Racing thoughts, restlessness, and sleep changes — these signs can mean different things. Here’s how people with bipolar disorder tell them apart.
Both anxiety and mania or hypomania are common in bipolar disorder. Their overlapping symptoms — like racing thoughts, restlessness, irritability, and sleep disturbance — can make them hard to tell apart, even for people who’ve lived with the condition for years.
The Diagnostic Challenge: Why They’re Confused
It’s easy to mistake one for the other because both can feel like your mind and body are revving too fast. The main difference lies in where that energy comes from and how it feels in your body.
Anxiety
The energy stems from fear or a sense of impending danger — even when no real threat exists. It’s often tense, constricting, and uncomfortable, like being wound too tightly.
Mania or Hypomania
The energy comes from an internal surge — a sense of being driven, supercharged, or unstoppable, and highly motivated by potential rewards. It may feel exhilarating and creative, or it can tip into irritability, restlessness, or agitation. The intensity propels action rather than freezing it, though judgment and control can become impaired.
Why It Matters
- Getting the Right Help Anxiety and mania or hypomania may look similar on the surface, but they need very different kinds of care. When the signs get mixed up, treatment can miss the mark — or even make things worse.
- Catching It Early Spotting the shifts early can make a big difference. As Mayo Clinic points out, stepping in at the first signs of mania or hypomania can help prevent things from escalating into a full-blown episode.
- Protecting Your Well-Being Cleveland Clinic notes that manic or hypomanic states can sometimes lead to impulsive or risky choices. Recognizing what’s happening early gives you a chance to pause, reach out for support, and avoid fallout that can strain your finances, relationships, or sense of stability.
Community Insights: How We Tell the Difference
We asked our community on Facebook how they tell the difference between anxiety and the early stages of mania or hypomania. Here is how they categorize their symptoms:
Editor’s note: Responses have been edited for length and clarity. They reflect personal experiences and perspectives; what works for one individual may not be effective for another.
Energy and Physical Sensation
- “With anxiety, I feel rotten and jumpy. With the early stages of mania, I actually feel pretty good — things look brighter and more vivid, and I start ‘riffing.’” — S.H.
- “Anxiety is a tightening in my stomach. If I take off my glasses, I realize the tension in my ears… When I start escalating [into mania], I feel fine — no anxiety at all.” — D.D.
- “With anxiety, I start pacing and can’t sit still for even a second. Right before a manic episode, I always talk super fast and stumble over my words.” — S.R.
- “When I get anxious, my muscles tense up, I start to tremble, and I stutter when speaking. Most of the time, when I’m manic, I’m always busy, can’t stop doing stuff.” — C.W.
- “Anxiety is a feeling in my chest that does not go away after using all my coping mechanisms (like deep breathing).” — D.S.
- “For me, hypomania is not anxiety; it feels like the whole world is smiling at me… Anxiety, on the other hand, is completely different. I become hyper-vigilant, my stomach twists into knots, and I tremble. Sometimes, I experience mixed states — when manic and depressive symptoms happen at the same time (and the depressive side can include anxiety) and those are the absolute worst.” — C.S.
- “I don’t have anxiety when I’m hypomanic.” — A.M.R.
Sleep Patterns
- “With anxiety, you try to sleep, and with mania, you think you don’t need sleep.” — J.M.J.
- “I don’t sleep in the initial stages of mania. I also write down my ideas furiously.” — T.J.S.
- “With mania, I’m overtired and cannot sleep. With anxiety, I’m sweaty, clammy, nauseous, have a racing heart, and feel the need to flee to a safe place.” — B.H.
Impulsivity and Decision Making
- “For me, I have a desire to shop, when I usually don’t like shopping.” — B.H.
- “Hypomania is racing thoughts or spending money. For me, anxiety shows up as scratching my skin or feeling like I can’t settle down.” — S.C.
- “I experience mixed states — mania with a touch of depression and a dash of anxiety… I tell them apart by looking at my sleep and impulsivity. Can I slow myself down enough to make good decisions, avoid overspending, and resist hypersexuality?” — J.W.
- “I think anxiety can be a precursor [to hypomania]… I go from anxiety to anger to hypomanic, and my drinking goes up, too.” — A.S.
Focus and Sociability
- “With my mania, I’m seriously focused on projects; that’s all I can think about. With my anxiety, I’m all over the place and feel like my heart’s going to beat out of my chest.” — M.W.
- “I feel an intense urgency with all tasks and action items with mania. Yet when anxious, I just want everything around me to stop and be still so that I feel safer.” — P.L.
- “I get creative and more social when hypomanic but not when dealing with anxiety. When entering a hypomanic state, my eyes develop flecks of green, and I start seeing everything with highly saturated colors that really pop.” — H.J.
- “I think anxiety paralyzes you, but with mania or hypomania, they put you on a hamster wheel, and you’re more talkative.” — L.R.
Self-Assessment and Professional Input
- “My therapist told me to look at my life and what’s going on, to try to assess if my emotions fit the circumstances. Is there a reason to be anxious, or how else am I feeling?” — C.H.
- “I talk about how I’m feeling with someone I trust, such as a therapist or my doctor, to help me see if what I’m experiencing looks like mania to them — or not.” — A.R.P.
Signs It’s Time to Reach Out to Your Care Team
It’s completely normal to feel a bit confused when your symptoms start to overlap, but a few clues can signal it’s time for extra support. If your usual “go-to” coping skills — like deep breathing or grounding exercises — suddenly stop working, it’s a sign that something deeper might be shifting. And if anxiety starts to feel overwhelming, unmanageable, or begins interfering with your sleep, work, relationships, or ability to function, that’s also a strong reason to check in.
Pay close attention to your sleep; if you’re wide awake and full of energy after only a few hours of rest for a couple of nights in a row, that’s a major signal that you may be moving toward mania. You should also check in if you feel a surge of euphoria or urgency that just doesn’t match what’s actually happening in your life, or if people you trust mention that you seem “faster” or more impulsive than usual.
Most importantly, reach out right away if you’re experiencing a mixed state — when high-energy symptoms collide with a depressed mood, often with intense anxiety or agitation. Mixed symptoms can make it harder to stay safe, so it’s worth getting support sooner rather than trying to push through.
Editorial Sources and Fact-Checking
UPDATED: Originally posted February 19, 2025
