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A Systematic Review of Rates and Diagnostic Validity of Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder
Abstract
OBJECTIVE: Adult attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized and reported to frequently coexist with bipolar disorder. Concurrent diagnosis of adult ADHD and bipolar disorder remains controversial. In this study, we conducted a systematic review to examine the rates and diagnostic validity of the concept of comorbid adult ADHD and bipolar disorder. DATA SOURCES: MEDLINE, Embase, PsycInfo, and Cochrane databases were searched for articles published before March 30, 2007, using the keywords manic, bipolar, attention deficit hyperactivity, and adult. The computer search was supplemented with bibliographic cross-referencing. STUDY SELECTION: Exclusion criteria were studies with only pediatric subjects, childhood ADHD only but not adult ADHD, and either bipolar disorder or ADHD only, but not both; review articles, case reports; letters to the editor; and book chapters. Of the 262 citations found, 12 studies met our inclusion criteria. DATA EXTRACTION: Specific diagnostic validating criteria examined were phenomenology, course of illness, heredity, biological markers, and treatment response. There were 6 studies on comorbid rates, 4 on phenomenology, 3 on course of illness, 2 on heredity, none on biological markers, and 1 on treatment response. DATA SYNTHESIS: The proposed comorbid syndrome is fairly common (present in up to 47% of adult ADHD and 21% of bipolar disorder populations), with a more severe course of illness compared with that of bipolar disorder alone, and high rates of comorbidity with other psychiatric disorders. Its treatment appears to require initial mood stabilization. CONCLUSIONS: Comorbid adult ADHD and bipolar disorder has been insufficiently studied, with more emphasis on comorbidity rates and few data on course, neurobiology, heredity, and treatment. The diagnostic validity of adult ADHD/ bipolar disorder as a true comorbidity is not well-established on the basis of this equivocal and insufficient literature. More studies are greatly needed to further clarify its diagnostic validity and treatment approach.
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“In bipolar disorder, mood stabilization is a prerequisite for effective ADHD treatment [76].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [76]
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Items 101–133 of 133
Mishra, V., Solanki, G., Singh, D., & Goyal, M. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_647_23 · Cited by 6
“The prevalence of ADHD in childhood varies between 3% and 12% [6-8] depending on the sample characteristics of the study, while the prevalence in adults is usually around 4%-5%.”
Walsh, R. F. L., Sheppard, B. K., Cui, L., Brown, C., Meter, A. V., & Merikangas, K. R. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.08.017 · Cited by 8
Amoretti, S., Prisco, M. D., Clougher, D., Garriga, M., Montse Corrales, F., Fadeuilhe, C., Forte, M. F., Martínez‐Arán, A., Oliva, V., Parramón, G., et al. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106081 · Cited by 6
“These common symptoms can complicate the differential diagnosis (Wingo and Ghaemi, 2007).”
TDA/H, trouble de l’enfance ou de l’âge adulte ?
Ilario, C., Alt, A., Bader, M., & Sentissi, O. (2019) · L Encéphale · doi:10.1016/j.encep.2019.05.004 · Cited by 7
Speech signal analysis as an aid to clinical diagnosis and assessment of mental health disorders
Bruno, E., Martz, É., Weiner, L., Greco, A., & Vanello, N. (2023) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2023.104854 · Cited by 5
Chu, C.-S., Tsai, S.-J., Hsu, J.-W., Huang, K.-L., Cheng, C.-M., Su, T.-P., Chen, T.-J., Bai, Y.-M., Liang, C.-S., & Chen, M.-H. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.097 · Cited by 4
Informing Evidence-Based Assessment of ADHD in Veterans and Service Members
Shura, R. D., Miskey, H. M., Williams, V. G., Jadidian, A., & Rowland, J. A. (2016) · Military Psychology · doi:10.1037/mil0000138 · Cited by 5
“In studies of adults with bipolar disorder, 9.5 to 21.2% had comorbid ADHD (Wingo & Ghaemi, 2007).”
BackgroundInfluentialClinician’s Guide to Adult ADHD Comorbidities
Sadek, J. (2017) · Springer eBooks · doi:10.1007/978-3-319-39794-8 · Cited by 4
The epidemiology and societal burden of ADHD
Fayyad, J. A., & Kessler, R. C. (2014) · Cambridge University Press eBooks · doi:10.1017/cbo9781139035491.004 · Cited by 4
Badrfam, R., Zandifar, A., Mehni, M. B., Farid, M., & Rahiminejad, F. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04124-6 · Cited by 5
Garakani, A., Buono, F., Larkin, K., & Goldberg, J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.087 · Cited by 2
Comorbidity of Social Anxiety Disorder and Attention Deficit Hyperactivity Disorder
Koyuncu, A., & Binbay, Z. (2014) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.5455/cap.20130726020101 · Cited by 1
“[66] Bu iki hastalığın eşzamanlı görülmesi oldukça yaygındır ve DEHB+bipolar bozukluk tanısı alan kişilerde, daha şiddetli hastalık seyri, daha şiddetli duygudurum bozukluğu belirtileri ve daha düşük işlevsellik ilişkili bulunmuştur[66,70,71] Sachs ve arkadaşları DEHB ve bipolar bozukluk birlikteliğine yönelik 4 olası…”
Retrospective assessment of premorbid psychopathology and cognitive impairments in bipolar disorder.
Estey, A. J., Coolidge, F., & Segal, D. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.11.014 · Cited by 2
“Garrulousness, restlessness, loss of sustained attention, and inappropriate social behavior can be seen in both BPD and ADHD populations; however, in individuals diagnosed with BPD, these symptoms tend to be more episodic than chronic [5].”
BackgroundAdult attention-deficit hyperactivity disorder and bipolar disorder
Gleason, A. J., & Castle, D. J. (2012) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.110.008508 · Cited by 3
Wang, L.-J., Shyu, Y., Yuan, S., Yang, C.-J., Yang, K.-C., Lee, T.-L., & Lee, S.-Y. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.10.014 · Cited by 2
“, 2014), related research has increasingly emphasized the cooccurrence of these two psychiatric disorders (Galanter and Leibenluft, 2008; Kent and Craddock, 2003; Masi et al., 2006b; Pataki and Carlson, 2013; Skirrow et al., 2012; Wingo and Ghaemi, 2007).”
Rothermel, B., Poustka, L., Banaschewski, T., & Becker, K. (2010) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917.a000019 · Cited by 3
Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior?
Teksin, M. G., Özalp, E., Bal, N. B., Özer, İ., & Çayköylü, A. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115302 · Cited by 1
Kang, H., Yoon, B., Kim, K., Jung, H.-R., Jeong, Y., Yun, H., Song, J., Park, S. H., & Sea, Y. (2019) · Mood and Emotion · doi:10.35986/me.2019.17.3.71 · Cited by 1
“Substance use disorder is one of the common comorbidities in adult ADHD patients, in which the patients use alcohol, drugs, and cigarettes as a form of selftreatment [37].”
BackgroundDowson, J. H. (2008) · The Open Psychiatry Journal · doi:10.2174/1874354400802010023 · Cited by 1
“Although the co-occurrence of ADHD and BPD beyond chance has been claimed for both children [56] and adults [57,58], this could reflect referral bias or mistaken diagnoses, as well as a degree of shared aetiology [59,60].”
BackgroundAdult ADHD in Bipolar and Related Disorders
Pallanti, S., & Salerno, L. (2020) · Springer eBooks · doi:10.1007/978-3-030-39051-8_9 · Cited by 2
Yrondi, A., Geoffroy, P., Amad, A., Weibel, S., Weiner, L., & Bertschy, G. (2021) · Annales Médico-psychologiques, revue psychiatrique · doi:10.1016/j.amp.2021.02.022 · Cited by 1
Martinico, D. M., & Soble, J. R. (2026) · Annals of Clinical Psychiatry · doi:10.1177/10401237261493989
Gomez, R., & Houghton, S. D. (2026) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20260012
Jwa, Y., Lee, J., Yu, H.-S., Lee, C.-W., Hur, H. J., Do, H. S., Lim, J., Lim, S.-W., Kim, J., Hwang, I.-A., et al. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02251-9
“…data demonstrate that childhood ADHD features remain a significant predictor of depressive severity through emerg - ing adulthood [9 ], while comorbid ADHD and mood dis - order are associated with notably high rates of additional psychiatric comorbidities such as anxiety disorder [10, 11 ].”
Abadi, A. F., Cetkovich, M., Klijnjan, H., Echavarria, N., Lischinsky, A. G., López, P. L., Michanie, C., Maresca, T., Remedi, C., Rovere, O., et al. (2025) · Vertex Revista Argentina de Psiquiatría · doi:10.53680/vertex.v36i167.802
“Wingo y Ghaemi (2007), en su revisión siste-mática, estimaron que la comorbilidad de TDAH en muestras de personas con TB oscila entre 9.5 % y 21.2 %, mientras que la comorbilidad de TB en muestras de TDAH varía entre un 5.1 % y 47.1 %.”
InfluentialMohamed, I. A., Ejas, F., Khan, S. A., Mujahid, A., & Nawaz, F. A. (2025) · Cureus · doi:10.7759/cureus.79376
“Adult ADHD and BPD have been found to be comorbid as 9.5% to 21% of bipolar patients were found to have comorbid ADHD (Wingo and Ghaemi, 2007) [15].”
InfluentialDiagnostiquer et traiter le TDAH et le trouble bipolaire comorbide chez l’adulte
Marques, S. C. S., Dondé, C., Bertrand, A., Polosan, M., & Pouchon, A. (2024) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2024.08.025
Barbuti, M., Rosa, U. D., Moriconi, M., Bartolini, D., Schiavi, E., & Perugi, G. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100700
Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report
Saffi, F., Rocca, C. C. D. A., Toschi‐Dias, E., Durães, R. S. S., & Serafim, A. D. P. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.867750 · Cited by 1
Sadek, J. R. (2016) · Springer eBooks · doi:10.1007/978-3-319-39794-8_6
Bipolar disorder and adult attention deficit/hyperactivity disorder: the same or different?
Karaahmet, E., & Alpak, G. (2011) · Journal of Mood Disorders · doi:10.5455/jmood.20110905060336 · Cited by 1
Li, S. M., Wang, D., & Zhu, Y. (2022) · International Conference on Biotechnology, Life Science and Medical Engineering (BLSME) · doi:10.23977/blsme.2022066
“These common features further proved the association between ADHD and BPD, and these phenomenons appeared more frequently in bipolar I over bipolar II and cyclothymia [10].”
BackgroundA genome-wide linkage scan and targeted family-based association analysis of dyslexia
Ryan, J. (2008) · doi:10.14288/1.0066433 · Cited by 1
“Previously identified candidate genes shown to be linked or associated with autism, ADHD, speech-sound disorder (SSD), specific language impairment (SLI), speech and language disorder (SPCH) and the autoimmune disorder systemic lupus erythematosus (SLE) should also be considered due to commonalities between dyslexia a…”
BackgroundInfluential
Metadata
- Authors
- Wingo, A. P., & Ghaemi, S. N.
- Affiliations
- Emory University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2007-11-15
- Volume
- 68
- Issue
- 11
- Pages
- 1776-1784
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2024945874
- Cited by
- 160
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 11 · 2016: 8 · 2015: 10 · 2014: 16 · 2013: 6 · 2012: 14
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-64189, K23MH064189)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, bipolar disorder, comorbidities, diagnostic validity, clinical course, heredity (biology), biomarkers, treatment response, mood stabilization, psychiatric comorbidity
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Child, Diagnosis, Differential, Humans, Comorbidity
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