ADHD
ADHD or bipolar disorder? How clinicians tell them apart
ADHD and bipolar disorder can look alike in adults. The pattern over time, mood episodes and a full assessment tell them apart, and the two can co-occur.
Short answer
They can look alike on the surface, because both can involve restlessness, racing thoughts, impulsivity, distractibility and irritability. What separates them is the pattern over time. ADHD is a lifelong pattern that starts in childhood and is present most days. Bipolar disorder comes in episodes: days or weeks when your mood, energy and sleep change clearly from your usual self, with ordinary stretches in between. The two can also exist together, so the honest answer to “ADHD or bipolar?” is sometimes “both”, and only a full assessment can say.
Why people confuse them
Talking fast, jumping between ideas, spending or deciding on impulse, sleeping badly, short temper, restless energy: you can find every one of these in both conditions. A short video that lists three of them makes it easy to decide “that is me, so it must be this”.
That is all-or-nothing thinking: one trait settles the diagnosis. Clinicians do the opposite. They look at the whole timeline of your life and ask which pattern fits all of it, not only your best-known trait.
The main differences a clinician looks for
1. The pattern over time
ADHD. The DSM-5-TR criteria ask for several symptoms that were already present before age 12, appear in more than one setting (for example home and work or study) and interfere with how you function [4]. You can have better and worse days, but the underlying difficulty with attention, organisation or impulsivity is there at baseline.
Bipolar disorder. The DSM-5-TR criteria ask for a distinct period of unusually raised, expansive or irritable mood together with unusually high energy: at least four days in a row for hypomania and at least one week for mania [4]. The period comes with other changes, such as needing much less sleep, talking more, racing thoughts and taking risks, and people around you notice that you are not your usual self.
When a change lasts for days and is clearly different from your normal, it matters, because duration and change from your usual self are what separate an episode from a busy or stressful week.
2. Questions that test a conclusion
A good assessment asks concrete questions, not “do you recognise yourself?”. For example:
Did these difficulties start in childhood, or at a clear point in adult life?
Was there a period when you slept much less than usual and still felt full of energy rather than tired?
Did people close to you say you were not yourself?
Between those periods, do the problems with attention and organisation remain?
Here is a question worth asking yourself. If you had a very energetic day after a good night’s sleep, does that make it an episode? Probably not. One good day is not an episode. Length, change from your usual self and the other signs are what count.
They can occur together
A 2021 systematic review and meta-analysis of 71 studies with 646,766 participants from 18 countries found that about one in thirteen adults with ADHD (7.95%) was also diagnosed with bipolar disorder, and nearly one in six adults with bipolar disorder (17.11%) had ADHD [1]. The rates varied a lot between studies, and bipolar disorder began about four years earlier in people who also had ADHD. The authors point out that clinicians should know how common the overlap is, so that misdiagnosis is avoided and both conditions are cared for [1].
So “ADHD or bipolar?” is a false either/or. Black-and-white thinking is a trap here too: having one does not rule out the other.
What a good assessment includes
A UK expert consensus on the quality of adult ADHD assessments says that an assessment should sit within a full psychiatric and neurodevelopmental review, use a semi-structured interview with open questions and real-life examples, and look at how much the symptoms impair your life [3]. The European consensus statement likewise stresses a proper diagnostic process rather than a quick label [2].
At this practice the usual ADHD assessment takes two appointments of 45 minutes. It uses the DIVA-5 interview and the ASRS questionnaire, and it looks carefully at other explanations for your difficulties, including mood problems, before reaching a conclusion. The free ASRS screener on this site (see Tests) is only a first step: it asks about ADHD symptoms, not about mood episodes, so it cannot tell you whether you might have bipolar disorder [5].
Because an episode is often easier to see from the outside, we also ask for the view of someone close to you, such as a parent or partner, who may remember periods you do not. A separate questionnaire asks about past periods of unusually high mood and energy. If no one else can take part, the clinical interview carries the decision.
Why the distinction matters
The treatment plan depends on the diagnosis, and the order in which the problems are addressed matters. That decision belongs to the doctor after the assessment, and it is never made from an online article or a questionnaire score.
I present the alternatives and we decide together. If medication becomes part of the plan, we agree in advance on the side effects to watch for, when they usually appear, and a trial period after which we review it together.
One example of why the order matters: when bipolar disorder is suspected, mood is stabilised first, before any treatment for ADHD. The reason is safety. ADHD treatment given to someone with an untreated bipolar disorder could trigger an episode of mania.
When to seek help
Seek an assessment when these patterns systematically get in the way of your work, studies, relationships or daily life, not only when you feel discomfort.
Ask for help when the problem keeps getting in the way of your functioning and your relationships, not only when you feel uncomfortable.
Do not wait for an appointment if you have gone for days with very little sleep and feel full of energy, you are making risky decisions that are out of character, or you have thoughts of harming yourself. Call 112 or go to the nearest hospital emergency department.
Be fair to yourself
Mood that swings or attention that slips is not a flaw of character. If you have struggled for years without a name for it, feeling worn down is an understandable reaction, not a failure.
Self-compassion is not self-pity. It is recognising your own strength.
If the question in your head is “is it my fault?”, try a more useful one: what is the pattern, and what helps it? Guilt can feel convincing, but what you feel is not proof of what is true. The assessment looks at the pattern, not at your character.
Next step
If you recognise these patterns, you can book an appointment, in English or Greek, in Trikala or online. Read more about adult ADHD care and mood disorders, or how the adult ADHD assessment in Greece works.
Educational information. It is not a diagnosis and does not replace an individual clinical assessment.
Sources
Schiweck C, Arteaga-Henriquez G, Aichholzer M, et al. Comorbidity of ADHD and adult bipolar disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;124:100-123. https://doi.org/10.1016/j.neubiorev.2021.01.017
Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14-34. https://doi.org/10.1016/j.eurpsy.2018.11.001
Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard. Front Psychiatry. 2024;15:1380410. https://doi.org/10.3389/fpsyt.2024.1380410
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256. https://doi.org/10.1017/s0033291704002892
