With bipolar disorder, anxiety may be part of an episode or a separate condition — and that distinction matters.
Key Takeaways
- Anxiety is common with bipolar disorder and can make mood symptoms feel more intense or harder to treat.
- Anxiety may happen during a mood episode or continue even when your mood is stable, so an accurate diagnosis matters.
- Anxious distress means anxiety symptoms are part of a bipolar mood episode, rather than a separate anxiety disorder.
- Treating both bipolar disorder and anxiety together can help you move toward greater stability and peace of mind.
Anxiety and bipolar disorder are deeply connected, with about one-half of people with bipolar experiencing an anxiety disorder at some point. This overlap can make mood episodes feel more intense or last longer, but treating both conditions together — rather than just one — is the most effective path to stability. Whether it’s generalized anxiety, panic, or social anxiety, these challenges are manageable with a targeted plan and support.
What Bipolar Anxiety Feels Like
For many with bipolar disorder, anxiety is more than just a word. It can feel like a constant buzz under your skin or a knot in your stomach that never goes away, even on good days. When anxiety hits, your mind races with endless ‘what ifs,’ making it hard to focus on the present. You might notice your chest feels tight, your breathing gets shallow, or you feel so restless that sitting still is tough. It’s a sense of being on edge that makes every worry seem louder.
Research shows that specific anxiety disorders occur alongside bipolar disorder at varying rates. For example:
- Social anxiety disorder: about 13 percent
- Panic disorder: about 18 percent
- Generalized anxiety disorder (GAD): about 14 percent
- Specific phobias: about 11 percent
When bipolar disorder and anxiety overlap, mood symptoms can become more intense, episodes may last longer, and finding the proper treatment can feel more challenging. That’s why it’s so important to recognize anxiety symptoms early — and to talk openly with your care team, whether your anxiety feels constant or tends to rise and fall with mood shifts.
Treating both conditions — not just one — is key. When bipolar disorder and a specific anxiety disorder are each addressed with targeted medication and therapy, outcomes tend to improve. It may take some trial and error to find the right combination, but both conditions are manageable. With the right support and treatment plan, you can move toward greater stability and peace of mind.
Understanding how these conditions influence each other — and how anxiety may show up in your life — is an important step in that process.
Why Anxiety Is Common in Bipolar Disorder
While research has established that people with coexisting bipolar and anxiety disorders tend to have a poorer course of bipolar, it’s still unclear why.
“Nothing in the symptomatology of anxiety itself is linked to a bad course of bipolar,” says Roger McIntyre, MD, FRCPC, a professor of psychiatry and pharmacology at the University of Toronto, as well as head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Canada.
One possibility, he says, is that a history of trauma is associated with a worse course of bipolar, and past trauma is also a known trigger for anxiety disorders. Therefore, underlying trauma creates correlation (a mutual relationship) rather than causation (one is responsible for the other).
RELATED: Living With Both Bipolar Disorder and Anxiety — the Tension Tango
Another possibility is that bipolar disorder affects multiple regions of the brain, and anxiety also affects multiple regions of the brain, so together, there are more areas of the brain involved than in either condition individually.
For example, both bipolar and anxiety can create cognitive difficulties, and “if you have two problems affecting cognition, it’s worse than one problem,” Dr. McIntyre notes.
How Anxiety Symptoms Differ From Mood Episodes
Recognizing anxious symptoms and anxiety disorders alongside bipolar disorder can be a challenge.
For one thing, a number of symptoms overlap between the two conditions. Obsessive thoughts and insomnia characterize manic episodes but can also be part and parcel of anxiety. Catastrophic thinking — anticipating the worst possible outcome — also links to both depressive and anxious states.
What Is Anxious Distress in Bipolar Disorder?
If anxious symptoms show up only during a mood episode, a specifier for “anxious distress” can be added to the original bipolar diagnosis, per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). This is different from having a separate anxiety disorder; it means the anxiety symptoms are part of the mood episode itself.
Yet experiencing continued anxiety when otherwise well makes the diagnosis of an anxiety disorder more clear-cut.
Types of Anxiety Disorders That Occur With Bipolar
According to the DSM-5-TR, there are 11 types of anxiety disorders. Let’s take a look at some of the most common ones:
1. Generalized Anxiety Disorder (GAD)
Excessive worry and anxiety are telltale signs of generalized anxiety disorder, and they occur more days than not for at least six months. The symptoms also impact social, occupational, and other areas of functioning. Also, at least three of these symptoms must occur to meet the diagnostic criteria:
2. Panic Disorder
Panic disorder occurs when panic attacks are recurrent. You have intense fear or anxiety about something, even though it is out of proportion to the actual danger at hand. Some symptoms include:
- Accelerated heart rate
- Shortness of breath
- Dizziness or lightheadedness
- Chest pain or discomfort
- Sweating
- Nausea or abdominal distress
- Fear of losing control
3. Social Anxiety Disorder
Social anxiety disorder is characterized by a marked fear or anxiety about social situations where others might judge you. These situations often include:
- Social interactions (e.g., conversations, meeting new people)
- Being observed (e.g., eating or drinking in public)
- Performing in front of others (e.g., giving a speech)
Key aspects of social anxiety disorder include:
- Fear of being negatively evaluated
- Consistent fear response in these situations
- Avoiding these situations or enduring them with distress
- The fear is out of proportion to the actual threat
- It lasts for at least six months and causes significant distress or impairment in daily life
Physical symptoms can include blushing, sweating, or trembling. If you’re experiencing these symptoms, it’s important to consult with a mental health professional for proper diagnosis and treatment.
4. Phobia-Related Disorder
A phobia-related disorder may be present when you have an ongoing, intense fear that is triggered by a particular situation or object, such as a fear of flying. Symptoms must also last at least six months and include things like:
- Greatly impacts your personal, work, or school life
- The fear is not in proportion to the actual danger at hand
- You go to great lengths to avoid the situation or object or confront it with much distress
If you’re noticing symptoms of any of the anxiety disorders listed above — whether it’s social anxiety, panic attacks, constant worry, or specific fears — try not to self-diagnose. Instead, talk to your healthcare provider. They can help determine which type of anxiety you’re experiencing and work with you to create a treatment plan that supports both your anxiety and your bipolar disorder.
Editorial Sources and Fact-Checking
- Spoorthy MS et al. Comorbidity of Bipolar and Anxiety Disorders: An Overview of Trends in Research. World Journal of Psychiatry. January 4, 2019.
- Eser HY et al. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: Meta-analysis and Meta-Regression Study. Frontiers in Psychiatry. June 27, 2018.
- Nabavi B et al. A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-Analysis of 52 Interview-based Studies of Psychiatric Population. eBioMedicine. September 8, 2015.
UPDATED: Originally posted as sidebars to “Side-by-Side Solutions,” Fall 2022