Autism and Bipolar
August 15, 2022 4:03 PM Subscribe
I was diagnosed with bipolar disorder around 12 years ago, and now I'm wondering if I might be autistic too.
I scored 37 on the Autism Quotient test and 142 on the RAADS-R test, and I relate strongly to autistic people's experiences. I also feel like my autistic traits have had a greater impact on my life than bipolar has. I had one manic episode and two major depressive episodes in my early 20s, but I haven't had either in the last 12 years (although I have been medicated the whole time). I have always had serious problems with communication though, which have made it very difficult to form relationships. Is it likely that I could have ASD, as well as BD? If so, would it be worth it to try and get a formal diagnosis?
I scored 37 on the Autism Quotient test and 142 on the RAADS-R test, and I relate strongly to autistic people's experiences. I also feel like my autistic traits have had a greater impact on my life than bipolar has. I had one manic episode and two major depressive episodes in my early 20s, but I haven't had either in the last 12 years (although I have been medicated the whole time). I have always had serious problems with communication though, which have made it very difficult to form relationships. Is it likely that I could have ASD, as well as BD? If so, would it be worth it to try and get a formal diagnosis?
Best answer: Bipolar disorder is 6x more common in autistic people, and there's also a lot of underlying genetic connections between the two (there's been talk of a "neurodevelopmental continuum" including autism, bipolar, schizophrenia, ADHD, intellectual disability). However, autism is also often misdiagnosed as bipolar disorder.
Legal impacts definitely vary by location. There aren't any where I live, no effect on insurance or anything. It might limit immigration to some countries. However, if you get assessed at a private clinic without insurance and do not share this information with your GP it will not be a part of your larger medical record, and you can still share the diagnosis/documentation with employers.
A formal assessment can help clarify how your brain works and may be insightful; it may also provide you access to therapists that typically only work with autistic adults (though many are becoming open to self diagnosis). You'll also get more information about autism and it may explain or draw connections between experiences you've had that were confusing or frustrating.
However, it may be expensive and it can be hard to find someone who will do a good job. You would definitely want someone who specializes it, not just any old clinic. Also, even though there aren't formal legal limitations where I live, there's always the risk of a doctor or someone else seeing the diagnosis and acting in a biased manner. So those are some things to weigh.
posted by brook horse at 6:10 PM on August 15, 2022 [2 favorites]
Legal impacts definitely vary by location. There aren't any where I live, no effect on insurance or anything. It might limit immigration to some countries. However, if you get assessed at a private clinic without insurance and do not share this information with your GP it will not be a part of your larger medical record, and you can still share the diagnosis/documentation with employers.
A formal assessment can help clarify how your brain works and may be insightful; it may also provide you access to therapists that typically only work with autistic adults (though many are becoming open to self diagnosis). You'll also get more information about autism and it may explain or draw connections between experiences you've had that were confusing or frustrating.
However, it may be expensive and it can be hard to find someone who will do a good job. You would definitely want someone who specializes it, not just any old clinic. Also, even though there aren't formal legal limitations where I live, there's always the risk of a doctor or someone else seeing the diagnosis and acting in a biased manner. So those are some things to weigh.
posted by brook horse at 6:10 PM on August 15, 2022 [2 favorites]
Just popping in to recommend the reddit sub "autisminwomen" (if you are female, apologies for making an assumption!) for asking this question.
posted by Zumbador at 9:21 PM on August 15, 2022
posted by Zumbador at 9:21 PM on August 15, 2022
Best answer: I was diagnosed with bipolar II in 2014 during my mid 20s after many years of significant mood instability (mostly severe depression, but also mild SSRI-triggered hypomania). I now believe that my previous mental health & related issues (disordered eating & alcohol abuse) were entirely a result of unrecognised C-PTSD and autism. Some of the C-PTSD was incidental, because of my circumstances when I was a child, while some of it was the direct result of the numerous traumas caused by growing up neurodivergent in a situation where that possibility wasn't on anyone's radar.
Reframing my challenges through that lens and doing trauma-focused therapy (rather than therapy aimed at reducing the severity or impact of mental illness symptoms) has been extremely impactful for me. I haven't taken any medication since 2017, and haven't been in therapy full-time since 2019 (I went back for a few sessions last year when something very stressful was happening), and I'm doing well. I don't believe that remaining unmedicated and stable for so long would be likely or possible if I truly did have bipolar disorder. And when I was in the throes of the symptoms of those untreated & unacknowledged issues, I never imagined that my life might one day be as steady as it is today.
Like dorothyisunderwood, I'm not seeking an autism diagnosis for various reasons. One is the fact that I'm trans and want top surgery in the next few years, and a formal autism diagnosis might complicate that. I also feel basically the same contempt for autism-as-diagnosed-by-neurotypical-people that I do for trans-as-diagnosed-by-cis-people; the idea that a neurotypical person with narrow, biased diagnostic criteria is a better judge of whether or not I'm autistic than my own 30+ years of lived experience as someone who is very obviously different to a lot of other people is laughable. On bad days it's insulting. On good days it's totally unnecessary to my understanding of myself.
The thing that's most helped on the autism side has been reading about the experiences of other autistic people, understanding the root causes of some of the things I struggle with (e.g. knowing I have sensory issues and giving myself permission to work around them has drastically reduced my risk of having a meltdown, when before I had no idea that I had sensory issues at all and wouldn't have necessarily identified them as the thing that was pushing me over the edge into meltdown territory), and giving myself permission not to meet (and in some cases not to attempt to meet) neurotypical standards for living. I didn't need a formal diagnosis to do any of that stuff, but living as though I'm already undoubtedly autistic and allowing myself to make my life easier in ways that are targeted at me (and not some idealised neurotypical person who should be doing this or that), regardless of diagnosis, has been immensely helpful.
It's definitely possible that you have bipolar too! But if I were you, I'd be inclined to spend some time working on your trauma and optimising your life to meet your own specific autistic needs as much as you can, and see if the mood instability that led to the suggestion of bipolar still persists.
posted by terretu at 2:10 AM on August 16, 2022 [6 favorites]
Reframing my challenges through that lens and doing trauma-focused therapy (rather than therapy aimed at reducing the severity or impact of mental illness symptoms) has been extremely impactful for me. I haven't taken any medication since 2017, and haven't been in therapy full-time since 2019 (I went back for a few sessions last year when something very stressful was happening), and I'm doing well. I don't believe that remaining unmedicated and stable for so long would be likely or possible if I truly did have bipolar disorder. And when I was in the throes of the symptoms of those untreated & unacknowledged issues, I never imagined that my life might one day be as steady as it is today.
Like dorothyisunderwood, I'm not seeking an autism diagnosis for various reasons. One is the fact that I'm trans and want top surgery in the next few years, and a formal autism diagnosis might complicate that. I also feel basically the same contempt for autism-as-diagnosed-by-neurotypical-people that I do for trans-as-diagnosed-by-cis-people; the idea that a neurotypical person with narrow, biased diagnostic criteria is a better judge of whether or not I'm autistic than my own 30+ years of lived experience as someone who is very obviously different to a lot of other people is laughable. On bad days it's insulting. On good days it's totally unnecessary to my understanding of myself.
The thing that's most helped on the autism side has been reading about the experiences of other autistic people, understanding the root causes of some of the things I struggle with (e.g. knowing I have sensory issues and giving myself permission to work around them has drastically reduced my risk of having a meltdown, when before I had no idea that I had sensory issues at all and wouldn't have necessarily identified them as the thing that was pushing me over the edge into meltdown territory), and giving myself permission not to meet (and in some cases not to attempt to meet) neurotypical standards for living. I didn't need a formal diagnosis to do any of that stuff, but living as though I'm already undoubtedly autistic and allowing myself to make my life easier in ways that are targeted at me (and not some idealised neurotypical person who should be doing this or that), regardless of diagnosis, has been immensely helpful.
It's definitely possible that you have bipolar too! But if I were you, I'd be inclined to spend some time working on your trauma and optimising your life to meet your own specific autistic needs as much as you can, and see if the mood instability that led to the suggestion of bipolar still persists.
posted by terretu at 2:10 AM on August 16, 2022 [6 favorites]
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You don't need a formal diagnosis to be autistic to other autistic and neurodivergent people. I chose not to get a formal diagnosis because of the legal and medical impact - insurance becomes a huge hassle etc. I did get a formal diagnosis for my child so she can access essential accommodations. Your decision should take into account the laws and social mores of where you live and please please check the impact this would have on your insurance and legal rights.
You may want to discuss your results with your psychiatrist off the record so they can consider modifying your medication and/or treatment to support you. That's what I did and it was my psychiatrist who recommended against a formal diagnosis because I don't need the support enough to outweigh the legal limitations.
Good luck with your journey!
posted by dorothyisunderwood at 5:18 PM on August 15, 2022 [3 favorites]