are diagnosed in a single patient, they are called "comorbid," which simply means they occur together.

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  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Arlington, VA: American Psychiatric Publishing, 2013. 124-125, 156. Print.

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.