Navigating the Complexity of Dual Diagnosis

What is Bipolar Disorder with ADHD?

Bipolar Disorder and Attention Deficit Hyperactivity Disorder (ADHD) are two distinct neurodevelopmental conditions that can co-occur in some individuals. Recent research suggests that up to 20% of individuals with bipolar disorder also meet criteria for ADHD, and vice versa. When someone has both bipolar disorder and ADHD, it creates a unique neurological profile that we’ll refer to as bipolar-ADHD.

The Diagnostic Evolution of Bipolar-ADHD

Historically, bipolar disorder and ADHD were often viewed as mutually exclusive conditions. The DSM-IV did not allow for co-diagnosis, leading to potential misdiagnosis or incomplete treatment for individuals experiencing symptoms of both disorders. With the release of the DSM-5 in 2013, clinicians can now diagnose both conditions concurrently, reflecting a more nuanced understanding of neurodevelopmental diversity.

This change in diagnostic criteria has significant implications for research and treatment. Studies conducted before 2013 may have inadvertently excluded individuals with both conditions, potentially skewing our understanding of each disorder in isolation. It also means that many adults diagnosed before 2013 may benefit from reassessment to ensure they’re receiving comprehensive care for all their symptoms.

The Neurological Complexity of Bipolar-ADHD

Brain imaging studies have revealed that both bipolar disorder and ADHD involve alterations in prefrontal cortex functioning and neurotransmitter systems, particularly dopamine and norepinephrine. However, the specific patterns of these alterations can differ between the two conditions. In bipolar-ADHD, these neurological differences interact in complex ways, creating a unique cognitive and emotional landscape.

For example, the dysregulation of the reward system seen in ADHD may interact with the mood instability characteristic of bipolar disorder, leading to more severe impulsivity during manic episodes. Conversely, the attentional deficits in ADHD might exacerbate the cognitive difficulties often experienced during bipolar depressive episodes.

The Push-Pull of Opposing Traits

Living with bipolar-ADHD often feels like an internal tug-of-war between competing neurological needs and tendencies:

• Bipolar disorder involves episodic mood changes, while ADHD symptoms are more persistent
• ADHD may drive a need for constant stimulation, while bipolar disorder can lead to periods of extreme withdrawal during depressive episodes
• The hyper-focus sometimes seen in ADHD can be amplified during manic or hypomanic states
• Impulsivity from ADHD may be further intensified during manic episodes

These contradictory traits can result in:

• Difficulty maintaining consistent performance at work or school
• Challenges in interpersonal relationships due to mood swings and attentional issues
• Increased risk of substance abuse as a form of self-medication
• Struggles with self-esteem due to the unpredictable nature of symptoms

Gender Differences in Presentation

Bipolar-ADHD can manifest differently across genders, adding another layer of complexity to diagnosis and treatment:

• Women with bipolar-ADHD may experience more depressive episodes and inattentive ADHD symptoms, which can be mistaken for unipolar depression
• Men might display more manic episodes and hyperactive-impulsive ADHD traits, potentially leading to misdiagnosis as a personality disorder
• Hormonal fluctuations in women can influence both bipolar and ADHD symptoms, complicating symptom tracking and treatment

These gender differences contribute to the underdiagnosis of bipolar-ADHD, particularly in women and individuals who don’t fit the stereotypical presentation of either disorder.

Rethinking Treatment for Bipolar-ADHD

Managing bipolar-ADHD requires a nuanced, personalized approach that addresses the unique symptom profile of each individual:

• Medication management is complex, often involving a combination of mood stabilizers and stimulants. Close monitoring is crucial to avoid triggering manic episodes with ADHD medications
• Cognitive Behavioral Therapy (CBT) can be adapted to address both bipolar and ADHD symptoms, focusing on mood regulation, organizational skills, and impulse control
• Mindfulness-based interventions may help individuals develop greater awareness of their mood states and attentional patterns
• Psychoeducation is essential, helping individuals and their support systems understand the interplay between bipolar and ADHD symptoms

Emerging treatments like neurofeedback and transcranial magnetic stimulation (TMS) show promise in addressing the neurological underpinnings of bipolar-ADHD. These approaches aim to directly modulate brain activity to improve mood stability and attentional control.

The Strengths of a Bipolar-ADHD Mind

While the challenges of bipolar-ADHD are significant, this neurological combination can also confer unique strengths:

• Intense creativity and innovative thinking, particularly during hypomanic states
• Ability to make quick decisions and think on one’s feet
• Heightened empathy and emotional sensitivity, allowing for deep connections with others
• Capacity for hyper-focus on engaging tasks, leading to periods of exceptional productivity
• Resilience developed from navigating the complexities of both conditions

When properly managed, these strengths can lead to success in fields that value creativity, problem-solving, and emotional intelligence.

Embracing the Bipolar-ADHD Experience

Understanding bipolar-ADHD as a distinct neurotype is crucial for proper support and self-acceptance. It requires moving beyond viewing these conditions as separate entities and instead appreciating the unique ways they interact and shape an individual’s experiences.

For those living with bipolar-ADHD, developing a deep understanding of their personal symptom patterns is key. This might involve:

• Mood and attention tracking to identify triggers and cycles
• Building a strong support network educated about both conditions
• Advocating for accommodations in work and educational settings
• Connecting with others who share similar experiences through support groups or online communities

With the right combination of professional support, self-management strategies, and self-compassion, individuals with bipolar-ADHD can lead fulfilling lives that honor the complexity of their neurological makeup.

If you resonate with the descriptions in this article, consider seeking an assessment from a mental health professional experienced in both bipolar disorder and ADHD. Remember that your experiences are valid, and support is available to help you navigate this complex and unique neurotype.

Resources to ADHD Comorbid with Other Disorders

Taproot Therapy Collective (Birmingham, AL)

• Treatments: Brainspotting, EMDR, Somatic Experiencing, Lifespan Integration, Parts-Based Therapy, Trauma Mapping.
• Specialties: Specializes in trauma therapy, PTSD, anxiety, panic, and dissociative disorders. Their therapists use integrative methods to help clients heal from trauma at a deep, somatic level.
• Website: gettherapybirmingham.com
  

  1. Crisis Center Birmingham (24/7 Crisis Line)

  • Phone: (205) 323-7777
    Provides immediate support for individuals in emotional distress, including suicide prevention, trauma, and mental health crises.
  • Website: crisiscenterbham.org

  2. Rape Response Line (Crisis Center Birmingham)

  • Phone: (205) 323-7273
    Dedicated to providing support for survivors of sexual assault, available 24/7.
  • Website: crisiscenterbham.org/rape-response

  3. Teen Link (Crisis Center Birmingham)

  • Phone: (205) 328-5465
    Teen-specific support line for youth in emotional or mental distress.
  • Website: crisiscenterbham.org

  4. National Suicide Prevention Lifeline (Serving Alabama)

  • Phone: 988
    A national 24/7 suicide prevention hotline accessible to individuals in Birmingham and the rest of Alabama.
  • Website: 988lifeline.org

  5. UAB Psychiatry Emergency Services

  • Phone: (205) 934-7008
    Provides immediate psychiatric evaluation and crisis intervention at the University of Alabama at Birmingham Hospital.
  • Website: uabmedicine.org

  6. Alabama Domestic Violence Hotline

  • Phone: 1-800-650-6522
    24/7 support for individuals experiencing domestic violence, available statewide, including Birmingham.
  • Website: acadv.org

  7. Birmingham AIDS Outreach Crisis Line

  • Phone: (205) 322-4197
    Provides crisis support for individuals affected by HIV/AIDS, including mental health services and support for LGBTQ+ communities.
  • Website: birminghamaidsoutreach.org

  8. Alabama 2-1-1 Call Center

  • Phone: 2-1-1
    A statewide information and referral line connecting individuals to crisis support services for housing, food, mental health, and substance abuse issues.
  • Website: 211connectsalabama.org

  9. Jefferson County Family Resource Center Crisis Line

  • Phone: (205) 945-6000
    Provides crisis intervention, including family support, domestic violence resources, and mental health services.
  • Website: jcfrc.org

  10. Veterans Crisis Line (Serving Birmingham)

  • Phone: 988 (Press 1)
    A specialized crisis line for veterans experiencing emotional distress, available nationwide and locally.
  • Website: veteranscrisisline.net

LGBTQ+ and Poly-Friendly Support

Magic City Acceptance Center (MCAC)

LGBTQ+ youth programs, adult support groups, and community events in Birmingham.

Website: mcacbham.org

Birmingham LGBTQ+ Circle of Healing

Support groups for LGBTQ+ individuals focusing on mental health and holistic wellness.

Contact through Magic City Acceptance Center.

Inclusive Therapists

Directory of therapists in Birmingham and Hoover specializing in LGBTQ+ and poly-friendly care.

Website: inclusivetherapists.com

PFLAG Birmingham

LGBTQ+ support groups for families and friends of LGBTQ+ individuals, offering mental health and advocacy resources.

Website: pflaga.org/birmingham

Steel City Spectrum

Provides support and resources for the transgender and gender-nonconforming communities in Birmingham.

Website: steelcityspectrum.org

Free & Low-Cost Therapy and Counseling

Impact Family Counseling (Birmingham, AL)

Provides sliding-scale counseling services for trauma, anxiety, depression, and family therapy.

Website: impactal.org

Firehouse Shelter (Birmingham, AL)

Offers mental health services and crisis support for homeless individuals in the Birmingham area.

Website: firehouseshelter.com

Pathways Birmingham

Women’s shelter offering mental health and trauma support for homeless women and children.

Website: pathwayshome.org

United Way of Central Alabama

Offers access to free or low-cost mental health counseling and crisis intervention through partnerships.

Website: uwca.org

BridgeWays Alabama

Offers family and youth counseling, including trauma recovery, on a sliding fee scale.

Website: bridgewaysalabama.org

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Holistic & Alternative Therapy Centers

Taproot Therapy Collective (Birmingham, AL)

Offers holistic mental health services like Brainspotting, EMDR, and somatic trauma therapies.

Website: gettherapybirmingham.com

Birmingham Wellness Institute

Focuses on alternative healing practices such as yoga therapy, mindfulness, and EMDR.

Website: bhamwellness.com

Sojourn Counseling (Hoover, AL)

Provides integrative counseling with a focus on EMDR, trauma work, and mindfulness.

Website: sojourncounseling.com

Red Mountain Therapeutics (Birmingham, AL)

Offers somatic therapies, acupuncture, and integrative emotional healing for trauma recovery.

Website: redmountaintherapeutics.com

Shanti Healing Arts Center (Birmingham, AL)

Focuses on trauma-sensitive yoga, meditation, and holistic therapies for emotional and mental health.

Website: shantihealingarts.com

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Lifespan Integration & Trauma Mapping

Birmingham Counseling Associates

Provides Lifespan Integration therapy for complex trauma and PTSD.

Website: bhamcounseling.com

Lifeline Counseling (Hoover, AL)

Trauma-informed care specializing in Lifespan Integration and Somatic Trauma Mapping.

Website: lifelinehoover.com

River Oaks Counseling

Offers Lifespan Integration and other trauma-focused therapies for PTSD and dissociation.

Website: riveroakscounseling.com

Emotional Wellness Counseling

Provides Lifespan Integration therapy and somatic trauma work.

Website: emotionalwellnesshoover.com

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qEEG Brainmapping and Neurofeedback Resources

Focus-MD Birmingham

Specializes in ADHD treatment and qEEG brain mapping for neurodevelopmental disorders.

Website: focus-md.com

Birmingham Neurofeedback Clinic

Provides qEEG brain mapping and neurofeedback for trauma, anxiety, and ADHD.

Website: birminghamneurofeedback.com

Alabama Neurofeedback

Offers qEEG brain mapping and neurofeedback to improve brain function and emotional regulation.

Website: alneurofeedback.com

Covenant Neuropsychology

qEEG brain mapping services for trauma-related symptoms and neurological issues.

Website: covenantneuro.com

Psych Wellness South (Hoover, AL)

qEEG and neurofeedback services to treat anxiety, ADHD, and trauma.

Website: psychwellnesssouth.com

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Poly-Friendly & Non-Monogamy Support

Inclusive Therapists

Directory for poly-friendly and non-monogamy affirming therapists in the Birmingham and Hoover areas.

Website: inclusivetherapists.com

Birmingham LGBTQ Circle of Healing

Offers support for polyamorous and non-monogamous relationships.

Contact through Magic City Acceptance Center.

Alabama Polyamory Network

A supportive community providing mental health resources for polyamorous individuals.

Contact via Meetup: meetup.com/polybirmingham

New Hope Counseling

Poly-friendly therapy services, offering support for non-traditional relationships.

Website: newhopecounselingbham.com

Open Counseling Birmingham

Provides mental health counseling for those in polyamorous or open relationships.

Website: opencounseling.com

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Youth & Family Services

Oasis Counseling for Women and Children

Provides trauma therapy, parenting support, and family counseling.

Website: oasiscounseling.org

Children’s Aid Society of Alabama (Birmingham)

Family and individual counseling, including trauma services for children.

Website: childrensaid.org

Aletheia House

Mental health and substance abuse services for families, including trauma recovery programs.

Website: aletheiahouse.org

Big Brothers Big Sisters of Greater Birmingham

Offers mentorship and emotional support for at-risk youth.

Website: bbbsbhm.org

The Exceptional Foundation

Provides support for children and adults with special needs, including mental health resources.

Website: exceptionalfoundation.org