By Tim Aiello, MA, LPC, NCC, ADHD-CCSP, ASDCS
Myndset Therapeutics
As a clinician specializing in working with ADHD, Autistic, and AuDHD adults, I often encounter individuals who have been misdiagnosed with bipolar disorder when they actually have ADHD. The similarities in symptom presentation—particularly emotional dysregulation—can lead even well-intentioned mental health professionals to an incorrect diagnosis. This misdiagnosis can result in ineffective treatments, unnecessary medications, and increased frustration for individuals seeking answers about their mental health.
The Overlap Between ADHD and Bipolar Disorder
Both ADHD and bipolar disorder involve mood instability, impulsivity, and difficulties with executive functioning. However, the critical distinction is in how these symptoms present:
Bipolar disorder is characterized by distinct mood episodes—periods of mania or hypomania followed by depressive episodes. These mood states last for days or weeks and are often unrelated to external circumstances.
ADHD is a neurodevelopmental condition where emotional dysregulation is a consistent, lifelong challenge. The mood shifts seen in ADHD are typically short-lived, reactive, and tied to immediate situations rather than occurring in prolonged cycles.
This fundamental difference is often overlooked by clinicians who are not well-versed in the latest ADHD research, leading to an incorrect bipolar diagnosis.
Why ADHD Is So Often Misdiagnosed as Bipolar Disorder
Many mental health professionals were trained before emotional dysregulation was recognized as a core component of ADHD. Because of this, they often view mood instability as a sign of a mood disorder rather than a feature of ADHD. Recent research confirms that ADHD-related emotional dysregulation involves difficulty managing frustration, rejection sensitivity, and stress tolerance—not true manic episodes (Barkley, 2020).
Furthermore, gender and cultural biases play a role in misdiagnosis:
Women with ADHD are more likely to be misdiagnosed with bipolar disorder or borderline personality disorder due to societal perceptions of emotional instability (Quinn & Madhoo, 2014).
Black and Hispanic individuals are less likely to be diagnosed with ADHD and more likely to be misdiagnosed with mood disorders or schizophrenia (Morgan et al., 2016). Systemic biases in mental health care contribute to these disparities.
The Consequences of Misdiagnosis
When an ADHD adult is misdiagnosed with bipolar disorder, the treatment they receive is often inappropriate for their actual needs. Common issues include:
Unnecessary medication: Many misdiagnosed individuals are prescribed mood stabilizers (such as Depakote) or antipsychotics, which do not address the core symptoms of ADHD and may cause significant side effects (Biederman et al., 2005).
Delayed access to effective ADHD treatment: Without the correct diagnosis, individuals may not receive stimulant or non-stimulant ADHD medications, cognitive-behavioral therapy, or appropriate executive function support.
Increased mental health stigma: Being incorrectly labeled with bipolar disorder can affect a person’s self-perception, relationships, and willingness to seek further care.
How We Can Improve Diagnosis
As mental health professionals, we have a responsibility to stay updated on ADHD research and improve our diagnostic practices. Here are a few ways we can reduce misdiagnosis:
Expand clinician training to include updated ADHD research, particularly regarding emotional dysregulation in adults.
Use structured diagnostic tools, such as the Adult ADHD Self-Report Scale (ASRS), rather than relying solely on subjective clinical impressions.
Take a longitudinal approach by assessing symptom history and patterns over time, rather than making a diagnosis based on a single clinical interview.
Ensure cultural competence in assessments to recognize how ADHD presents differently across genders and racial/ethnic backgrounds.
Conclusion
The misdiagnosis of ADHD as bipolar disorder is a widespread issue that can have serious consequences for those affected. Understanding the key differences between the two conditions—especially regarding emotional dysregulation—is crucial for improving diagnostic accuracy. By staying informed and practicing culturally competent care, we can ensure that individuals with ADHD receive the correct diagnosis and access to the most effective treatments.
References
Asherson, P., Buitelaar, J., Faraone, S. V., & Rohde, L. A. (2016). Adult attention-deficit hyperactivity disorder: Key conceptual issues. The Lancet Psychiatry, 3(6), 568-578. https://doi.org/10.1016/S2215-0366(16)30032-3Barkley, R. A. (2020). Emotional dysregulation is a core component of ADHD. Journal of Clinical Psychology, 76(5), 867-874. https://doi.org/10.1002/jclp.22957Biederman, J., Mick, E., Spencer, T., Doyle, R., Joshi, G., Hammerness, P., & Faraone, S. V. (2005). A randomized, placebo-controlled trial of divalproex in the treatment of bipolar disorder in children and adolescents. American Journal of Psychiatry, 162(1), 58-66. https://doi.org/10.1176/appi.ajp.162.1.58Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn, J. H. (2019). Practitioner review: Emotional dysregulation in ADHD – implications for clinical recognition and treatment. Journal of Child Psychology and Psychiatry, 60(2), 133-150. https://doi.org/10.1111/jcpp.12964Morgan, P. L., Farkas, G., Hillemeier, M. M., & Maczuga, S. (2016). Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics, 138(3), e20160456. https://doi.org/10.1542/peds.2016-0456Quinn, P. O., & Madhoo, M. (2014). A review of ADHD in women: Clinical implications and treatment considerations. International Journal of Women’s Health, 6, 555-562. https://doi.org/10.2147/IJWH.S54675
Comments