Self-medicating and increased pleasure-seeking or risk-taking behaviors in bipolar disorder could contribute to habitual gambling.

Bipolar disorder is a mental health condition featuring extreme changes in mood and energy. These “highs” and “lows” occur episodically and can involve depressive periods as well as times of elevated mood and agitation, known as mania or hypomania.

Several variations of bipolar disorder exist, including bipolar I disorder, bipolar II disorder, and cyclothymia. They’re defined by the type, frequency, and severity of mood episodes someone experiences.

If you live with bipolar disorder, you may be more likely to live with co-occurring conditions related to pleasure-seeking behaviors. These might include substance use disorder or gambling disorder.

According to a systematic review from 2018, gambling is the most common behavioral addiction that co-occurs with bipolar disorder. In the literature, as many as 68% of people with a behavioral addiction also had bipolar disorder.

Currently, not much is known about the relationship between bipolar disorder and habit-forming behaviors like gambling. The majority of research has focused on the link between bipolar disorder and substance use disorders, not behavioral addictions.

This may, in part, be because they aren’t well understood, have wide variability, and lack clearly defined diagnostic criteria.

Gambling disorder, however, is included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) along with substance use disorders as conditions of addiction.

Gambling is the only behavioral addiction the DSM-5-TR recognizes. This isn’t because other behavioral addictions don’t exist. It’s because gambling is the only behavioral addiction with enough supporting research for inclusion in the DSM-5-TR.

The DSM-5-TR states that, like substance use disorders, gambling activates reward systems in the brain similar to those activated by substance misuse, and habitual gambling produces symptoms comparable to those of substance use disorders.

Why might people with bipolar disorder gamble?

Gambling can appeal to some people with bipolar disorder.

The reward systems it activates in the brain may offer a way to temporarily self-medicate bipolar disorder symptoms. Also, gambling’s risk-reward nature may appeal to those experiencing mania and hypomania, which can lead to increased risk-taking and pleasure-seeking behaviors.

For some people, gambling may seem like a less harmful opportunity for stress relief than alcohol consumption or drug misuse.

An increase in pleasure-seeking or risk-taking behaviors, like gambling, can be an indicator of a manic or hypomanic episode.

Manic episodes are disruptive periods of elevated mood and agitation. If you have these, you may feel as though your mind is rapid-firing thoughts, you have endless energy, and your confidence is through the roof.

Hypomania is similar, but symptoms are less severe and may not cause major impairment in your daily life.

Symptoms of a manic or hypomanic episode

According to the DSM-5-TR, symptoms of a manic or hypomanic episode might include:

  • inflated self-esteem or a sense of grandiosity
  • rapid speech or an urge to talk
  • racing thoughts
  • a decreased need for sleep
  • distractibility
  • heightened activity levels
  • increased risk-taking and pleasure-seeking behaviors

Living with a mental health condition like bipolar disorder may increase your chances of developing gambling disorder, but this doesn’t mean bipolar disorder directly causes gambling disorder.

The underlying causes of gambling disorder, sometimes referred to as gambling addiction, are complex. Your environment, genetics, socioeconomic background, culture, and innate traits, like impulsivity, can all factor in.

For some people, bipolar disorder symptoms such as grandiosity and pleasure seeking may encourage habitual gambling. This can create a greater opportunity for gambling to become impairing.

Gambling during mania or hypomania doesn’t mean you’re living with a gambling disorder, however.

Gambling disorder can be episodic, but it persists regardless of mood. While it may worsen during mania or hypomania, gambling disorder isn’t limited to elevated mood episodes.

Gambling disorder is defined as recurrent and chronic gambling behaviors that cause significant distress and impairment and continue despite major negative consequences.

According to the DSM-5-TR, a healthcare professional may diagnose gambling addiction when someone experiences four or more of the following behaviors over a 12-month period:

  • restlessness or irritability during attempts to stop gambling
  • repeated attempts to control or cease gambling
  • preoccupation with thoughts of gambling
  • lying to hide gambling activities
  • gambling in response to negative emotions
  • risking or losing interpersonal relationships, jobs, or education due to gambling
  • needing outside financial assistance due to gambling
  • needing to gamble with increasing amounts of money to achieve the desired excitement

If gambling behaviors in bipolar disorder become persistent, are compulsive, or continue despite major negative consequences, you may be living with gambling disorder.

Treating bipolar disorder may help reduce habitual gambling when gambling behaviors are the result of mania or hypomania.

Gambling disorder and bipolar disorder are two separate diagnoses, however. While they may share treatment approaches, they often require different plans and goals.


Both bipolar disorder and gambling disorder are treatable through psychotherapy interventions like cognitive behavioral therapy (CBT), which focuses on restructuring unhelpful thoughts and behaviors.

Other shared therapy options include:

  • group therapy
  • family therapy
  • psychoeducation

Bipolar disorder and gambling disorder may require separate psychotherapy treatments.

Bipolar disorder psychotherapy, for example, may also include dialectical behavior therapy or interpersonal and social rhythm therapy, while gambling disorder may focus primarily on CBT.


Healthcare professionals may use medications to stabilize mood symptoms in both bipolar disorder and gambling disorder.

Medications like antidepressants and mood stabilizers are first-line treatments for bipolar disorder. They can provide long-term management of symptoms by regulating chemical messaging in the brain.

There are no medications with Food and Drug Administration (FDA) approval for the treatment of gambling disorder, but your doctor may prescribe medications to help with secondary symptoms like depression and anxiety.

Habitual gambling is possible if you live with bipolar disorder.

Gambling’s ability to activate your brain’s reward systems is similar to what happens in substance use disorders, and gambling can be part of increased risk-taking and pleasure-seeking behaviors in mania or hypomania.

Gambling disorder, which is when gambling behaviors become persistent and independent of mood, is one of the most common behavioral addictions in bipolar disorder. The treatments for bipolar disorder and gambling disorder are separate, but therapy may be a beneficial option for both.