10/29/25 | By: Carissa Hannum

As a clinician that works in the field of eating disorders and trauma, many clients come to me to uncover the reasons underlying why they have developed an eating disorder or several other behaviors to deal with their mood or other mental health issues. Clients at times feel that their mental health is “too complicated” or have felt that no one has been able to “figure them out”. One of my jobs as a clinician is to help clients uncover the underlying causes of their mental health issues. Through the course of treatment, many of my clients with eating disorders and trauma are diagnosed with mood disorders like depression, anxiety, posttraumatic stress disorder, obsessive compulsive disorder, and bipolar disorder. In addition, I like to explore neurodevelopmental disorders including autism and ADHD throughout treatment.

According to the National Eating Disorder Collaboration “55-97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder” (Link to Research). In addition, although research is limited around neurodivergence and eating disorders, some research and the National Eating Disorder Association (NEDA), report that “22% of women diagnosed with ADHD also develop an eating disorder and children with ADHD are almost 6 times more likely to have an eating disorder by the time they reach late adolescence than those without ADHD” (Link to research). In addition, “ 39% of children and adolescents being treated for ARFID also met the diagnostic criteria for ADHD compared to up to 10% of the general population” (Link to Research). The reality is, if you are a clinician working with eating disorders, you are highly likely to encounter the need to treat both ADHD and mood disorders.

Now, for a highly asked question, can you have a mood disorder and ADHD? Yes, you can, but specifically, I have been asked if you can have both bipolar disorder and ADHD. Again, yes you can, although there is some confusion around this. As a clinician, I have even encountered other treatment providers that have been taught that you can only have ADHD or bipolar disorder and not the other. This previously known fact and way of approaching mental health can be harmful to our clients. Our duty as clinicians is to appropriately explore any underlying conditions and work with our clients to treat those conditions. The reality is, based upon the statistics above, I would say it is highly likely within the field of eating disorders to encounter clients who may have both bipolar disorder and ADHD.

Below I explore both mental health conditions, the prevalence of both ADHD and bipolar disorder, how these conditions may “look” and be experienced by clients, as well as treatment for both conditions.

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder characterized by episodic moods, including the lows of depression episodes and more elevated mood including manic and hypomanic episodes. There are three diagnosable types of bipolar disorder, which include Bipolar Disorder Type I, Bipolar Disorder Type II, and Cyclothymic disorder. These disorders are highly genetic and tend to run in families.

What Characterizes Each Type of Bipolar Disorder?

Bipolar I Disorder

These individuals experience alternative depressive and manic episodes that impair daily functioning and may even lead to hospitalization to stabilize mood. Mania can result in psychotic episodes due to the elevation in and biochemical changes in the brain.

Bipolar II Disorder

Individuals who experience Bipolar II Disorder alternate between more depressive episodes and what is considered hypomanic episodes. Hypomanic episodes are less severe than mania. Hypomania does not cause the same functioning impairments as mania, but would be a marked change from the depressive episodes that the individual normally experiences. For instance, many individuals can suddenly seem more productive for a period, but then go back into a depressive episode.

Cyclothymic Disorder

I like to remember that Bipolar Disorder, like many other disorders, exists on a spectrum. Within Psychotherapy, psychotherapists use the DSM-5 to diagnose individuals using certain subsets of criteria. At times, individuals do not meet full criteria for hypomania, mania, or depression symptoms as well nor do not meet full criteria for duration of Bipolar I disorder and Bipolar II disorder episodes. When this happens, individuals may still experience symptoms of these disorders. When individuals do not meet the full criteria but exhibit episodic mood symptoms, they are diagnosed with Cyclothymic Disorder.

What Are the Symptoms of Bipolar Disorder?

Symptoms of Mania/Hypomania

Psychosis
Distractibility
Irresponsible, erratic Behavior, or risky behaviors
Grandiosity
Flight of Ideas
Increase in sexual libido
Decrease need for sleep or no sleep at all
Pressured speech

Symptoms of Hypomania (less severe than mania)

High level of energy or activity level
Sleep disturbance, including the need for less sleep
Inflated self-esteem
Talking fast
Racing thoughts
Increase in Distractibility
Pacing or other repetitive behaviors like fidgeting
Feeling extremely happy, which is a marked change from previous depressive mood
Increase in impulsivity

Symptoms of Depression

Sleep disturbance
Feelings of guilt or shame
Decrease in self-esteem
Suicidal thoughts, ideations, or behaviors
Changes in appetite
Difficulty concentrating
Loss of energy
Loss of interest in activities that one enjoys
Isolation
irritability

What Is ADHD?

Attention-deficit/hyperactivity disorder or ADHD is a neurological condition that affects children, adolescents and adults. Although the known cause isn’t quite understood, this is starting to be recognized as a genetic condition that may run in families (Link to Research). Due to the struggles with inattention, hyperactivity, and/ or impulsiveness, individuals diagnosed with ADHD can have struggles in several areas of daily life including work, school, basic needs, and social relationships. Due to difficulties in these areas and with executive functioning, individuals diagnosed with ADHD can struggle with rejection, self-esteem issues, depression, and anxiety.

What are the Types and Symptoms of ADHD?

Predominately Inattentive Presentation

Difficulty with focus
Issues with organization
Trouble with following directions and staying on task
Makes mistakes/does not pay attention to small details which leads to mistakes
May lose concentration during conversations or seem to be elsewhere in their mind
Due to difficulty focusing, individuals may start certain tasks but not follow through or finish tasks.
Difficulty breaking down tasks leads to messy, disorganized work or missing due dates.
Struggles with activities that require consistent attention or mental effort.
Often loses materials or everyday things i.e. keys
Very distractable
Forgetting tasks that they agreed to, such as paying bills or a daily chore.

Predominately Hyperactive/Impulsive Presentation

Tends to fidget with hands or feet
Tends to interrupt others
Seems to be driven by a motor
Overly talkative
Not able to stay seated in situations where it is required
Difficulty with turn-taking
Seems to have impulsive or excessive energy

Combined Type Presentation

With this type of ADHD, individuals struggle with both inattentive and hyperactive ADHD symptoms throughout their daily life.

What is the Prevalence of ADHD and Bipolar Disorder?

As I started writing this blog, I mentioned that I have encountered some providers that have learned that you must rule out either ADHD or Bipolar Disorder. This means that many practicing clinicians still believe that clients can only have either ADHD or Bipolar Disorder. In reality, some research has indicated that 20% of those diagnosed have both ADHD and Bipolar Disorder (Link to Research). That is significant! I suspect that number could be higher and it is necessary to be able to screen for ADHD and Bipolar disorder, understand the similarities as well as differences of both diagnoses, and understand appropriate treatment for a diagnosis of both ADHD and Bipolar Disorder.

What is the Overlap and Symptoms of ADHD and Bipolar Disorder?

The Commonalities of ADHD and Bipolar Disorder

Mood Dysregulation, Depression, Anxiety

Both Bipolar disorder and ADHD can experience mood changes including depression and anxiety, but also mood dysregulation like irritability and frustration. Many individuals with ADHD discuss that their ADHD and difficulties with executive functioning can cause frustration and irritability. In addition, due to the changes in mood with bipolar disorder, individuals may feel more angry, frustrated, and irritable within an elevated state or when feeling depressed due to the changes in mood they are encountering. As you can see the symptoms may look the same, but how they are encountered or “caused” may be different.

Impulsivity

Both sets of criteria for ADHD and Bipolar Disorder include impulsivity. Impulsivity related to Bipolar Disorder is related to hypomania and mania and how this can lead to interruption, excessive talking, and at times an increase in risky behaviors, such as overspending, and pressured speech. Although the cause of impulsivity is different for ADHD, those diagnosed with ADHD can struggle with the same behaviors although it will not be as extreme as someone that is experiencing a manic episode.

Hyperactivity/Distractibility

ADHD and Bipolar Disorder can both experience the symptoms of hyperactivity and Distractibility. A manic or hypomanic episode can cause the experiencer to be highly distracted or at times even hyperactive. I’ve had clients suddenly feel as if they needed to go do an activity they have been putting off or had no interest in previously when experiencing both hypomania and manic episodes. Both diagnoses can also cause hyperactivity and appear as though one is being driven by a motor. ADHD is characterized by hyperactivity that is based upon movement, fidgeting, and difficulty staying still to soothe one’s nervous system, while a manic or hypomanic episode can cause needs like lack of sleep to become affected due to mood shifts.
Both diagnoses also manifest in distractibility as a symptom. ADHD causes distractibility due to difficulty focusing, being forgetful, and lack of following directions due to inattentiveness. ADHD causes difficulties in the prefrontal cortex of the brain. These symptoms are not caused by mood changes, like bipolar disorder in which a shift in mood can cause distractibility or difficulty following along with tasks due to the intense emotions one feels.

So how do I know if I have Both ADHD and Bipolar Disorder?

For me, as a clinician working with both of these mental health conditions, I look for ways that these disorders are different and try to explore those differences with clients who I suspect may have ADHD and bipolar disorder. A major way that ADHD and Bipolar Disorder are different from one another is the way that mood symptoms manifest. Both disorders can cause an individual to experience depression and anxiety. However, how these mood issues come to be for each disorder tends to be different.

Although I will explain later in this blog how Bipolar mood shifts can be tracked by the client to gain awareness of mood shifts and mood patterns, without appropriate tracking, mood shifts within Bipolar Disorder are neurochemical. At times, mood shifts in bipolar disorder can feel highly unpredictable. Many people can pinpoint exactly what causes their depression, anxiety, or elevated mood. For instance, I know that if I sleep less and then make a major mistake at work, my mood will be lower. This obviously isn’t the case with any type of Bipolar Disorder. Bipolar disorder mood shifts are caused by neurochemical and biological changes in the brain. There isn’t always an external force causing lower mood and depression. There may be times when clients with bipolar disorder can pinpoint causes. For example, some of my clients know that if they don’t sleep well for a couple of days, they may have a hypomanic or manic episode followed by a depressive episode. However, this is still caused and triggered by a neurochemical reaction in the brain.

With ADHD, depression and anxiety are effects of ADHD symptoms. For example, many clients who are struggling with executive functioning issues may have difficulty turning in tasks on time or misplace objects continuously, despite how hard they try to change these areas. People experiencing ADHD symptoms can feel frustrated by these mistakes or that there is something “wrong with them” internally. Many with undiagnosed ADHD frequently feel that their symptoms are a character flaw and that they are “lazy” or that their symptoms are really a character flaw. These thoughts and reactions to their symptoms can cause mood issues like depression and anxiety.

For myself, I like to work with my clients to recognize mood-related patterns and explore where these mood shifts may be coming from. I try to stabilize any bipolar-like symptoms with my clients, and after, if there are any ADHD-like symptoms, try to explore these together and with a qualified team that knows how to work with both conditions. With time, clients can pinpoint what is a Bipolar mood shift and what may be a mood symptom linked to ADHD symptoms.

What is the Treatment of ADHD and Bipolar Disorder?

Psychiatric Assessments
- Treatment for ADHD and Bipolar Disorder requires a delicate balance to explore and treat each individual's unique symptoms and interplay of symptoms. When I’m treating both mental health conditions, I do have my clients see both a psychiatrist and receive a psychiatric assessment to gather information about the interplay of these symptoms. Not only can a psychiatrist help track and explore mood shifts, but a neuropsychological/psychiatric assessment can help identify the type of ADHD an individual has and the unique ways that each individual’s brain works by identifying both their strengths and areas of struggle. Psychiatric assessments will also identify certain areas of recommendation for treatment.

Medications for Bipolar Disorder and Possible Inpatient Treatment
- Management of Bipolar Disorder does include psychotropic medication, including mood stabilizers and antipsychotic medications. These medications stabilize mood shifts and help an individual return to a level of daily functioning that the individual approves of. Antidepressant medications may be useful in some cases but generally do not help address mania and hypomania. Actually, at times, these medications can cause mania and hypomania episodes. My clients tend to be treated by mood stabilizers and antipsychotics with their psychiatrists. It should be stated that the severity of symptoms when an individual first comes into treatment may dictate an acute need for inpatient treatment. For instance, if an individual comes into treatment with suicidal thoughts and they are unable to keep themselves safe, severe manic episodes that are leading to risky behaviors, or manic episodes that are leading to psychosis, the individual should attend inpatient treatment to stabilize these behaviors.

Talk Therapy and Mood Tracking for Bipolar Disorder
- Talk therapy is also extremely helpful to name and identify how one’s mood may shift and the individual's unique patterns of mood shifting. When working with clients who are diagnosed with bipolar disorder, I usually employ an eclectic range of treatment modalities. One of these tactics includes mood tracking to identify and understand mood shifting patterns, how these shifts tend to appear within the body, how behaviors, and any other identifying information. I’m a firm believer that the more information we know, the more we can begin to tame these behaviors. Mood tracking can also help clients understand what symptoms are related to mood shifts and what symptoms are related to patterns from their ADHD. In addition, emotional tolerance skills, distress tolerance skills, coping skill development, and continuing self-care strategies can help with any mood shifts. Dialectical behavioral therapy, cognitive behavior therapy, and any other emotional tolerance skills can be helpful.
Stimulant Medications, to Use or Not to Use?
- Now, for the hard part, how does treatment change if an individual is diagnosed with ADHD on top of Bipolar Disorder? For the first part, medication is something that will need to be balanced and monitored by an individual’s team of professionals. A common medication used in treating ADHD is called a stimulant medication. Stimulants help increase neurotransmitters in the brain, which then allows an individual to have improved executive functioning behaviors, develop better impulse control, as well as improve attention. The problem, however, is that stimulant medications can trigger mania and hypomania in the brain. Some individuals can tolerate taking these medications, and for some, these medications are not possible due to how they affect an individual's mood shifts and mood instability. Generally, there are a few non-stimulant medications that can be used and tried in these cases, although at times these medications may not be as useful.
Sleep Tracking
- Although I could say this about any mental health condition, being aware of sleep patterns and making sure that one gets enough sleep is paramount to dealing with ADHD and bipolar disorder. Not getting enough sleep can trigger hypomanic and manic episodes and cause difficulty with executive functioning. I recommend to my clients that when waking up, to get outside in the sunlight to help regulate circadian rhythms. Clients can benefit from nighttime and morning routines that help regulate these rhythms and let the body know when it is time to both go to sleep and get up in the morning. Individuals with ADHD can benefit from short periods and bursts of exercise in the morning to help wake and regulate the nervous system.
Executive Function Coaching
- Executive Function Coaching can be done both in therapy and with a specified individual coach that can help develop skills to help attention, impulse control, and of course, executive functioning skills, like organizing, planning, time management skills, etc. Working with an executive function coach can help each individual identify their unique strengths and areas of improvement related to their ADHD and come up with a plan of action for utilizing these strengths as well as creating a plan of action around their struggles.
Talk Therapy for ADHD
- Much like Bipolar Disorder, talk therapy can be utilized for both ADHD and Bipolar Disorder. As stated earlier, there are several similarities between ADHD and Bipolar Disorder. Because of the similarities with impulsivity and mood-related issues that can be the result of both diagnoses, a combination of therapeutic approaches, including dialectical behavior therapy, cognitive behavior therapy, and other emotional tolerance strategies,s can help individuals identify negative thought patterns that continue ADHD executive function struggles, create coping skills, and develop mood regulation skills.
Treatment is a Balance
- It is important to remember that each individual and their presentation with both Bipolar Disorder and ADHD is unique and different. Individuals diagnosed with ADHD and Bipolar Disorder should work with a team of professionals, which can include but are not limited to a therapist, psychiatrist, and an executive function coach, to work on a treatment plan that works for that individual’s unique symptom presentation. These are only a few treatment strategies that can be used for both ADHD and Bipolar Disorder. Your treatment team will come up with a plan of action and skills that work best for you!

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