Bipolar disorder, which is sometimes called manic-depressive illness, causes severe mood swings that can make daily functioning difficult. At times, these shifts in mood and energy level can be overwhelming. Extreme social anxiety, the fear of being criticized or embarrassed in social situations, can be a separate anxiety disorder, or it can occur with bipolar disorder. When they exist together, they can be a dangerous mix.
People with bipolar disorder experience mood swings that range from severe sadness and hopelessness to overly high levels of energy, restlessness, and irritability, known as mania. Here are some clues that suggest you may have social anxiety along with bipolar disorder:
- Presence of panic attacks and fear of social situations along with mania or depression
- Symptoms that started during childhood or early adulthood
- Symptoms of anxiety and sleep problems that are present when you are no longer in a manic mood
- Poor response to the usual treatments for bipolar disorder
Impact of Social Anxiety on Bipolar Disorder
Research shows that about 20 percent of people with bipolar disorder experience panic attacks, compared with less than 1 percent of people without a mood disorder. Research also shows that social anxiety rarely exists by itself. Various studies have found that about 80 percent of people with social anxiety have at least one other mental disorder during their lifetime.
These are some of the dangers of having both bipolar disorder and social anxiety:
- A recent study found that people with both anxiety and bipolar disorder are more likely to display suicidal behaviors than people with bipolar disorder alone.
- People with both bipolar disorder and social anxiety are more likely to abuse alcohol and drugs, which may make symptoms of both disorders worse.
- Social anxiety makes bipolar disease more difficult to treat.
- People with both disorders score worse on measurements of daily life functioning than people with bipolar disorder alone.
Why Do Social Anxiety and Bipolar Disorder Occur Together?
It is clear that there is a relationship between social anxiety and bipolar disorder, but it is not clear whether one leads to the other, or if they have common causes and exist together.
Here is what some research shows:
- People with bipolar disorder may have traumatic experiences caused by their mania early in life that lead to a fear of social situations.
- People who have bipolar disorder may abuse alcohol or drugs to control some of their symptoms. Abuse and addiction can make social anxiety disorder worse.
- Both disorders may run in families, since studies show that family members of people with bipolar disorder also have a higher rate of anxiety disorders.
Treatment of Bipolar Disorder With Social Anxiety
If you have social anxiety and bipolar disorder, both disorders need to be addressed for treatment to be successful. This often requires a combination of drug treatment and talk therapy. In most cases, treatment of both disorders can be successful.
Treatment options include:
- Mood-stabilizing medications. These drugs are usually used first to treat the bipolar part of the disorder. Examples of mood stabilizers used for bipolar disorder include lithium, valproate, and olanzapine.
- Antidepressants. These medications work well for social anxiety disorders, but they must be used very carefully with bipolar disorder, since they can make some bipolar symptoms worse. For this reason, doctors may avoid antidepressants or use them only in lower doses.
- Benzodiazepines. These drugs may work well for anxiety and are safe for bipolar disorder, but can cause physical dependence and must be used with caution by anyone who has a history of substance abuse.
- Psychotherapy. Talk therapy has been shown to be very effective for treating social anxiety disorder, so one option may be to use a mood stabilizer along with cognitive-behavioral therapy (CBT). CBT teaches people with social anxiety to change their thought patterns and to replace poor responses with more healthy responses. Other types of talk therapy that may help include family therapy and relaxation training.
- Lifestyle changes. Keeping a regular schedule, getting enough sleep, and avoiding events that cause stress can be helpful for both disorders. Getting regular exercise and avoiding alcohol and drugs are also very important.
Bipolar disorder and social anxiety disorder frequently occur together. The addition of social anxiety causes an increased risk of suicide and of alcohol and drug abuse, and generally makes dealing with bipolar more difficult. The good news is that both disorders can be treated. With the right combination of drugs, lifestyle changes, and psychotherapy, most people with these disorders do recover.