Spotting the differences between bipolar disorder and schizophrenia

On paper, schizophrenia and bipolar are distinct conditions. One is a mood disorder, while the other is a psychotic disorder. But in reality, their symptoms can overlap significantly. Many people with bipolar disorder experience symptoms of psychosis. And it’s common for people with schizophrenia to experience mood disorders — especially depression. When symptoms of both conditions appear together, a diagnosis of schizoaffective disorder may be used.

If you or a loved one are experiencing symptoms, it can be difficult to understand the differences and similarities between bipolar disorder and schizophrenia. But getting a correct diagnosis is an important step toward getting the right care. With the right care, people living with either condition can manage symptoms and lead fulfilling lives.

Bipolar disorder vs. schizophrenia

While they can sometimes share some symptoms, bipolar disorder and schizophrenia are different conditions. The main difference is that bipolar disorder is a mood disorder, while schizophrenia is a psychotic disorder.

Symptoms of bipolar disorder

Bipolar disorder is categorized as a mood disorder, or a mental health condition that primarily affects your mood. Another example of a mood disorder is depression.

People who have bipolar disorder usually experience two different types of moods: depression and mania (or hypomania). These symptoms can look like:

• Episodes of depression:
  • Sad, empty, or irritable mood
  • Lack of energy
  • Difficulties sleeping, or sleeping too much
  • Slow movements or speech
  • Thoughts of death or suicide*
• Episodes of mania or hypomania:
  • Elevated, euphoric, or agitated mood
  • Abnormally high level of energy
  • Lack of sleep 
  • Talking excessively or very fast
  • Reckless or impulsive behaviors

*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988.The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors.

Symptoms of schizophrenia

Schizophrenia is a psychotic disorder, which means it involves symptoms that cause a person to be out of touch with reality..

Symptoms of schizophrenia include:

• Delusions, or believing things that aren’t true
• Hallucinations, which includes seeing, hearing, or sensing things that aren’t really there
• Disorganized speech or thought process
• Disorganized or catatonic behavior (not reacting to surroundings)
• Negative symptoms, which might be things like a lack of emotional expression, speaking very little (or not at all), or a loss of interest or motivation to do things you once enjoyed

Shared symptoms

Although bipolar disorder and schizophrenia are distinct conditions, their symptoms can sometimes overlap.

People with bipolar disorder can experience psychosis (hallucinations or delusions) particularly during manic episodes. According to research, over half of people with bipolar disorder will experience psychosis in their lifetimes. This overlap can sometimes make it challenging to distinguish bipolar disorder from a psychotic disorder like schizophrenia.

On the other hand, people with schizophrenia can also experience mood symptoms. Research shows that around 40% of people with schizophrenia also live with depression. However, mood swings or depression in schizophrenia are generally considered secondary to the primary psychotic symptoms of the disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to meet the diagnostic criteria for schizophrenia, your mood episodes (of either mania or depression) must be “brief” in comparison with how long you’ve lived with schizophrenia. For example, if you’ve lived with schizophrenia for several years and had a manic episode that lasted one month, you might still be diagnosed with schizophrenia — not bipolar disorder.

Schizoaffective disorder 

If you experience frequent or long-lasting mood episodes alongside psychotic symptoms that occur even when mood symptoms are absent you may be diagnosed with schizoaffective disorder. There are two types of schizoaffective disorder: bipolar type and depressive type. People with bipolar type schizoaffective disorder have symptoms encompassing both bipolar disorder and schizophrenia.

These symptoms include:

• Psychotic symptoms, including hallucinations and delusions, that occur even when mood symptoms are not present
• Disorganized thinking and speech
• Disorganized or catatonic behavior
• Major mood episodes (manic, hypomanic, or depressive) that occur for more than half the duration of the illness

Is it possible to have both?

There is ongoing debate about whether a person can be diagnosed with both schizophrenia and bipolar disorder at the same time. Some clinicians use the diagnosis of schizoaffective disorder when both mood and psychotic symptoms are present, while others consider schizophrenia and bipolar disorder as potentially co-occurring conditions.

Getting an accurate diagnosis is essential for finding the right treatment, whether that means treating bipolar disorder, schizophrenia, or both as co-occurring conditions.

The care you need, when you need it

Learn how Rula can support your mental health journey

Subscribe

I agree to receive emails from Rula and accept the terms outlined in Client Email Consent and Privacy Policy.

Diagnosing bipolar disorder, schizophrenia, or both

Bipolar disorder and schizophrenia are distinct conditions. One doesn’t “turn into” the other. But it is possible to be diagnosed with both bipolar disorder and schizophrenia. However, their symptoms can overlap, making diagnosis complex. Misdiagnosis is common. 

The only people who can tell you for sure whether you live with bipolar disorder, schizophrenia, or another mental health condition are licensed and qualified medical providers. They can assess you for schizophrenia and bipolar disorder and make a decision about whether your symptoms meet the criteria for one of these conditions (or if they’re a better fit for a diagnosis of schizoaffective disorder — or another mental health condition entirely).

A mental health professional may ask you detailed questions about your symptoms, including when you started experiencing them, how much of the time you experience them, and how they affect your life. This information can guide them in making the right diagnosis for you — and the right diagnosis can help them understand how to best help you.

Treatment approaches and support 

Whether you have bipolar disorder, schizophrenia, or schizoaffective disorder, all mental health conditions can successfully be treated. They can’t be “cured,” but with the right treatment and support, you can manage symptoms, improve relationships, and build skills for daily life.

Regardless of your diagnosis, your treatment plan will probably include a combination of therapy, medication, and social support. It’s important to work with your provider to determine a treatment approach that makes the most sense for your situation and goals. 

• Therapy: Research has found that therapy — especially modified versions of cognitive behavioral therapy (CBT) — can help people with schizophrenia and bipolar disorder practice thinking and behaving in ways that help them feel better.
• Family and community support: Getting family support is an essential part of treatment for people who live with these conditions. Therapists can help your family members understand your condition more deeply and get support for their own mental health as well. 
• Living skills: When symptoms get in the way of daily living tasks, like working, you might benefit from skills training programs. For example, you might learn how to prepare for a job interview or how to successfully live on your own.
• Medication: Medication can help manage symptoms and stabilize mood. Your provider can work with you to find the right options based on your unique needs.

Find care with Rula

Bipolar disorder and schizophrenia can sound like serious diagnoses, and it can be scary to receive them. But know that you’re not alone. Both are treatable mental health conditions, and with support, you can continue to reach your goals and build a life that feels meaningful to you.

At Rula, we have a network of over 10,000 licensed therapists who can help you with a wide range of mental health symptoms, including those of bipolar disorder, schizophrenia, and schizoaffective disorder. If you need medication as part of your treatment plan, then they can make referrals to other providers.

Find a therapist with Rula