Bipolar disorder and post-traumatic stress disorder (PTSD) are two serious conditions that are sometimes challenging to tell apart. That’s mainly because they can give rise to some of the same symptoms, such as disturbing thoughts, a deeply depressed mood, difficulty concentrating, and suicide attempts.
Yet PTSD and bipolar disorder are two distinct mental health conditions, and arriving at a correct diagnosis is an important step in creating an appropriate treatment plan. Complicating the process of diagnosis is the fact that some people are living with both conditions at once.
In the United States, about
How can you tell the two conditions apart, and what should you do if you think you have PTSD, bipolar disorder, or both? Read on to find out.
PTSD is a trauma- and stressor-related disorder affecting some people who have experienced or witnessed a traumatic event such as war, a natural disaster, an accident, sexual violence, or terrorism or who have been threatened with death.
PTSD can affect people of all ages and from any culture. In the United States,
Complex PTSD (CPTSD)
CPTSD is a condition related to PTSD that has become more widely recognized by mental health experts in recent years. Instead of being caused by one single traumatic event, CPTSD stems from multiple traumas that occur over a period of time, such as months or years.
Examples of ongoing traumas known to lead to CPTSD include prolonged abuse such as torture, kidnapping, domestic abuse, being enslaved, experiencing war, and other occurrences of long-term or repeated trauma.
PTSD is a different experience for every person who has the disorder because the disorder arises from traumatic experiences, which are unique to each person.
However, some symptoms are more common than others. People with PTSD may experience:
- disturbing feelings
- intrusive thoughts
- distressing memories linked to the traumatic event that first sparked or contributed to the disorder’s occurrence
- avoidance of people, places, situations, and other things that trigger feelings associated with the trauma
A person with PTSD may have repeating nightmares or memories of the event. While rare, some individuals with PTSD or CPTSD may experience flashbacks of the traumatic event, which may be triggered by a sight, smell, emotion, event, or person.
During a flashback, an individual with PTSD relives some part of a traumatic event. More vivid than a memory, a flashback can feel very real.
People with PTSD experience avoidance, or trying to keep away from situations, people, places, and other possible triggers of their trauma.
This avoidant behavior can severely impact a person’s ability to carry out their lives and can prolong PTSD by helping a person to avoid facing their fears.
Those with CPTSD may experience any of the symptoms of PTSD, along with these additional symptoms:
- challenges in forming and maintaining relationships
- difficulty or inability to regulate emotion
- dissociation, or feeling disconnected from your emotions, body, or the traumatic experience
- distorted view of an abuser
- diminished sex drive
- negative self-image
- loss of connection to the world and others
Life can be full of ups and downs. But for the lives of people with bipolar disorder, those highs and lows are much more extreme and can make it harder to navigate everyday life.
There are four types of bipolar disorder, and bipolar I and II are the most common. The “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)” defines the criteria for diagnosing the different types of bipolar disorder in the following way:
To have bipolar I, an individual must experience manic episodes, which the DSM-5 defines as:
- shifts in mood or behaviors that are different from the person’s typical behavior
- these mood shifts must occur most of the day, most days during the episode
- these mood shifts last at least
1 weekor are so severe that the person needs hospital admission for care
People with bipolar I generally have depressive episodes as well, but having depressive episodes isn’t necessary for a bipolar I diagnosis, and an individual can’t have another condition that may explain these symptoms.
An individual with bipolar II also has high and low moods, but they’re more likely to have depressive symptoms, while their manic symptoms are usually less severe. These less severe manic episodes are called hypomania.
To receive a diagnosis of bipolar II disorder, an individual must have:
- had at least one episode of major depression
- had at least one episode of hypomania
- no other condition that could be causing their symptoms
Cyclothymic disorder is similar to bipolar I and II in that an individual has mood shifts, but these mood shifts are less extreme. An adult with cyclothymic disorder must have had episodes of both hypomania and depression for at least
Bipolar disorder not otherwise specified
Bipolar disorder not otherwise specified is a more general category that describes an individual who has symptoms of bipolar disorder, but those symptoms don’t fall into the other diagnostic categories.
If you or someone you know is considering suicide or self-harm, please reach out to:
- community-based alternatives to avoid calling the police in a mental health emergency
- the National Suicide Prevention Lifeline, available 24 hours a day at 800-273-8255
- the Crisis Textline by texting “HOME” to 741741
- the Trevor Project, which provides help for teens in the LBGTQIA+ community
- Befrienders Worldwide to find a helpline in your country if you’re outside the United States
If you believe there’s an emergency or life threatening situation, call 911 or your local emergency services.
While you wait for help to arrive, stay with someone and remove any weapons or substances that can cause harm. You are not alone.
As with PTSD, CPTSD, and so many other mental health conditions, the symptoms of bipolar disorder aren’t uniform for all people and may vary in severity from person to person.
While each type of bipolar diagnosis gives rise to different patterns and symptoms, the defining symptoms of bipolar disorder generally include:
These states are defined by extreme elation, irritability, jumpiness, racing thoughts, less need for sleep, rapid speech, and grandiose thoughts or actions, as well as an increased appetite for food, drinking, sex, drugs, and other pleasurable activities.
Some episodes may become so severe that they bring a person into psychosis, which is serious and may require hospitalization.
During depressive episodes, an individual experiences lasting low or depressed mood and may also have fatigue, feelings of worthlessness, difficulty maintaining a sleep routine (sleeping too much or too little), appetite changes, a loss of interest in things that a person once enjoyed, and thoughts of death.
Episodes with mixed features
As with all types of bipolar disorder, mixed episodes include both manic and depressive states, but an individual may cycle between them in the same episode or they may occur at the same time.
Some of the symptoms of PTSD are very similar to the symptoms of bipolar disorder, such as:
- increased risk of suicide attempts
- sleeping issues
- difficulty concentrating
- feeling restless
- drug or alcohol abuse
- difficulty with relationships
- emotional withdrawal
The simple answer is yes. While not everyone who experiences trauma will have PTSD, having another mental health diagnosis, including bipolar disorder, may put a person at risk of developing PTSD.
It’s possible for some people with bipolar disorder to develop PTSD from a traumatizing event or events or for a person who has PTSD to receive a diagnosis of bipolar disorder.
Only a licensed mental health professional can diagnose PTSD, bipolar disorder, and other mental health conditions.
When screening for mental health conditions, a mental health professional will look for key signs of each disorder and evaluate an individual’s:
- mental health histories
- relationship status and history
- overall health
- daily habits
- history of substance use
Mental health professionals may also work with other healthcare professionals to be sure symptoms aren’t being caused by an underlying physical condition.
Mental health professionals will carefully record symptoms and take a complete history including any traumatic events. There are also screening tools and tests available that may be performed by a qualified mental health professional to help determine if an individual has either PTSD or bipolar disorder.
Treatment will be based on an individual’s specific diagnosis an may include one ot more of the following options.
PTSD treatment options
Treatment for PTSD generally involves psychotherapy and can be very successful at providing relief. Some common treatment options for PTSD include:
Prolonged exposure (PE) therapy
This therapy may be used during cognitive behavioral therapy (CBT) to address the avoidance common in PTSD. It helps people gradually face the trauma-related feelings, memories, and situations they usually avoid at all costs. This therapy usually occurs over a period of weeks or months.
Therapy plans are clearly explained and agreed upon. Once the person with PTSD feels safe in the therapy setting, with help from the therapist, they move from imagining frightening or stressful stimuli to facing the stimuli in real life.
Cognitive processing therapy (CPT)
This type of CBT helps an individual learn to challenge and change unhelpful beliefs surrounding their trauma. Generally conducted over 12 sessions, CPT helps people with PTSD and CPTSD build a new understanding of the traumatic events they’ve experienced, and in doing this, their PTSD symptoms are reduced.
Psychotherapy (talk therapy)
Though only somewhat effective in treating PTSD, medications may help with some symptoms, but PE therapy or CPT is often needed for marked relief in the long term.
Medications used to treat depression and anxiety, such as sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac), are sometimes prescribed to people with PTSD or CPTSD. Some people benefit from long-term use of medication, while others may benefit from short-term use while strengthening healthy coping strategies in therapy.
Bipolar disorder treatment
Medication is the primary and most successful treatment for bipolar disorder, but other treatment options may be helpful along with medications.
- Mood stabilizers: lithium (Lithobid)
- Anticonvulsants: divalproex sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
- Antipsychotics: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), lurasidone (Latuda), aripiprazole (Abilify), and asenapine (Saphris)
- Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta, Yentreve), and venlafaxine (Effexor)
- Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR, Pexeva), and sertraline (Zoloft)
- Tricyclic antidepressants (TCAs) such as amitriptyline, desipramine (Norpramin), imipramine (Tofranil, Tofranil-PM), and nortriptyline (Pamelor)
- Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate)
While medications are the primary treatment for bipolar disorder, along with medication, psychotherapy may also be helpful a helpful treatment option.
Common types of psychotherapy used to treat bipolar disorder include CBT, psychoeducation to help a person better understand bipolar disorder, and interpersonal and social rhythm therapy (IPSRT) to help regulate daily habits.
An individual’s outlook will depend on their specific diagnosis, treatment, and circumstances.
What’s the outlook for an individual with PTSD?
Living with PTSD or CPTSD may feel exhausting, as a person who is affected often feels they must constantly be on guard against being reminded of or reliving their trauma.
While it’s not possible to “cure” PTSD or CPTSD, treatment can significantly help. Mental health treatment options can help a person manage their symptoms and lead a happier, healthier, and fuller life.
What’s the outlook for an individual with bipolar disorder?
Bipolar disorder is defined as a chronic condition, meaning that once it affects a person, that person will have it for life. However, people with bipolar disorder can and do live healthy, wonderful lives.
Sticking to a daily treatment plan can help people with bipolar disorder keep their mood more stable and reduce symptoms, including psychosis and suicidal thoughts.
What’s the outlook for people who have both?
If you or a loved one seems to have or has recently received a diagnosis of both PTSD or CPTSD and bipolar disorder, you might be wondering where to start.
Someone who shows symptoms of one or both of these conditions should consider scheduling an appointment with a licensed mental health professional. They’ll rule out any other possible causes of PTSD or CPTSD and bipolar symptoms to arrive at a correct diagnosis.
When a person receives a diagnosis of PTSD or CPTSD and bipolar disorder, a mental health professional can help develop a treatment plan that will include treatments for each of the different types of disorders.
Additional specialists or healthcare professionals may be recommended.
With treatment, it’s possible to significantly reduce or manage symptoms of PTSD or CPTSD and bipolar disorder.