When overlapping symptoms are present, it can be difficult to identify any comorbid conditions that may be underlying. Here, we are exploring the potential co-occurrence of autism and bipolar disorder, the signs and symptoms that may indicate this, the implications for diagnosis and treatment, other challenges of this comorbidity, and where to seek help if you think you or a loved one has both autism and bipolar disorder.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about autism or bipolar disorder, we can help. 

What is autism?

Autism is a neurodevelopmental condition affecting how a person understands sensory information around them, how they respond to that information, and how they interact with others. An autistic person may experience sensory issues that lead to negative reactions to particular triggers, and these reactions contribute to the difficulties they face with communication, social interaction, repetitive or restrictive behaviours, developing intense interests, and more. 

Some common symptoms of autism in adults include: 

• Difficulty reading social cues
• Difficulty participating in conversations with others 
• Difficulty relating to others’ thoughts and feelings 
• Difficulty regulating emotions 
• Difficulty building and maintaining relationships 
• Difficulty reading body language and facial expressions of others 
• Using a monotone speaking pattern, which makes it difficult to convey emotions
• Difficulty maintaining eye contact in conversations
• Restrictive or repetitive behaviours  
• Difficulty with last-minute changes to plans or routines
• Fixation on a favourite subject they care a lot about or are particularly skilled in 
• Sensitivity to sensory input like pain, touch or sound

Many of these symptoms are considered common, but each autistic person will experience their own unique traits depending on their specific sensitivities, personal preferences, and any co-occurring conditions they may have, which are common in autistic people. One 2020 study found 91% of children and adolescents, and 31% of young adults, were diagnosed with at least one co-occurring psychiatric condition. 

You can read more about common comorbid conditions in our other guides:

• Dual Diagnosis And Overlaps In Autism And Anxiety
• The Essentials of BPD and Autism
• Differences and Similarities Between OCD vs Autism
• AuDHD: Dual Diagnosis of Autism & ADHD

What is bipolar disorder?

Bipolar disorder was previously known as manic depression, but this term was changed in 1980 in an attempt to minimise stigma and negative attitudes toward the condition. It is characterised by extreme mood swings that cause euphoric highs–known as mania or hypomania–and emotional lows that cause depression. 

It is believed that for most people with bipolar disorder, these mood swing episodes from depression to mania happen rarely or could occur a few times a year, lasting several days. Between these mood swings, some people experience long stretches of emotional stability, and most can start a treatment plan that helps them to manage mood swings effectively. 

The symptoms of bipolar disorder depend on whether the person is in a manic episode or a depressive episode. For those going through a manic episode, they may experience: 

• Feeling extremely elevated, or high
• Feeling very irritable
• Feeling wired or jittery, and more active than usual
• Having thoughts racing through their mind 
• A decreased need for sleep
• Talking rapidly about many different subjects 
• Having an excessive desire for enjoyable activities like eating, drinking, sex and more
• Believing they can achieve many things at once without tiring 
• Feeling uncharacteristically powerful or talented

The symptoms of a depressive episode might include: 

• Feeling extremely low or sad 
• Feeling anxious or restless 
• Having trouble focusing 
• Finding it difficult to make decisions
• Finding it difficult to fall asleep, waking too early or sleeping excessively 
• Talking slowly and forgetting things 
• Having a lack of interest in activities they once enjoyed 
• Finding it hard to do simple tasks 
• Feelings of hopelessness, worthlessness, or suicidal thoughts 

Like autism, those with bipolar disorder are thought to be more likely to have a comorbid condition. This could be a number of conditions, including attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), substance use issues, or autism. 

You may find more useful information in our guide: Understanding How a Person with Bipolar Disorder Thinks

In what ways do autism and bipolar disorder overlap? 

It is possible for an autistic person to also have bipolar disorder as a comorbid condition, causing symptoms that overlap and influence each other. There are a number of potential reasons for this comorbidity, but it is thought genes could be a contributor since both have genetic links that can run in families, and one study found autism and bipolar disorder share global gene expression patterns. 

Despite these genetic links, the two are distinct and separate conditions, with bipolar disorder classed as a psychiatric illness and autism classed as a neurodevelopmental disability. A 2021 study found an estimated 5-8% of autistic people also have bipolar disorder, and this estimate is supported by the National Autistic Society, which suggests 5-7% of autistic people could have bipolar disorder, compared with 1% of the general population. Conversely, a 2019 study found 42.7% of those diagnosed with bipolar disorder also exhibited autism traits. 

Some factors that impact both autism and bipolar disorder include:

Sensory Sensitivities

Sensory sensitivities are a known and common feature of autism which can cause intensified reactions to sensory inputs like loud noises, bright lights or unpleasant textures. This can be more of a problem when an environment feels less predictable or overstimulating, which can lead to an autistic person struggling to filter out and process sensory input. 

Studies find that many of those with psychiatric disorders suffer from sensory processing difficulties, and while autism is one of the most known examples of this, other conditions may also experience these symptoms, including bipolar disorder. 

One study noted differences in mood states in a number of brain regions involved in visual and other sensory processing, and suggested altered visual processing may occur in bipolar disorder specifically.

Mood Symptoms Earlier in Life 

Emotional dysregulation and mood symptoms are common in autistic people, and similar mood symptoms are usually seen in bipolar disorder. When the emotional highs and lows of bipolar disorder are combined with depression symptoms which are typical in autism, this can be challenging.

Bipolar disorder-related mania is usually an obvious symptom to identify in most cases, but this could be more difficult in those with autism. If the behaviour has not been consistent since an autism diagnosis was made, and the person exhibits a sudden shift in their behaviour, this could be bipolar disorder which tends to emerge in early adulthood. 

The onset of bipolar symptoms tends to be around age 25, however it can occur anytime. On the other hand, autism symptoms and traits are often evident prior to age 3. Studies find that young people with both autism and bipolar disorder tend to have an earlier symptom onset. 

Engaging in Risky Behaviours 

The combination of autism and bipolar disorder symptoms could lead to a person exhibiting more risky behaviours. Studies have found heightened risk-taking behaviour is already a feature of bipolar disorder, but when combined with autism–which can cause a person to misunderstand social cues–this can lead to even more problematic and potentially dangerous behaviours.  

"Bipolar symptoms already come with risky behaviour… but I think I ended up in more dangerous situations than maybe I would have if I weren’t autistic because I didn’t recognize the different social innuendos."
– Megan, via VeryWellMind.com 

Social Difficulties 

Comorbid autism and bipolar disorder can lead to social difficulties, withdrawal, struggles in social settings and more, all compounded by mood instability. This can lead to strained relationships. 

One of the main features of autism is a difficulty understanding social cues or the emotional state of others, which can lead to difficulty forming connections with others, performing in front of others (such as trying new things in public), and communicating effectively. This may be compounded for autistic people who also have bipolar disorder, as they may experience greater impairments in their social relationships compared to those without bipolar disorder.

Also, due to the early age at which an autistic person may develop bipolar disorder, they could experience disruptions in their ability to form and function in relationships. 

Depression

Autistic people are known to have a higher risk of developing depression, and a 2019 review of studies suggested around 14% of autistic people could experience depression at some point in life. This is thought to be due to a number of factors, but one notable theory for the prevalence of depression in autistic people is its connection to chronic stress, which many autistic people face due to social challenges, sensory sensitivities, difficulties adapting to change, and more. These things can be overwhelming, and as a result can lower self-esteem, leading to potential depression. 

Bipolar disorder is characterised by depressive episodes, which can lead to feelings of sadness, hopelessness, and could cause thoughts of self-harm and suicide. 

As well as the above overlapping symptoms, both autistic people and those with bipolar disorder may experience feelings of shame or loss of memory after a manic episode, changes in personality, and trouble sleeping. Other possible overlapping symptoms include hyperactivity, impulsivity, irritability and agitation. 

How is comorbid autism and bipolar disorder diagnosed? 

Diagnosing comorbid autism and bipolar disorder can be a complex process, depending on whether or not the person has already been diagnosed with one or the other. In most cases, due to symptoms of autism being exhibited in childhood, this could be the first condition to be diagnosed, followed by a diagnosis of bipolar disorder later in life when symptoms tend to arise. However, either condition could be the first to be discovered. 

A 2021 study found some autistic traits mimic symptoms of bipolar disorder, so these overlapping symptoms can make it very difficult to identify one condition over another. For this reason, if you suspect you or a loved one has comorbid autism and bipolar disorder you can begin by speaking to your GP to discuss symptoms and the likelihood of both conditions. They may refer you or your loved one to a specialist, or if you or your loved one has not yet been diagnosed with autism, they may refer you for an autism assessment. 

Many people in the UK find wait times for autism assessments are very long, so if this is the case for you, keep in mind you can also choose to seek a private assessment if your circumstances allow. You can read more about what to expect from an adult autism assessment here.

If you are diagnosed with autism, a treatment plan will be developed for you, but first you may also be tested for comorbid bipolar disorder. A diagnosis of bipolar disorder usually involves a discussion with your doctor where you will answer questions about the symptoms you experience, your mood episodes, how long mood episodes tend to last, how often they occur, the impact on your life, your family history and more. You may also need to undergo physical tests to rule out any other conditions, and you may be encouraged to keep a mood diary to identify patterns and triggers.

To distinguish between autism and bipolar disorder, a doctor or specialist will usually consider the duration, nature and severity of symptoms, and the age of onset in order to make an accurate diagnosis. While symptoms may overlap, they can look different in both conditions. As an example of this, autistic people might exhibit impulsive behaviour regularly, whereas those with bipolar disorder may exhibit this in a cyclical manner.  

Overlapping symptoms can make it challenging to distinguish between these two conditions, so having a comprehensive, thorough assessment is incredibly important with any mental health condition to ensure you are accurately diagnosing and treating the underlying cause. 

How might comorbid autism and bipolar disorder be treated? 

If you are diagnosed with both autism and bipolar disorder, a tailored treatment plan will usually be drawn up to ensure both conditions are treated effectively, and the treatment of one does not affect the other. 

Treatment will usually involve a combination of medications (such as mood stabilisers, antipsychotics and antidepressants), therapies aimed at improving social and communication skills (such as cognitive behavioural therapy), and support systems such as family and local groups. 

Some other strategies that could help include keeping a mood diary to identify triggers of episodes, practising calming activities, following routines, and having support networks around, such as friends and family.

If you have comorbid autism and bipolar disorder, remember it is important to learn to ask for help from your loved ones when you need it. The overlapping symptoms of both conditions can be challenging, and you do not need to face the difficulties of this alone.

"I’ve spent most of the last decade becoming reasonably competent at managing the condition, through a combination of medication, various talking therapies, mindfulness, and, possibly most important of all, keeping a daily mood diary."
– Anonymous, via the National Autistic Society 

What other challenges might someone with comorbid autism and bipolar disorder face? 

There remains a lot of stigma attached to autism, and as bipolar disorder is also affected by stigma, a comorbid diagnosis of both can be more challenging. 

A 2023 study found stigma can negatively impact the treatment of those with bipolar disorder, and can also lead to families hiding the disorder and not seeking treatment. There are also misconceptions that those with bipolar disorder are considered dangerous and unpredictable, and these assumptions can lead to a negative view of people with the condition. Similarly, autism faces its own stigma, with many autistic people experiencing loneliness and not having as many friendships compared to their neurotypical peers. 

It is clear that greater awareness and understanding is required of both conditions in order to reduce the amount of stigma and improve support for individuals trying to navigate the complexities of this comorbid diagnosis.

Where can someone with comorbid autism and bipolar disorder seek support? 

If you or a loved one has been diagnosed with comorbid autism and bipolar disorder, your doctor or the specialist who made the diagnosis will usually put a treatment plan in place that includes recommendations for further support, but you may also be able to find support within your immediate circle of family and friends, as well as through local support groups. 

It is important to understand that these comorbid conditions do not need to be managed alone, so if you feel you need further support, speak to your loved ones about the specific challenges you face and discuss how they may be able to help. You could also engage in additional therapy options such as family therapy, which could help your loved ones understand more about your condition and how they can best help you.

You can utilise resources from organisations like Mind and the National Autistic Society for managing co-occurring autism and bipolar disorder, including: 

• Information on autism and mental health conditions available on Mind.org.uk
• The National Autistic Society’s page dedicated to comorbid bipolar disorder 
• Bipolar UK’s resources and advice on their website

At Augmentive, we believe advice and support for anyone with a mental health condition should always be bespoke and tailored to the individual to help with their specific symptoms and traits. So whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms. 

You can get a private adult autism assessment and find an autism specialist near you, or our free 15 minute consultation can help match you with an appropriate professional who can help you if you already have an autism diagnosis but feel you may also have bipolar disorder symptoms.