Is It Bipolar Disorder or Schizophrenia?

Medically Reviewed by Smitha Bhandari, MD on May 15, 2023
4 min read

It's sometimes tricky to tell whether someone you care about has bipolar disorder or schizophrenia. They're both mental illnesses that affect how people think and act, and some of the symptoms look a lot alike. But there are big differences, too.

When you have bipolar disorder, you have huge swings in mood and energy that can make it hard to do everyday activities. With schizophrenia, mood problems aren't so central, but your senses can play tricks on you, making it hard sometimes to know what's real and what's not. It can be difficult to think clearly and relate to people.

Schizoaffective disorder has features of both bipolar disorder and schizophrenia. Talk to your doctor about how to distinguish between these overlapping diagnoses.


If you have bipolar disorder, your mood can have big shifts. You may have periods called mania, when you feel extremely happy and full of energy. But you may also go into a depression phase and start to feel sad and hopeless.

There are two main types of bipolar disorder, which vary in how serious your episodes get and how long they last.

Bipolar I disorder involves periods of full-blown mania. You may have high energy, behave recklessly, and act in an extremely impulsive way.

If you have bipolar II disorder, you'll get "low-grade" periods of mania. When that happens, you might have "up" moods and high energy, but your symptoms don't get in the way of your daily life.

With severe bipolar disorder, you may have hallucinations, where you see or hear things that aren't there. You may also have delusions, where you firmly believe in something that just isn't true. This is when it's easy to confuse bipolar disorder for schizophrenia.

Some signs that you've got bipolar disorder are:

Mania symptoms. When you're in an "up" period, you may feel:

  • Easily triggered or set off
  • Full of energy and great ideas 
  • Happy and bursting with joy
  • Jumpy or wired

You may also:

  • Keep jumping from one activity to the next
  • Stop eating or sleeping
  • Talk fast and have thoughts that are all over the place
  • Think you can do anything, so you do something risky like spend money you don't have

Depression symptoms. When your mood swings to a depressed phase, you may feel:

  • Down and hopeless
  • Empty and worried
  • Nothing brings you joy or pleasure
  • Slow and tired

You may also:

  • Eat too much or too little
  • Have a hard time focusing
  • Sleep too much or too little
  • Think about killing yourself

Some folks get more periods of mania, while others get more periods of depression. And in between, you may feel normal.

Other people can have four or more times a year when they get a manic or depressive episode. This is called rapid cycling. And others get mixed states, like feeling depressed and active at the same time.

When you have schizophrenia, you may have some of these symptoms:

Hallucinations. You see things or hear voices that aren't there.

Delusions. You totally believe something that isn't true, like thinking someone's out to get you.

Confused thoughts. Also called disorganized thinking, you can't stay focused and might feel foggy or hazy. Your speech may also be hard to follow.

Behavior and thought changes. The way you act becomes less normal. You may shout for no clear reason. You may even think that someone's taking over your body.

Unusual body movements. You may move in odd, disturbed ways or hold postures that don't make sense.

You may also find that you no longer do things that you used to, such as:

  • Enjoy activities
  • Go out often
  • Pay attention to cleaning and grooming yourself
  • Show emotion (Your voice may be flat and your face may not reveal your feelings) 


Doctors don't know for sure, but they think a mix of things can make you more likely to get it.

Brain structure and chemistry. People with the illness may have changes in the brain itself, as well as in the way chemicals called neurotransmitters work. These chemicals send information between nerve cells.

Genes. You're more likely to have it if someone in your family does, so your genes probably have something to do with it.

Stress. Emotional events, like the death of a loved one, can trigger bipolar disorder for the first time, so how you handle stress may play a role, too.

There are probably a number of things behind this illness.

Brain structure and chemistry. Just like with bipolar disease, the makeup of the brain and neurotransmitters are different in people with schizophrenia.

Mind-altering drugs. Taking certain drugs when you're a teenager or young adult may be a factor.

Problems before birth. If your mother didn't get the right nutrition or had a virus while they were pregnant with you, some theories suggest that your odds of getting schizophrenia may be higher.

Very active immune system. If your immune system -- your body's defense against germs -- gets triggered often, as with an autoimmune disease, some research suggests that your chances of getting schizophrenia may go up.

With both illnesses, you need treatment for the rest of your life, even if your symptoms get better. The approach to both is similar.

Bipolar disorder. You might take drugs such as mood stabilizers, antipsychotics, antidepressants, and others. You'll also get talk therapy -- where you discuss your feelings with a mental health professional -- to help you understand and manage the illness.

Schizophrenia. Drugs called antipsychotics are a key part of treatment to help with your brain chemistry. It may take some time to settle on the right drug and dose. 

You'll probably also need daily support. You may get talk therapy, help with social skills, support for your family, and help getting and keeping a job.