The NHS define bipolar disorder as:
“a mental health condition that affects your moods, which can swing from one extreme to another. It used to be known as manic depression. Bipolar usually means a person experiences episodes of mania and depression.”
Mania can make you feel full of energy, over-confident, excitable and on edge. In contrast, depression can make you feel down, tired, tense and cause you to withdraw. Everyone will experience different cycles or durations of these mood states.
You might also experience:
- hypomania (not as severe or long-lasting as mania)
- mixed episodes (experiencing both mania and depression at the same time, or in quick succession)
- psychotic symptoms (experiencing delusions, such as paranoia or hallucinations, such as hearing voices).
Psychosis is more common during manic episodes, but can happen during depressive episodes too. Not everyone with a diagnosis of bipolar disorder experiences psychosis.
Bipolar disorder usually develops in a person’s late teens (15-19 years old). It is rare for someone to develop it after the age of 40.
What causes bipolar disorder?
The exact cause of bipolar disorder is unknown but potential causes include:
- family history of bipolar disorder
- brain chemistry
- childhood trauma
- extreme stress, such as relationship breakdown.
We do not know how many autistic people have bipolar disorder. Some studies estimate between 5 and 7%, compared with an estimated rate of 1% in the general population. More research is needed.
How might bipolar disorder affect me?
It is thought that bipolar disorder affects both autistic and non-autistic people in similar ways. It may be distressing and can have a significant effect on your day-to-day life.
If you have bipolar disorder you may experience:
- thoughts of self-harm and suicide
- difficulty with sleeping and eating
- strained relationships
- a change in personality
- a desire to engage in risky behaviour
- shame or loss of memory (following a manic or hypomanic episode).
While it is common to have stable periods between episodes, a severe episode may need crisis support such as admission to hospital.
Treatment and support are essential to help manage bipolar disorder.
If you think you might have bipolar disorder then it is important to get help.
Your GP will assess your symptoms. If your GP thinks you may have bipolar disorder, they will usually refer you for further assessment and treatment with a mental health specialist or team.
You will be asked some questions to get a better understanding of your symptoms and what treatments might be best for you. These might include:
- What are your symptoms?
- How many symptoms do you experience?
- How long do your manic or depressive episodes last?
- How many episodes have you had and how frequently do they occur?
- What impact do your symptoms have on your life?
- What is your family history of mental health conditions?
Autistic people may face additional barriers to receiving a diagnosis of bipolar disorder due to a lack of diagnostic tools adapted specifically for use with autistic people. Additional issues include:
- existing tools may not be appropriate for individuals who have difficulties identifying and communicating emotions
- existing tools may be over-reliant on the reports and observations of parents or carers
- there may be issues of ‘diagnostic overshadowing’ – that is, some autistic characteristics may mask or be similar to bipolar symptoms, for example talking rapidly without pause, and a change in mood as a result of a change in routines
- misdiagnosis of other conditions such as schizophrenia, psychosis and borderline personality disorder.
There are NICE guidelines that professionals should follow for the assessment and treatment of bipolar disorder. If you feel you have not received the correct diagnosis, speak to your GP about your concerns.
Treatment for bipolar disorder is the same for autistic and non-autistic people. The support offered may vary depending on where you live. In England, there is statutory guidance for adults that states autistic people should have support adapted to their needs if they have a mental health condition.
The National Institute for Clinical Excellence (NICE) recommend both psychological therapies and medication for treating bipolar disorder.
Therapies
You can access counselling or therapy through your GP or privately. Therapies such as cognitive behavioural therapy (CBT) and individual therapy are recommended for bipolar disorder.
Research suggests that CBT can be effective for some autistic people, if adapted appropriately.
Ideally, someone with a good understanding of autism should deliver all treatments and therapies. Most importantly, to be accessible and effective, support should be adapted to a person’s specific needs. Visit our Seeking help with mental health page for more advice.
Search our Autism Service Directory for details of counsellors and therapists in your area who have experience of working with autistic people.
Strategies for managing bipolar disorder
Strategies that might be useful include:
- keeping a mood diary (to help identify early signs or triggers of episodes)
- practicing calming activities
- following routines (including regular meals and sleep)
- engaging support networks, such as friends and family.
