Bipolar disorder and coexisting mental health conditions

Bipolar disorder is a group of mental health conditions that cause episodes of manic symptoms and depressive symptoms, sometimes referred to as manic episodes and depressive episodes. Bipolar disorder can also cause changes in behavior, energy levels, thinking, and sleep habits. There is no cure for bipolar disorder, but it can be managed. The main treatments are medications and psychotherapy.

In many cases, bipolar disorder does not exist on its own. People who have bipolar disorder often have coexisting conditions, including other mental health conditions. Conditions that coexist alongside bipolar disorder may be referred to as comorbidities or multimorbidities.

Comorbidity or multimorbidity?

The word morbidity means having a condition or having a symptom of a condition. Comorbidity and multimorbidity are terms that refer to having two or more health conditions at the same time. They typically refer to chronic or long-term conditions. These terms are sometimes used interchangeably, but they have different meanings:

• Comorbidity. With this term, there is one primary condition or diagnosis. Comorbidities are conditions that occur in addition to the primary diagnosis. For example, if bipolar disorder is the primary diagnosis, a coexisting anxiety disorder would be a comorbidity.
• Multimorbidity. With this term, there is no primary condition or diagnosis, and there’s a greater focus on how coexisting conditions interact with one another. For example, if a person is diagnosed with bipolar disorder and an anxiety disorder, neither condition is considered the primary diagnosis.

Knowing these terms is probably not essential knowledge for managing bipolar disorder, but you may come across them when reading about bipolar disorder, reading about other health conditions, or talking to healthcare professionals.

Having working definitions of comorbidity and multimorbidity may also be helpful in framing how you think about a diagnosis of bipolar disorder, and how that diagnosis relates to other aspects of your physical and mental health.

What conditions coexist with bipolar disorder?

Comorbidity and multimorbidity can refer to coexisting mental health conditions, as well as conditions that primarily affect physical health. Research has found several mental health conditions to be prevalent among people who have bipolar disorder:

• Anxiety disorders, a group of conditions that cause excessive and long-lasting worry, fear, and/or panic that interferes with normal functioning.
• Substance use disorders, including alcohol substance use disorder.
• Obsessive-compulsive disorder, a condition characterized by repeated unwanted thoughts, ideas, feelings, and behaviors.
• Attention Deficit and Hyperactivity Disorder (ADHD), a group of conditions that causes difficulties with concentration, impulsivity, and attention span, and a need for constant activity.

These are examples, and this is not a comprehensive list. But it does emphasize the importance of working with a mental health professional who has the training and experience to recognize the symptoms of different mental health conditions.

The coexisting conditions listed above are often associated with worse treatment outcomes for bipolar disorder. A successful treatment plan will need to address all symptoms a person is experiencing, whether those symptoms are caused by bipolar disorder or another health condition.

In addition to coexisting mental health conditions, people who have bipolar disorder are at an increased risk for physical ailments, including high blood pressure, diabetes, obesity, and dental problems. A primary care provider is an essential part of a healthcare team who can help you identify potential health problems and guide you toward appropriate treatment.