Trauma, PTSD, and Bipolar Disorder: Understanding the Overlap and the Differences
Mental health conditions often have overlapping symptoms, making diagnosis complex and nuanced. Two conditions that are frequently confused by patients and sometimes even professionals are Post Traumatic Stress Disorder (PTSD) and Bipolar Disorder. Both can involve mood swings, emotional dysregulation, impulsivity, and disrupted functioning, but their causes, course, and treatment differ significantly.
This post unpacks the differences and similarities between trauma related disorders and bipolar disorder, exploring why they can look alike, how to tell them apart, and what it means when a person experiences both.
Written by an NYC Psychiatrist, Dr. Soe Thein with expertise in both therapy and medication management.
What is PTSD?
Post Traumatic Stress Disorder is a condition that can develop after a person experiences or witnesses a traumatic event such as combat, sexual assault, childhood abuse, serious accidents, or natural disasters. Trauma overwhelms a person’s ability to process what happened, leaving them in a persistent state of psychological threat long after the danger has passed.
PTSD is characterized by four main symptom clusters:
Intrusion symptoms – Flashbacks, nightmares, or intrusive thoughts about the trauma
Avoidance – Trying to stay away from reminders, thoughts, or feelings connected to the trauma
Negative alterations in cognition and mood – Persistent negative beliefs about oneself or the world, guilt, shame, numbness, or loss of interest
Hyperarousal and reactivity – Irritability, insomnia, exaggerated startle response, difficulty concentrating, or hypervigilance
What is Bipolar Disorder?
Bipolar Disorder is a mood disorder marked by shifts between depressive and manic or hypomanic episodes. It is a biological condition with a strong genetic component and typically emerges in adolescence or early adulthood.
There are several subtypes of bipolar disorder:
Bipolar I: Characterized by full blown manic episodes, often alternating with depression
Bipolar II: Features hypomania, a milder form of mania, and major depressive episodes
Cyclothymia: Involves chronic mood fluctuations that do not meet the criteria for full mania or major depression
Mania or hypomania can include:
Elevated or irritable mood
Inflated self esteem or grandiosity
Decreased need for sleep
Pressured speech or racing thoughts
Impulsivity or risky behavior including spending sprees, sexual indiscretions, and substance use
Depression in bipolar disorder includes the same symptoms seen in unipolar depression: sadness, fatigue, lack of interest, changes in sleep or appetite, hopelessness, and sometimes suicidal ideation.
Why PTSD and Bipolar Disorder Get Confused?
The confusion between these two conditions often arises from overlapping symptoms. Here are a few areas where they can resemble each other:
Emotional Instability
Both PTSD and bipolar disorder involve emotional ups and downs, but the quality and triggers differ. In PTSD, mood shifts are often tied to reminders of trauma or environmental stressors. In bipolar disorder, mood episodes often arise endogenously, meaning they are not necessarily triggered by an external event.
Impulsivity and Risky Behavior
During manic or hypomanic episodes, people with bipolar disorder may act recklessly or impulsively. Individuals with PTSD may also show impulsivity, especially when trying to cope with distress, dissociation, or hyperarousal. Both conditions are linked to increased risk of substance use, risky sexual behavior, and self injury.
Sleep Disturbances
Insomnia or disrupted sleep is common in both disorders. In PTSD, sleep disturbances may come from nightmares or hypervigilance. In bipolar mania, sleep is reduced due to less need for rest. People may feel rested after only a few hours of sleep during manic phases, a hallmark symptom of bipolar disorder.
Irritability and Anger
Irritability can show up in both conditions. In PTSD, it is often part of a fight or flight response. In bipolar disorder, it may stem from manic energy or frustration. Both presentations can lead to interpersonal conflict.
Key Differences Between PTSD and Bipolar Disorder
Despite some shared symptoms, there are important distinctions.
Origin and Course of the Illness
PTSD is trauma based. It develops as a psychological response to one or more life threatening or overwhelming experiences. Symptoms often begin within months of the trauma but can also emerge later.
The etiology of Bipolar disorder is multifactorial but heavily biologically based, often with a strong family history. It tends to follow a cyclical course, with episodes of mania or hypomania and depression that are more episodic than situational.
Nature of Mood Changes
In PTSD, mood shifts often relate to external stimuli, like trauma reminders. The emotional reactivity is more situational and reactive.
In bipolar disorder, mood shifts are more internal and episodic. Mania or depression can last days to weeks and are not necessarily linked to life events.
Cognitive Features
PTSD is frequently accompanied by dissociation, flashbacks, and intrusive thoughts. People may feel detached from their body or reality, known as derealization or depersonalization.
In bipolar disorder, mania may produce grandiose thinking, pressured speech, and racing thoughts, but not flashbacks or dissociation.
Response to Medications
Antidepressants can help treat PTSD, especially SSRIs like sertraline or paroxetine. Trauma focused therapy, such as EMDR or CPT, is a first line treatment.
In bipolar disorder, antidepressants alone can trigger mania. Mood stabilizers like lithium or valproate and atypical antipsychotics are mainstays of treatment.
Misdiagnosing PTSD as bipolar disorder and treating with the wrong medications can lead to worsening symptoms.
When Both Conditions Co Occur
It is entirely possible for someone to have both PTSD and bipolar disorder. Studies show that rates of trauma exposure are higher among individuals with bipolar disorder than the general population. In fact, childhood trauma may increase the risk of developing bipolar disorder.
Having both conditions can complicate treatment. For example, trauma reminders might trigger manic episodes. Or manic behavior might lead to traumatic experiences, such as unsafe sex or physical fights, perpetuating a cycle of mood instability and trauma reactivation.
Clinicians must take care to:
Stabilize mood first to reduce risk and increase insight
Address trauma through psychotherapy after mood is more regulated
Use trauma informed approaches throughout treatment
A Diagnostic Dilemma: Case Vignettes
Case 1: A 30 year old woman reports mood swings, impulsivity, nightmares, and panic attacks. She alternates between feeling shut down and feeling highly energized and reckless. A deeper history reveals childhood sexual abuse, ongoing flashbacks, and self injury. Her highs are triggered by dating or conflict, and she has no family history of mood disorders. In this case, the mood instability may be trauma related emotional dysregulation, not bipolar disorder.
Case 2: A 22 year old man reports a history of feeling on top of the world for several days, talking fast, sleeping only a few hours a night, and then crashing into depression. He has had several periods like this, even during otherwise calm times in life. No trauma history. This clinical picture is more consistent with bipolar I disorder.
Final Thoughts: Why Accurate Diagnosis Matters
Labeling PTSD as bipolar disorder or vice versa can lead to inappropriate treatment. Bipolar patients may be overmedicated if their primary issue is trauma, while trauma survivors may be exposed to medications that worsen their instability.
Key considerations for distinguishing the two:
Ask about trauma: Always explore whether distressing life events preceded the onset of symptoms
Understand timeline: Is there a pattern of discrete episodes, or are symptoms constant and triggered by reminders
Look at the whole picture: Sleep, energy, thought patterns, behavior, and emotional triggers all offer clues
Getting an accurate diagnosis is the first step toward healing. Whether someone is navigating bipolar disorder, PTSD, or both, compassionate, individualized treatment can make a significant difference.
If You Are Struggling
If you suspect you or someone you care about is dealing with PTSD or bipolar disorder, seek a mental health professional who takes a trauma informed and comprehensive approach. Diagnostic clarity can open the door to the right kind of support and healing.
About the Author : Dr. Soe Thein is a board certified psychiatrist and psychotherapist based in New York, offering online care for trauma, mood disorders, and LGBTQ+ mental health. Dr. Thein integrates psychodynamic therapy with evidence based medication management, supporting patients with warmth and depth.
For more information, visit the Home Page, About Me, LGBTQIA Mental Health, or Contact Page to schedule a consultation.
