ADHD vs. Bipolar Disorder: What’s the Difference and Why It Matters?
Written by an NYC Psychiatrist Specializing in ADHD, Bipolar Disorder, and Mood Regulation
ADHD and bipolar disorder are two psychiatric conditions that are often confused—by patients, families, and even professionals. Both can involve impulsivity, mood changes, and difficulty concentrating. Both may look like “emotional rollercoasters.” And both can be disruptive to relationships, work, and daily functioning.
But here’s the thing: despite some surface similarities, ADHD and bipolar disorder are fundamentally different in cause, pattern, and treatment. Understanding the distinction is key to getting the right diagnosis and care.
What Is ADHD?
ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental condition that typically shows up in childhood. It’s defined by chronic patterns of:
Inattention (e.g., losing focus, disorganization, forgetfulness)
Impulsivity (e.g., blurting out, interrupting, acting without thinking)
But ADHD also impacts emotional regulation—a feature that’s often overlooked. People with ADHD may have intense emotional reactions, rapid mood shifts, or experience a specific form of emotional pain known as Rejection Sensitivity Dysphoria (more on that below).
What Is Bipolar Disorder?
Bipolar disorder is a mood disorder that causes cycles between:
Mania or hypomania: elevated or irritable mood, racing thoughts, increased energy, impulsive decisions, decreased need for sleep
Depression: low mood, fatigue, poor motivation, hopelessness
These episodes are episodic and longer-lasting, typically lasting several days to weeks, and represent a clear shift from someone’s usual behavior.
Types include:
Bipolar I (full mania)
Bipolar II (hypomania + depression)
Cyclothymia (mild, chronic mood fluctuations)
Rejection Sensitivity Dysphoria (RSD) can look like a mood episode.
One of the most painful and misunderstood symptoms of ADHD is Rejection Sensitivity Dysphoria. RSD is a pattern of intense emotional pain triggered by perceived criticism, rejection, or failure, even if it’s subtle or unintended.
People with RSD might:
Feel devastated after receiving constructive feedback
Replay a single social interaction for hours or days
Avoid trying new things due to fear of disapproval
Misread neutral expressions as disapproving
While anyone can feel hurt by rejection, RSD is extreme and overwhelming. The reaction is not just emotional. It’s physical. Many describe it as a “wave of shame,” a “gut punch,” or an “emotional wound.” But people with RSD do not meet criteria of depression or (hypo)mania.
Here’s why this matters:
RSD can look like a mood episode, but it’s not the same as bipolar depression or mania.
The emotional intensity in ADHD is often short-lived and highly reactive, in contrast to the prolonged episodes of bipolar disorder.
Shared Features: Why It Gets Confusing
Both ADHD and bipolar disorder can involve:
Mood instability
Difficulty with impulse control
Risky behavior
Problems with sleep and concentration
Emotional outbursts
But they differ in pattern and timing:
In ADHD, symptoms are chronic, lifelong, and typically constant (even if situational stress makes them worse).
In bipolar disorder, symptoms appear in distinct episodes with clear shifts between normal, elevated, and depressed moods.
Can Someone Have Both ADHD and Bipolar Disorder?
Yes, and it’s more common than you might think. Studies show that up to 20% of people with bipolar disorder also meet criteria for ADHD.
Co-occurring ADHD and bipolar disorder can complicate diagnosis and treatment:
A child with untreated ADHD might look like they have mood swings due to emotional reactivity and impulsiveness.
A teen with emerging bipolar disorder might first be labeled ADHD due to concentration problems and erratic energy.
Treatment needs to be strategically layered:
Mood stabilizers like lithium or lamotrigine are usually started first if bipolar symptoms are present.
Stimulants may be cautiously added to treat ADHD, but only once mood is stable to avoid triggering mania.
Get the Right Support from a Psychiatrist in New York City
When someone is dealing with emotional outbursts, distractibility, or dramatic mood changes, the label matters. Misdiagnosing ADHD as bipolar—or vice versa—can lead to inappropriate medications and worse outcomes.
Understanding RSD, emotional dysregulation, and the nuances of each condition allows us to tailor treatment that actually helps. Whether it’s ADHD, bipolar disorder, or both, there is help—and hope—with the right support.
Are you or your teen struggling with mood swings, rejection sensitivity, or emotional overwhelm?
As an NYC psychiatrist specializing in ADHD and mood disorders, I provide therapy and medication management that takes the whole picture into account.
📍 North Star Psychiatry has offices in New York City and California (via telehealth)
📞 Ready to take the next step? Contact us today to schedule your consultation.
