Bipolar Disorder vs. Anxiety Disorder: Understanding the Differences

Bipolar vs. Anxiety: Key Differences

Both disorders can have symptoms that seem to overlap or be present in both. However, their differences become more apparent when they are broken down into their key diagnostic components and treatment.

	Bipolar disorder	Generalized anxiety disorder
Behavioral Patterns	Euphoric feelings can place an individual in risky situations without regard for themselves. Feelings of sadness or hopelessness.	Distracted with behavioral signs and symptoms of worry
Trouble Sleeping	Too much sleep during a depressive episode or little to no sleep during a manic episode	Disrupted sleep by constant thinking of past or future events
Social Isolation	May isolate during a depressive episode and heightened social interaction during a manic episode	Increased isolation during panic attacks and feelings of worry
Low Self-Esteem	Low self-esteem during a depressive episode and heightened sense of self during a manic episode	Feelings of shame, embarrassment, and failure can be common
Negative Thought Patterns	Can exhibit negative thoughts during depression and positive/thrilling thoughts during mania	Can view self and future negatively
Energy Levels	Low energy during depression and sharp increase in energy during mania	Build up of anxious tension causing increased energy
Level of Risk (DTO/DTS)	Elevated level of risk to self or others	Elevated level of risk to self or others
Duration of Symptoms	Likely to last for several days to a couple weeks	Can last several minutes to days and weeks

What Is Anxiety?

Anxiety is a normal and necessary primary emotion without which individual survival would be impossible.³ The components are best characterized by intense, excessive, persistent worry, fear about everyday situations, and accompanying bodily sensations. However, anxiety is considered disordered when it arises in the absence of any threat or is disproportionate concerning the threat and keeps the affected individual from leading an everyday life.³ Anxiety disorders are the most prevalent mental health conditions, being present in up to 13.3% of individuals in the United States.⁴

Statistics on anxiety show it does not affect all groups equally. Anxiety in women is two to three times as common as anxiety in men.³ Hereditary ranges from 30-67%. The wide variability of genetic impact on the disorder results from interactions with other adverse environmental factors.³ Anxiety disorders are developed through an over-activation of the fight-or-flight system in our body. We begin to feel surrounded by threats when one is not present. Worry and rumination are hallmarks of the disorder. Physical signs and symptoms are also present.

Common symptoms of anxiety include:

• Constant fear that something terrible is going to happen
• Difficulty sleeping
• Rapid heartbeat
• Isolation from social situations
• Reluctance to leave the house
• Anxiety tremors
• Dizziness
• Sweating and clammy hands
• Irritability
• Restlessness
• Muscle tension
• Panic attacks

Types of Anxiety

Anxiety disorders all share the feature of excessive worry. However, it is manifested differently within specific disorders. Many types of anxiety diagnoses have similar presentations and signs/symptoms. Still, they all have different themes of the content they revolve around and different severity and length of time for symptoms. Panic attacks are a particular type of fear response in anxiety disorders.² Many different forms of anxiety disorders can simultaneously be present in an individual, becoming comorbid conditions.

Treatment for Anxiety

The positive news is that anxiety is highly treatable. Talk therapies and anxiety medication can work well on their own but can be more effective if taken together. All talk therapy forms involve rewiring how individuals navigate their flight or fight response and their perception of the environment. Individuals can respond quickly to anxiety treatment without medication, sometimes seeing relief in a few sessions.

Some examples of therapy for anxiety include:

• CBT for Anxiety
• EMDR for Anxiety
• Hypnosis for Anxiety

The first line of defense with medications for anxiety treatment includes selective serotonin reuptake inhibitors (SSRI). These medications inhibit the brain from reabsorbing serotonin after being used, allowing it to be activated again in the connection of neurons. Depending on your type of anxiety and severity, can get anxiety medication varying in intensity and length of effectiveness from your medical provider.

What Is Bipolar Disorder?

Bipolar Disorder is a mental health disorder whose core feature is bipolar cycles and disturbance in mood.⁵ The hallmark feature of the diagnosis is mania.⁶ Mania is a dysregulated form of mood instability where an individual can feel extreme elation with accompanying disturbances in thinking and behavior.⁵ While depression may be present, it is unnecessary for a diagnosis. What is needed for a diagnosis is at least one experience of a manic episode. The peak age at the onset of bipolar I disorder across studies is between 20 and 30 years, but the onset occurs throughout the life cycle.²

Common symptoms of bipolar disorder include: 

• Restlessness
• Feelings of euphoria
• High energy
• Racing thoughts
• Grandiose ideas
• Excessively cheerful
• Aggressive behavior
• Disturbed periods of sleep, needing either minimal or a lot
• Impulsive behavior
• Increased substance use
• High sex drive
• Mania
• Pressured Speech
• Depressive episodes
• Rapid-cycling mood

Types of Bipolar Disorder

Three types of bipolar disorder exist with Cyclothymia, Bipolar I, and Bipolar II. Mania is still present in all of these, but Bipolar II has a less severe form of mania called hypomania and the experience of at least one depressive episode. The mania in Bipolar I will need to be present for at least one week, for most of the day, nearly every day. Cyclothymic disorder is characterized by much milder mood episodes that typically don’t create any impact on daily living.

Treatment for Bipolar Disorder

Acute stabilization is the conventional approach to bipolar disorder, where the goal is to move a person from a manic or depressive state into a period of stability.⁷ The first line of treatment for the treatment of bipolar disorder is mood stabilizers. These medications for bipolar disorder provide the brain with much-needed chemical stability preventing the person from cycling between extreme highs and low lows of mood episodes. One such drug, Lithium, remains the best-established long-term treatment for bipolar disorder.⁷ Antipsychotic drugs are also effective in managing acute episodes of mania ⁷. Most individuals will start seeing these medications’ benefits within the first couple of days.

Additional mood stabilizers include:

• Lamictal
• Depakote
• Tegretol

Talk therapy is a great adjunctive treatment with medication. It can help the individual build healthy coping mechanisms to deal with the effects of mania and depression. Psychotherapy is also powerful at addressing how the individual feels about being diagnosed with bipolar disorder and managing symptoms.

How Are Bipolar Disorder & Anxiety Related?

While distinct mental health challenges, bipolar disorder and anxiety-related disorders can share many features. Compelling evidence explains this relationship more by demonstrating that anxiety disorders may be the most prevalent psychiatric comorbidity amongst persons with bipolar disorder.⁸

Comorbidity of the two appears to be a dangerous combination that is associated with an:⁸

• Intensification of symptoms
• Insufficient treatment response
• Non-recovery
• Poor functional outcome
• Suicidality

The estimated lifetime prevalence of any anxiety disorder in bipolar disorder (? individuals diagnosed with bipolar disorder) was estimated at 92.9%.⁸ Comorbid anxiety disorders with other forms of anxiety have been reported at rates of 10.6%–62.5% for panic disorder, 7.8%–47.2% for social anxiety disorder, and 7%–32% for generalized anxiety disorder.⁹

Diagnosis of Anxiety Disorders vs. Bipolar Disorders

Bipolar disorder and anxiety disorders have specific criteria for diagnosis. There might be some overlap in the signs of a disorder, which can complicate the diagnosis between the two. However, a comprehensive review of someone’s background and medical history can route out the constellation of signs and symptoms into a diagnosis.

Diagnosis for Anxiety

With anxiety, a mental health professional will look for long-standing worrying past the appropriateness of the situation. Cognitive distortions (mental biases that filter how we navigate the world) are likely present in an anxiety disorder. Diagnosing professionals will also take a detailed history of accompanying physical behaviors.

The provider will need to know if the individual has experienced such sensations as:

• Panic attacks
• An overwhelming sense of worry
• Feelings of dread that paralyzes the individual
• Rapid heartbeat
• Sweating

Diagnosis for Bipolar Disorder

A mental health provider diagnosing bipolar disorder will be looking for criteria related to mania. A history of a diagnosis of depression might not rule out bipolar disorder as the individual may have experienced mania without fully being aware. The mania will need to be present for at least one week with Bipolar I and at least 4 days for Bipolar II.² Specialists, as well as friends and family, can observe mania when the person demonstrates a marked change in behavior.

Diagnosis for bipolar disorder will consider the level of impulsivity of risky behavior, such as:

• Increased substance use
• Hypersexual behavior
• Staying up for days
• Excessive spending/shopping

Risk Factors for Bipolar Disorder & Anxiety Disorders

Bipolar and anxiety disorders don’t develop in a vacuum. There is a high rate of a genetic predisposition for these conditions. Bipolar disorder can be genetic and among the most heritable medical disorders.¹ People may be predisposed to these mental health issues through their genetics and biology. However, several nuanced environmental factors complicate the clinical picture. Acute stress disorders and poor stress management are major risk factors that can amplify the likelihood of these disorders developing.

A poor stress response can indicate that you did not develop the appropriate skills to navigate demanding situations. Impaired early attachments can also factor into the development of these disorders. With a lack of secure attachments comes the likelihood that a person has poor social support. Not having appropriate social outlets can damage the mind and body and their ability to regulate themselves. Without external checks, an individual can be left with negative and rigid thoughts that can lead to mental illness. With this, an individual with bipolar or anxiety-related disorders is also at risk of developing other mental health issues.

Other possible comorbid disorders with bipolar and anxiety include:

• Major depressive disorder
• Additional anxiety disorder
• Substance use disorders
• Post-traumatic stress disorder  

Recovery & Management of Bipolar Disorder & Anxiety

One of the best ways to deal with most mental health issues is to adhere to long-term treatment. Bipolar disorder can’t be cured as it is a chronic condition; however, management of symptoms is possible through routine adherence to treatment. Bipolar and anxiety are treatable through adherence and commitment to treatment. Medication is necessary to regulate mood disturbances in bipolar disorder. Anxiety disorders respond well to medication but are not always necessary to relieve symptoms.

Treatment will look different for each person, but given bipolar’s chronicity, medication and talk therapy will likely be a long-term part of treatment. Individuals may discontinue their medication if they feel more leveled and stable. However, stopping medication without speaking with your medical doctor is never a good idea. Discontinuing medication abruptly can cause someone with bipolar disorder to experience rapid mood shifts.

An anxiety disorder may benefit from medication or long-term talk therapy to manage symptoms and negative thinking. CBT has received the greatest amount of empirical support for the psychological treatment of anxiety disorders.³ Some anxiety medications do not need to be taken regularly and are only required during panic or when phobic situations arise. Anxiety responds well to other coping skills besides talk therapy, including exercise and meditation. Anxiety does not have to be a chronic condition. It can be transitory and pop up at certain points in your life and resolve itself in a timely manner.

Some common coping skills for both anxiety and bipolar disorder include:

• Maintaining a healthy diet
• Developing a support network
• Seeking out treatment and considering talk therapy and medication
• Adherence to medication regimen
• Exercise for mental health
• Maintaining healthy sleeping habits for mental health
• Reframing negative self-talk and thought using thought stopping techniques
• Practicing meditation
• Engaging in mindfulness techniques
• Using mantras to calm emotions
• Finding group therapy and support groups

Final Thoughts

Anxiety and bipolar disorder are distinct disorders that may share similar features. Anxiety is an overarching construct with specific conditions. Its foundational components are excessive worrying, panic attacks, and accompanying bodily sensations. Bipolar disorder is marked by a disturbance in mood and thought. Both are treatable through adherence and commitment to treatment. Medication is necessary to regulate mood instabilities in bipolar disorder, while anxiety disorders respond well to medication but may not be needed. Talk therapy is a significant component of treatment and can help with symptom reduction of both disorders. There are many ways of finding a therapist, and using an online therapist directory is a great way to start.