ADHD and bipolar disorder show up together far more often than chance would predict, and they can look alike enough that one hides the other for years. If you’ve been diagnosed with one and something still doesn’t add up, or you suspect either for the first time as an adult, the most useful next step is a thorough assessment with a qualified clinician who checks for both.
How common each one is
ADHD isn’t only a childhood condition. A global meta-analysis estimated that 2.58% of adults have persistent ADHD that started in childhood, and 6.76% have symptomatic adult ADHD, regardless of whether it was noticed in childhood. Both rates were lower in older age groups.[1]
Bipolar disorder is less common. In World Health Organization surveys of 61,392 adults across 11 countries, lifetime prevalence was 0.6% for bipolar I, 0.4% for bipolar II and 1.4% for milder, subthreshold forms, or 2.4% for the bipolar spectrum overall. Fewer than half of people on that spectrum had ever received mental health treatment.[2]
How often they occur together
A 2021 meta-analysis pooled 71 studies with 646,766 participants from 18 countries. About 1 in 13 adults with ADHD also had a bipolar disorder diagnosis (7.95%), and nearly 1 in 6 adults with bipolar disorder also had ADHD (17.11%). In people with both, bipolar disorder started about four years earlier on average. The rates varied a lot from study to study, depending partly on which diagnostic system was used and where the study took place.[3]
Compare those figures with the general population rates above and the point is clear: if you live with one of these conditions, the odds that the other is also present are much higher than average. The authors concluded that clinicians should keep this overlap in mind to prevent misdiagnosis.[3]
Why one can hide the other
In adults, ADHD can resemble bipolar disorder, and the two often co-occur. That overlap can lead to the wrong diagnosis and to treatment that doesn’t work, which matters because bipolar disorder is linked with suicidal thoughts and behavior.[4]
The biggest clue is the pattern over time. ADHD tends to be steady and trait-like. Bipolar disorder comes in episodes, with stretches of more typical mood in between, although day-to-day functioning may not fully bounce back. In people who have both, ADHD symptoms stay visible between mood episodes.[4] That’s why a single snapshot visit can miss what a timeline makes obvious.
Bipolar disorder is also slow to get recognized in general. A meta-analysis of 27 studies covering 9,415 patients found an average gap of 5.8 years between when bipolar disorder began and when it was first managed.[5] For adult ADHD, researchers say a well-defined strategy for diagnosing it is still needed.[1] Put those together and it’s easy to see how someone can reach their 30s, 40s or later with only part of the picture.
Why getting assessed is worth it
An accurate diagnosis is what lets treatment target the right thing, and expert reviewers stress that it matters for outcomes.[4] A diagnosis isn’t a label that limits you. It’s information: a way to make sense of long-running patterns and to find support that fits how your brain actually works, at any age.
How to prepare for an assessment
- Build a simple timeline. Note when focus, restlessness or impulsivity problems first showed up. Old school reports can help. Then list any stretches of unusually high or low mood: roughly when, how long they lasted, and what happened to your sleep and energy.
- Ask someone who knows you well. A partner, sibling or close friend may remember patterns you don’t.
- Track your mood for a few weeks. A notes app or paper log with a daily mood rating, sleep hours and one line about your day gives the clinician real data instead of memory.
- Ask directly. “Have you screened me for both ADHD and bipolar disorder?” is a fair question at any appointment.
- If you’re already in treatment, keep your prescriber in the loop. If something feels off, say so. Don’t start, stop or change a medication on your own.
Only a qualified clinician, such as a psychiatrist or psychologist, can assess you for ADHD or bipolar disorder, so talk to one about what you’re noticing.
If you’re in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline (US), available 24/7. If you’re outside the US, contact your local emergency number.
References
↑︎ Song P, Zha M, Yang Q, Zhang Y, et al. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health. 2021;11:04009. Population: population-based studies of general adult populations published from 2000 onward. DOI: https://doi.org/10.7189/jogh.11.04009. Finding as used: adjusted to the 2020 global demographic structure, prevalence of persistent adult ADHD (with childhood onset) was 2.58% and of symptomatic adult ADHD (regardless of childhood onset) was 6.76%; both decreased with advancing age; a well-defined strategy for diagnosing adult ADHD is needed.
↑︎ Merikangas KR, Jin R, He J, Kessler RC, et al. Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry. 2011;68(3):241-251. Population: 61,392 community adults in 11 countries, face-to-face household surveys. DOI: https://doi.org/10.1001/archgenpsychiatry.2011.12. Finding as used: aggregate lifetime prevalence was 0.6% for bipolar I, 0.4% for bipolar II, 1.4% for subthreshold bipolar and 2.4% for bipolar spectrum disorder; less than half of those with lifetime bipolar spectrum disorder received mental health treatment.
↑︎ Schiweck C, Arteaga-Henriquez G, Aichholzer M, Edwin Thanarajah S, et al. Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2021;124:100-123. Population: 71 studies, 646,766 participants, 18 countries. DOI: https://doi.org/10.1016/j.neubiorev.2021.01.017. Finding as used: about one in thirteen adults with ADHD was also diagnosed with bipolar disorder (7.95%, 95% CI 5.31-11.06) and nearly one in six adults with bipolar disorder had ADHD (17.11%, 95% CI 13.05-21.59); substantial heterogeneity partly explained by diagnostic system, sample size and geography; bipolar onset was 3.96 years earlier with comorbid ADHD; clinicians should be aware of high comorbidity rates to prevent misdiagnosis.
↑︎ Asherson P, Young AH, Eich-Höchli D, Moran P, et al. Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults. Current Medical Research and Opinion. 2014;30(8):1657-1672. Population: clinical review (four databases, DSM-5, expert experience). DOI: https://doi.org/10.1185/03007995.2014.915800. Finding as used: ADHD in adults can resemble and often co-occurs with bipolar disorder, which can lead to mistaken diagnoses and ineffective treatment; bipolar disorder is associated with suicidality; bipolar disorder is episodic, with periods of normal mood though not necessarily normal function, while ADHD is associated with chronic trait-like symptoms; in comorbid ADHD-bipolar disorder, ADHD symptoms are apparent between episodes; accurate diagnosis is important for correctly targeting treatment and improving outcomes.
↑︎ Dagani J, Signorini G, Nielssen O, Bani M, et al. Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder. The Canadian Journal of Psychiatry. 2017;62(4):247-258. Population: 27 studies, 51 samples, 9,415 patients. DOI: https://doi.org/10.1177/0706743716656607. Finding as used: the pooled estimate of the interval between onset of bipolar disorder and its management was 5.8 years, with very high between-sample heterogeneity.
Kurt Greiner
Kurt is a digital strategist and IT professional blending emerging technology with practical application to help businesses and individuals streamline their digital presence. His current work focuses on the intersection of intentional living and technological resilience, exploring how individuals can leverage modern tools to navigate the second half of life with purpose.
Leave a Reply