Bipolar disorder vs. schizophrenia: How to tell the difference

People with bipolar disorder may experience episodes of mania and depression, often separated by periods of relative stability.

Individuals with schizophrenia experience symptoms of psychosis, such as hallucinations or delusions. Some people with bipolar disorder also experience psychotic symptoms.

Because of some overlap in symptoms, getting the right diagnosis can be challenging. Also, a person can have both schizophrenia and bipolar disorder, which can complicate diagnosis.

Some people have schizoaffective disorder, which involves a combination of schizophrenia symptoms and those of a mood disorder.

In this article, we look at the similarities and differences between bipolar disorder and schizophrenia. We also discuss methods of diagnosis and treatment options.

Symptoms of bipolar disorder

Symptoms of bipolar disorder and schizophrenia vary and can differ in type and severity.

They may get worse, then significantly improve or go away for a period, which some doctors call remission.

People with bipolar disorder experience extremes in mood. Doctors may classify “highs” as mania or hypomania, while “lows” involve a decrease in mood and often depression.

In some types of bipolar disorder, people experience a less severe form of mania, known as hypomania. The symptoms are the same, but in hypomania, they are less severe. Nonetheless, they affect a person’s life and relationships.

A manic episode is all that is necessary for a diagnosis of bipolar I, while hypomania preceding or following a major depressive episode is necessary for a diagnosis of bipolar II. A person often experiences periods of relative stability in between.

Symptoms of mania

Mania can involve:

  • anger or irritability
  • difficulty sleeping or less need for sleep
  • excessive energy and restlessness
  • high self-esteem
  • inability to concentrate or make decisions
  • increased engagement in pleasurable activities, such as sexual activity or drug use
  • intense excitement
  • racing thoughts
  • reckless behavior, such as overspending

In a person with bipolar disorder, depressive symptoms are the same as those in major depressive disorder.

Symptoms of depression

The primary symptom is a feeling of sadness or hopelessness that persists for 2 weeks or longer.

Other symptoms include:

  • changes in appetite
  • changes in sleep habits
  • fatigue and low energy
  • a loss of interest in things once enjoyed
  • low self-esteem
  • physical aches and pains without an apparent cause
  • suicidal thoughts or behaviors

Bipolar disorder can also cause anxiety and psychotic episodes, during which a person loses touch with reality.

Approximately half of all people with a bipolar disorder diagnosis experience psychotic hallucinations or delusions.

When people display psychotic symptoms, doctors may be unsure whether they have bipolar disorder or schizophrenia.

Symptoms of schizophrenia

Schizophrenia symptoms affect a person’s thoughts, emotions, and behaviors. They include:


These are false beliefs, and most people with schizophrenia experience them.

People may think, for example, that they are famous or special in a certain way, that they are being harassed or stalked, or that something terrible is about to happen.


During a hallucination, people see, hear, or smell things that are not there. The most common type involves hearing voices.

Disorganized thinking and speech

People may not make sense when communicating with others. They may give unrelated answers to questions, or their sentences may seem meaningless to the people around them.

Abnormal behavior

People with schizophrenia may demonstrate unpredictable behavior, for example, by making childlike actions, strange postures, or excessive movements.

Inability to function regularly

Schizophrenia can affect a person’s ability to take care of their personal hygiene, engage with others in socially acceptable ways, or perform everyday activities.

Bipolar disorder is more common than schizophrenia.

According to the National Institute of Mental Health, approximately 2.8 percent of adults in the United States experience bipolar disorder in a given year, and 4.4 percent experience it at some point in their lives.

Among them, 82.9 percent have serious impairment due to their symptoms, and 17.1 percent have moderate impairment.

On average, the disorder develops at 25 years of age, and it occurs at an equal rate in males and females.

According to a study in American Family Physician, 0.3–0.7 percent of people worldwide have schizophrenia, making it the most common psychotic illness.

It is marginally more common among males, and symptoms tend to first appear between late adolescence and a person’s mid-30s.

Many people with bipolar disorder require medications to stabilize their moods.

These may include:

  • lithium, a mood stabilizer that may significantly help prevent relapse in the long term
  • antipsychotic drugs
  • antidepressants
  • anti-anxiety medications
  • sleeping pills

Psychotherapy is an important part of bipolar disorder management. It may take place individually or with a group or the person’s family.

Therapy can help people manage their thoughts and emotions, establish a routine, and identify triggers.

Those who do not respond to medications or psychotherapy may benefit from electroconvulsive therapy (ECT). The goal is to alter the brain’s chemistry by sending electrical currents through the brain, causing a seizure.

Other strategies that can help people with bipolar disorder include:

  • avoiding alcohol and drugs
  • eating a balanced diet
  • establishing a daily routine
  • exercising regularly
  • getting enough sleep
  • identifying triggers and taking steps to prevent or lessen manic or depressive episodes
  • managing stress
  • seeking help and support from family, friends, and others

Treatment for schizophrenia

Antipsychotic medications are a vital part of treatment for most people with schizophrenia. Doctors believe that they alter the brain’s chemistry and reduce symptoms such as hallucinations and delusions.

Some individuals also require other medicines, such as antidepressants or anti-anxiety drugs. For people who do not respond to medications, a doctor may recommend ECT, which can improve psychotic symptoms.

When the symptoms of psychosis are under control, people with schizophrenia typically benefit from psychological and social interventions. These may include:

  • psychotherapy, both in individual and family settings
  • social skills training, to improve interactions with others
  • employment support, to help a person secure or perform a job more easily
  • daily living support, to help people find housing and manage daily responsibilities

Other coping strategies include:

  • avoiding alcohol and drug use
  • joining a support group
  • learning about schizophrenia
  • making certain healthful lifestyle choices, such as eating a balanced diet, exercising, and maintaining a sleep schedule
  • managing stress through meditation, exercise, and yoga
  • seeking help from family and friends


Although there are similarities between bipolar disorder and schizophrenia, there are also key differences, particularly relating to symptom severity and treatment.

People with bipolar disorder generally alternate between periods of low and high moods, while people with schizophrenia typically lose touch with reality as they experience hallucinations and delusions.

With treatment, a person who has either condition can manage their symptoms and reduce the impact that it has on their life.

Bipolar disorder is typically more manageable after a person receives appropriate treatment. Schizophrenia is more challenging to treat, and people who have it tend to require greater support.

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