Understanding Autism and Bipolar Disorder

Table of ContentsView AllTable of ContentsConnection Between Autism and Bipolar DisorderComplicationsDiagnosisTreatmentMedicationsCoping

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Table of Contents

Connection Between Autism and Bipolar Disorder

Complications

Diagnosis

Treatment

Medications

Coping

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Autism spectrum disorder (ASD) and bipolar disorder have some common symptoms and may sometimes co-occur.Autismis a neurodevelopmental difference that affects how people communicate, behave, learn, and interact.Bipolar disorderis 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.

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:

AuDHD: When Autism and ADHD Co-Occur

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 NowPeople who have bipolar disorder have an increased risk of dying fromsuicide.If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for 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 ourNational Helpline Database.988

Get Help Now

People who have bipolar disorder have an increased risk of dying fromsuicide.If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for 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 ourNational Helpline Database.

People who have bipolar disorder have an increased risk of dying fromsuicide.If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for 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 ourNational Helpline Database.

988

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:

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.

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, andpost-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.

Doctors and mental health professionals use theDiagnostic 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.

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 amanic or hypomanic episodeor contribute to therapid cyclingof 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:

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:

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 experiencesymptoms 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 ormental health professional.

12 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.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/122350Joshi 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.12m07392Goes 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)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.aad6469National Human Genome Research Institute.Gene expression.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/s41386-020-00949-5Borue 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.2016.08.011Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review. Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403American Academy of Pediatrics.Autism spectrum disorder.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.201.01.006Hollander 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)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

12 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.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/122350Joshi 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.12m07392Goes 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)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.aad6469National Human Genome Research Institute.Gene expression.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/s41386-020-00949-5Borue 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.2016.08.011Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review. Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403American Academy of Pediatrics.Autism spectrum disorder.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.201.01.006Hollander 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)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

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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/122350Joshi 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.12m07392Goes 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)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.aad6469National Human Genome Research Institute.Gene expression.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/s41386-020-00949-5Borue 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.2016.08.011Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review. Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403American Academy of Pediatrics.Autism spectrum disorder.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.201.01.006Hollander 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)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

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

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

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)

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

National Human Genome Research Institute.Gene expression.

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

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

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

American Academy of Pediatrics.Autism spectrum disorder.

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

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)

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

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