The Complex Relationship Between Bipolar Disorder and Autism

Bipolar disorder and autism spectrum disorder (ASD) have long been thought to share some common traits and underlying causes. Recent research has uncovered a complex relationship between these two conditions, with some overlap in genetics and symptoms. While they are distinct diagnoses, it’s possible for someone to have both bipolar disorder and ASD. Understanding the connections and differences is critical for proper diagnosis and effective treatment.

The Complex Relationship Between Bipolar Disorder and Autism
The Complex Relationship Between Bipolar Disorder and Autism

What Do We Know About Links Between Bipolar Disorder and Autism?

Several studies have shown connections between bipolar disorder and ASD:

  • About 7% of autistic individuals also have a diagnosis of bipolar disorder, nearly three times the rate in the general population.
  • Around 40% of people with bipolar disorder exhibit traits of ASD.
  • There are genetic links between autism, bipolar disorder, and other mental health conditions like schizophrenia. This helps explain some of the symptom crossover between these diagnoses.
  • Autistic people are at higher risk of also having bipolar disorder compared to the general population.
  • Those with bipolar disorder have increased chances of also being on the autism spectrum.

The exact mechanisms behind this relationship are still unclear. However, the data makes it evident that overlap exists between bipolar disorder and ASD. Healthcare providers must be aware of this when exploring symptoms and making diagnoses.

Key Differences Between Bipolar Disorder and Autism Spectrum Disorder

Although they can look similar in some ways, bipolar disorder and ASD have distinct differences:

Classification and Causes

  • Bipolar disorder is a psychiatric illness. Autism is a developmental disability.
  • Bipolar disorder can be triggered by stressful life events. ASD is a genetic, lifelong neurological condition present from birth.
  • Bipolar disorder symptoms typically emerge around age 25. Autism symptoms are present before age 3.

Diagnostic Criteria

  • Bipolar disorder diagnosis is based on mood disturbances like mania and depression. ASD diagnosis focuses on social communication deficits and restricted, repetitive behaviors.
  • Moods rapidly cycle between mania and depression in bipolar disorder. ASD does not involve cycling mood episodes.
  • Autism criteria require communication difficulties like lack of eye contact. These social traits are not part of bipolar diagnosis.

Treatment Approaches

  • Bipolar disorder treatment emphasizes mood stabilizers and psychotherapy. ASD uses behavioral therapies and skills training.
  • Medications for bipolar aim to control mood swings. ASD meds target associated symptoms like anxiety.
  • Therapies for autism focus on improving social and communication skills. Bipolar therapy helps manage mood episodes.

Overlapping Traits and Behaviors

Despite clear diagnostic differences, some characteristics occur in both bipolar disorder and ASD:

  • Irritability
  • Disturbed sleep patterns
  • Repetitive or obsessive behaviors
  • Impulsivity and aggression
  • Pressured, disorganized speech

However, these behaviors manifest for very different underlying reasons in each condition. Healthcare providers must investigate the cause and context of overlapping symptoms to distinguish between bipolar disorder and autism.

Some key considerations:

  • Sudden severe mood swings without an external trigger likely indicate bipolar disorder rather than ASD.
  • Sensory issues, speech delays in childhood, and social communication challenges suggest autism, not bipolar.
  • If traits have been present since early childhood, ASD is more probable than sudden adolescent or adult onset of bipolar disorder.
  • Suicidal thoughts are more associated with bipolar disorder than ASD alone.
  • Special interests and stimming behaviors in autism may resemble obsessive or repetitive actions in bipolar, but have different motivations.

Careful examination of the timeline and nature of overlapping traits is needed for accurate differential diagnosis.

How Are Bipolar Disorder and Autism Diagnosed?

Bipolar disorder and ASD have different diagnostic processes:

Diagnosing Autism Spectrum Disorder

  • ASD is typically diagnosed early in childhood but can be identified in teens and adults.
  • Diagnosis is based on direct observations, questionnaires, and testing to identify core ASD symptoms and traits.
  • There are no definitive biological markers for ASD – diagnosis relies on behavioral criteria.

Diagnosing Bipolar Disorder

  • Bipolar diagnosis often begins after age 25 when clear episodes of mania and depression have occurred.
  • Physical exams and lab tests help rule out other potential causes of mood swings.
  • The person must have experienced at least one manic episode for a bipolar diagnosis.
  • There are no biological tests that confirm bipolar disorder. Diagnosis is clinical.

Obtaining an accurate diagnosis requires a skilled clinician. Misdiagnosing autism as bipolar disorder or vice versa is common without expertise in both conditions.

Appropriate Treatment Varies by Diagnosis

Treatment approaches for bipolar disorder and autism are different:

Bipolar Disorder Treatments

  • Mood stabilizing medication like lithium
  • Antidepressants or antipsychotics
  • Psychotherapy to manage mood episodes

Autism Spectrum Disorder Treatments

  • Behavioral therapies such as ABA
  • Communication training
  • Social skills practice
  • Sensory integration therapy
  • Medication for co-occurring anxiety

Some medications may be used for both conditions, like antipsychotics. However, the treatment focus and goals vary based on the specific diagnosis.

Integrated treatment from providers knowledgeable about both bipolar and autism is ideal when a dual diagnosis exists.

Getting Properly Diagnosed and Treated

If you suspect bipolar disorder or ASD in yourself or a loved one, the first step is discussing this with a healthcare professional. Describe all relevant history and symptoms, and request a full evaluation.

Adults seeking diagnosis should document symptoms and important questions for providers:

  • When did these traits first appear? Sudden adolescent or adult onset suggests bipolar disorder.
  • Have there been cycles of mania and depression? Frequency and duration are important for bipolar diagnosis.
  • Is there a history of speech or social deficits typical of ASD?
  • Are suicidal thoughts present? These are more associated with bipolar disorder.

Finding experienced providers who thoroughly understand both bipolar disorder and ASD is critical. Getting the correct diagnosis leads to appropriate and effective treatment.

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References

[1] National Institute of Mental Health. Bipolar Disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder

[2] Maenner MJ, Shaw KA, Baio J, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveill Summ 2020;69(No. SS-4):1–12. DOI: http://dx.doi.org/10.15585/mmwr.ss6904a1

[3] Skokauskas, N., & Frodl, T. (2015). Overlap between autism spectrum disorder and bipolar affective disorder. Psychopathology, 48(4), 209–216. https://doi.org/10.1159/000435787

[4] Dell’Osso, L., Carpita, B., Bertelloni, C. A., et al. (2019). Subthreshold autism spectrum in bipolar disorder: Prevalence and clinical correlates. Psychiatry Research, 278, 1126–1105. https://doi.org/10.1016/j.psychres.2019.112605

[5] Goes, F. S., Pirooznia, M., Parla, J. S., et al. (2016). Exome sequencing of familial bipolar disorder. JAMA psychiatry, 73(6), 590–597. https://doi.org/10.1001/jamapsychiatry.2016.0251

[6] Massachusetts General Hospital Lurie Center for Autism. Bipolar Disorder. https://www.massgeneral.org/children/autism/bipolar-disorder

[7] National Alliance on Mental Illness. Bipolar Disorder. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder

[8] Centers for Disease Control and Prevention. Diagnostic Criteria. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

[9] Cross-Disorder Group of the Psychiatric Genomics Consortium. Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders. Cell. 2019;179(7):1469-1482.e11. https://doi.org/10.1016/j.cell.2019.11.020

[10] Aldinger F, Schulze TG. Environmental Factors, Life Events, and Trauma in the Course of Bipolar Disorder. Psychiatry Clin Neurosci. 2017;71(1):6-17. https://doi.org/10.1111/pcn.12433

[11] National Institute of Mental Health. Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder

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