Bipolar disorder and post-traumatic stress disorder (PTSD) represent two different mental health diagnoses. But they share enough symptoms that they can sometimes resemble each other, even to experienced mental health professionals. This symptom overlap can create complications when it comes to diagnosis and treatment.

Here, we examine key similarities and differences between bipolar disorder and PTSD by answering four commonly asked questions about the two conditions and their potential impact on each other.

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The symptoms of bipolar disorder and PTSD can seem similar. Yet there are plenty of differences between the two conditions, both in the symptoms themselves and the patterns they take.

First, bipolar disorder falls into the category of mood disorders, so the symptoms you experience mainly relate to your mood and emotions. They’ll also appear in distinct episodes typically marked by significant changes in mood and energy.

These episodes of mania, hypomania, depression, or a combination of these symptoms (known as a mixed episode) can last from a few days to a few weeks, though depression can persist for a longer period of time. Between these episodes, you may not experience any symptoms at all.

As for PTSD, the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes the condition as a “trauma- and stressor-related disorder.” In other words, you won’t develop PTSD unless you experience some kind of trauma.

PTSD usually won’t involve these key symptoms of mania:

  • a “high” mood state characterized by heightened energy or euphoria
  • increased self-esteem, self-absorption, or grandiosity
  • pressured or confusing speech
  • feeling refreshed on little sleep

It often does, however, involve an irritable mood, along with impulsivity or a tendency to take risks — symptoms that commonly appear with mania.

PTSD also involves other trauma-specific symptoms, including:

  • flashbacks, intrusive thoughts and memories, or nightmares
  • difficulty remembering the trauma
  • a sense of detachment or disconnection
  • negative or pessimistic beliefs about yourself, other people, or the world in general
  • a tendency to avoid anything that reminds you of the trauma
  • a physical stress response when remembering the trauma

Which symptoms overlap?

Many of the symptoms that characterize episodes of depression can also occur with PTSD:

  • a lingering low or negative mood, which might include feelings of guilt, anger, worthlessness, or fear
  • difficulty experiencing positive feelings, like joy, optimism, or love and affection
  • problems with concentration and focus
  • sleep difficulties
  • disinterest in daily life
  • loss of pleasure in your regular activities and hobbies
  • withdrawal from friends and family
  • thoughts of suicide

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These symptoms may not appear immediately after the trauma, and they often show up when something triggers a memory of what happened.

Once they do appear, they may not go away until you get support. But when they seem to briefly improve before returning, they can easily resemble bipolar mood episodes.

Although little evidence points to PTSD as a direct cause of bipolar disorder, experts do recognize links between the two conditions.

It’s not clear what causes bipolar disorder, but a combination of brain chemistry/structure, genetics, and environmental factors may play a role.

One major environmental trigger? Stressful events, such as:

  • moving away from home
  • going through a breakup
  • dealing with challenges at work

Traumatic events can also cause stress — both in the moment and later, while you work to recover from the experience.

Not everyone who experiences trauma goes on to develop PTSD, bipolar disorder, or any mental health condition. That said, the lingering stress of a traumatic experience can factor into mental health symptoms, including anxiety and depression. Repeated childhood trauma also increases your chances of developing complex PTSD (C-PTSD).

What does the research say?

Research from 2016 reviewed multiple studies exploring the link between bipolar disorder and childhood trauma. Researchers concluded that trauma didn’t just increase bipolar disorder risk. It also seemed to lead to more severe symptoms, including suicidal thoughts or attempts.

In a nationwide study from 2016, researchers used the Danish Civil Registration System to explore potential links between bipolar disorder, schizophrenia spectrum disorders, and a diagnosis of PTSD or acute stress reaction.

Their findings suggest that people diagnosed with traumatic stress had a higher risk of developing bipolar disorder or schizophrenia spectrum disorders. This risk seemed to be highest during the first year following a traumatic stress diagnosis, but it stayed high for over 5 years. Researchers also noted that the link didn’t relate to a family history of either condition.

Of course, as other research points out, the link could run in the other direction, too. People often feel more impulsive than usual during manic episodes. This impulsivity can lead you to take risks that might put you in danger or cause other harm, such as:

  • driving too fast
  • trying an extreme sport without taking safety precautions
  • getting in a fight with your boss

These experiences can cause lasting trauma when they have a negative outcome, for you or anyone else.

Mental health conditions are misdiagnosed from time to time, often because many involve overlapping symptoms. What’s more, even the same symptoms won’t always affect everyone in the same way.

With mania, for example, many people feel as if they can get a lot done or spend hours focused on a specific task, such as the following scenarios:

  • You might feel inspired to rush to the store, buy a complete stock of baking ingredients, and spend the night baking your way through your favorite cookbook.
  • Someone else might start several different projects around the house — reorganizing closets, packing up clothes for donations, cleaning the bathrooms — but move from task to task, leaving them all unfinished.

Symptoms can also change over time, so the picture your therapist gets at first may not be a exact representation of how you feel on a regular basis.

In terms of bipolar disorder and PTSD, misdiagnosis does happen. Despite the differences in the two conditions, they do share symptoms. As a result, some therapists may diagnose bipolar disorder when a PTSD diagnosis would better explain your symptoms.

One possible explanation relates to the fact that PTSD may not show up for several months. When you do begin to notice emotional distress and changes in your mood and emotions, you might not immediately associate them with the trauma you experienced.

To a therapist who isn’t aware of your history, abrupt changes in your mood and emotions can resemble the shifting mood states of bipolar disorder. In reality, though, they stem from trauma triggers you may not be consciously aware of.

Symptoms aren’t always easy to describe, either. Certainly, the distress you experience during a mood episode or trauma flashback might remain vividly in your memory. But remembering specific details about your symptoms, like when they started and how long they lasted, could prove slightly more challenging.

The ”why” behind your symptoms matters

Unpacking the factors contributing to key symptoms, like avoidance of loved ones or feelings of self-criticism and judgment, may point to one condition over the other. A therapist can help you trace symptoms back to the source to arrive at the correct diagnosis.

For example, both bipolar disorder and PTSD can disrupt your sleep, but for different reasons:

  • With PTSD, you might have trouble falling asleep or wake up often due to frequent nightmares, which can leave you anxious and afraid to fall asleep.
  • If you have bipolar disorder, you might need only a few hours of sleep to feel rested. Or, you might often find yourself lying awake, mulling over feelings of hopelessness and guilt or dealing with racing thoughts.
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It’s possible to have both conditions — and many people do.

As noted above, evidence suggests that PTSD can increase your chances of developing bipolar disorder, while bipolar disorder could indirectly increase your chances of facing a traumatic experience.

Additional research supports the idea that either condition can contribute to the other.

One 2020 study explored the rates of PTSD in 212 people diagnosed with bipolar disorder who were receiving inpatient care. Just over 72 percent of the participants had experienced some kind of trauma, while over 35 percent had a diagnosis of PTSD.

According to a 2017 review of 32 studies:

  • Between 4 and 40 percent of people living with bipolar disorder also met criteria for PTSD.
  • PTSD appeared more common in women and people living with bipolar I.
  • Between 6 and 55 percent of people living with PTSD also met criteria for bipolar disorder.
  • People living with both conditions tended to report worse symptoms and lower quality of life.

Older research notes that PTSD occurs, on average, in about 16 percent of people with bipolar disorder, compared to just under 8 percent of the general population.

If you do have both conditions, getting treatment for one might ease some of your symptoms — but it generally won’t improve them all.

Keep in mind that some treatments could worsen your symptoms. Antidepressants, which can help treat depression symptoms in PTSD, may sometimes trigger mania when used without a mood stabilizer, for example.

When getting support for any mental health condition, it’s always best to tell your care team about any symptoms you have, even the ones that seem less important, with as much detail as possible.

Try not to worry about oversharing or giving them unnecessary information. Those details matter, since they can help them find the right diagnosis, which helps you get the right treatment.

Both bipolar disorder and PTSD can improve with professional support, but treatment for these conditions can take two very different routes. That’s why it’s so important to work with an experienced professional who can distinguish between the two conditions — and recognize when the right diagnosis includes both.

Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.