Many mental health disorders share symptoms and treatments. These overlaps—particularly among symptoms—can make getting an accurate diagnosis tricky. Bipolar disorder and schizophrenia are actually two very distinct conditions. However, in some cases, people with either may have similar symptoms.
“An element of losing touch with reality can occur in both disorders,” Thomas Plante, PhD, professor of psychology at Santa Clara University, tells Health. When people are at the extreme ends of the spectrum of bipolar disorder—very depressed or very manic—“they can think and behave in psychotic ways,” he says, which is also common among people with schizophrenia (think: hallucinations, delusional thinking).
However, Plante says, the difference between bipolar and schizophrenia is actually quite vast—and it takes different measures to treat them too. Here’s what you need to know.
Psychosis in schizophrenia can include delusions (that is, losing touch with reality), disorganized thinking, and hallucinations. “The vast majority of these hallucinations are auditory,” says Plante, who is also an adjunct clinical professor at Stanford University School of Medicine, “for example, hearing voices, voices telling you to do things or say things.”
People with schizophrenia can also sometimes become withdrawn, lose concentration easily, and have problems with their decision-making skills.
Bipolar disorder symptoms
When it comes to comparing schizophrenia vs. bipolar symptoms, the latter is more characterized by “extreme mood challenges,” Plante says. “On one end there’d be periods of mania or hypomania where a person will be very energized, animated, maybe a bit impulsive,” he says. “And on the other end, there are depressive episodes, where they are very depressed, find it hard to get out of bed, difficult to function, or go about their daily lives.”
These periods of deep depression can last a few weeks. There may also be long periods of time when the person is doing fine and is relatively symptom-free.
Diagnosing bipolar disorder and schizophrenia
Health care providers diagnose bipolar disorder and schizophrenia (not to mention other mental illnesses) using the Diagnostic and Statistical Manual of Mental Disorders or DSM, Plante explains. “The clinician looks at the diagnostic criteria laid out and sees if the person meets it for either of these two conditions.”
For schizophrenia, that means having at least two of the following symptoms: hallucinations, delusions, disorganized speech, agitated movement, and negative symptoms (such as withdrawing or cognitive impairment). One of the two necessary symptoms for a schizophrenia diagnosis has to be one of the first three listed here. The symptoms also have to be present for a significant amount of time during the span of a month.
A bipolar disorder diagnosis means having one or more manic or mixed episodes (a mixed episode is one where there is a manic episode and a major depressive episode within a week). The person must also have a period of mood disturbance and increased energy nearly every day for at least a week that includes three or more of the following: racing thoughts, inflated self-esteem or feelings of grandiosity, a reduced need for sleep, and extra risky behavior.
There is also a third distinct, albeit rare, disorder that can be diagnosed when a person exhibits symptoms of both conditions called schizoaffective disorder. “Schizoaffective disorder is diagnosed when a person meets the diagnostic criteria for both schizophrenia and a [mood] disorder like bipolar,” Plante says.
Treating schizophrenia vs. bipolar
Schizophrenia and bipolar disorder are treated with entirely different medications. Mood stabilizers are typically prescribed to people with bipolar disorder, while antipsychotic medications are mainly used in schizophrenia, Plante says.
However, there are some similarities in the approaches used in therapy to treat both bipolar disorder and schizophrenia. The goal, Plante says, is to improve how well people are coping with either condition. Therapy might include cognitive behavioral techniques, family support techniques, family therapy, and more, he explains, to “help people with these conditions get along in the world, hold down jobs, stay in school, or even just relate to their family and friends.”