Asperger's with Bipolar Disorder

Updated April 17, 2017

Because the symptoms of Asperger's syndrome and bipolar disorder can be similar, it's common for people to be diagnosed with one or the other when they really have both. It's not uncommon for the two conditions to occur together, but having comorbid disorders presents additional challenges in treating and living with the conditions.

Understanding Asperger's Syndrome

Asperger's (Asperger or Asperger's Syndrome or Disorder) is a developmental disability on the autism spectrum. People with Asperger's tend to have one or two very focused interests and can talk at length about them, without noticing when others are growing bored or disinterested in the conversation. They're not good at understanding body language or interpreting facial expressions and may speak very formally, as if they're reading from an encyclopedia. It's difficult for them to understand others' emotions or viewpoints. They have a hard time understanding sarcasm or idioms (phrases like "piece of cake" or "hit the road"). They may move awkwardly, with a stiff or clumsy gait. Many people with Asperger's have distinct mood swings. The inability to understand what goes on in social situations can lead to frustration and anger, creating behaviour issues and outbursts of temper.

Understanding Bipolar Disorder

Bipolar disorder is characterised by strong differences in mood, between extreme highs (mania) and lows (depression). Manic states are marked by extreme happiness or irritability, racing thoughts, the feeling that you need to do a hundred things at once, an inability to focus on anything, bad judgment, excessive risk-taking in activities like spending, driving and sex, and insomnia. Depression finds people feeling sad for weeks at a time, convinced they are worthless or to blame for everyone's problems. They may have an increase or decrease in appetite or sleep, appear apathetic, and lose interest in things they used to enjoy. Severe depression can lead to suicidal thoughts and attempts. A mixed state combines both manic and depressive elements, with people often feeling worthless and sad, but taking risks and otherwise behaving as in a manic state.

Difficult Diagnosis

It can be difficult to diagnose bipolar disorder or other psychiatric illnesses in someone who has Asperger's disorder. Doctors may attribute their symptoms to the developmental disability and not consider that there could be another, undiagnosed disorder. Because people with Asperger's are often less social than people in general, their moodiness may not affect relationships--a key factor in diagnosing bipolar disorder in the general population. Depressive apathy may be seen as the social deficit in Asperger's. What looks like the compulsive need to know everything about a topic of interest, common in people with Asperger's, may really be the impulsiveness and compulsive drive of bipolar disorder.

Getting Help

Before making a diagnosis, your doctor must take a comprehensive medical history, including any psychiatric illnesses among family members. He will carefully assess the symptoms, noting the severity and duration of mood swings and other symptoms. In the case of diagnosing children, the doctor may observe their behaviour over the course of several visits to get an accurate measure of their behaviour. Thyroid problems can cause symptoms similar to bipolar disorder, so the doctor may order a blood test to rule that out.


There are medications available for treating bipolar disorder in people with Asperger's. People taking medications for bipolar should be carefully monitored for side effects. Some antipsychotics commonly prescribed for bipolar disorder can cause involuntary movements in children; the risk of this is higher in kids with Asperger's. Because of possible communication deficits, it's essential to make careful note of any atypical behaviour in people with Asperger's who are taking any kind of medication.

Therapy can help you understand the symptoms and learn to manage them. Average to high IQ is one component of Asperger's, so therapy can be quite effective in teaching about the disorders.

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About the Author

April Fox has published articles about homeschooling, children with special needs, music, parenting, mental health and education. She has been a guest on Irish radio, discussing the benefits of punk rock on child development, and currently writes for several websites including Carolina Pediatric Therapy.