☐ Care Folder

Many individuals with bipolar disorder are initially misdiagnosed with panic disorder, generalized anxiety disorder (GAD), or chronic stress, especially when their symptoms present as racing thoughts, restlessness, physical tension, or emotional overwhelm.

Panic attacks and anxiety disorders can hide undiagnosed bipolar disorder due to several factors:

Anxiety Sensitivity: Individuals with bipolar disorder often experience heightened anxiety sensitivity, which can lead to panic attacks during manic episodes

Comorbidity: Panic disorder is frequently comorbid with bipolar disorder, making it challenging to diagnose the latter when the former is present

Misdiagnosis: Many people with anxiety disorders may not receive proper diagnosis and treatment, which can exacerbate symptoms and lead to further complications

Intensified Symptoms: Anxiety can exacerbate the symptoms of bipolar disorder, making it harder for individuals to identify the disorder

• Panic disorder and bipolar disorder
• Anxiety Sensitivity: Individuals with bipolar disorder often experience heightened anxiety sensitivity, which can lead to panic attacks during manic episodes
• Comorbidity: Panic disorder is frequently comorbid with bipolar disorder, making it challenging to diagnose the latter when the former is presentr
• Misdiagnosis: Many people with anxiety disorders may not receive proper diagnosis and treatment, which can exacerbate symptoms and lead to further complications
• Intensified Symptoms: Anxiety can exacerbate the symptoms of bipolar disorder, making it harder for individuals to identify the disorder

• Have I experienced panic attacks that seem to come out of nowhere?
• Do I experience waves of high energy, sleeplessness, or racing thoughts in between periods of anxiety?
• Have I ever been told I’m “overreacting” emotionally but don’t know why?
• Do I have a family history of mood disorders, bipolar disorder, or suicide?
• Have I tried multiple anxiety medications with inconsistent or ineffective results?
• Do I ever feel better temporarily, only to crash even harder later?

Sharing this checklist and your history with your therapy team may help reveal if panic attacks are a symptom and not the whole diagnosis.

• Anxiety is more socially accepted and commonly diagnos

• Panic and racing thoughts are seen as stress-related instead of mood-driven.

• Short-lived “highs” are ignored if they don’t cause severe disruption.

• Anxiety often masks early or mixed episodes of mania.

• Patients may not recognize their elevated moods as abnormal.

• Panic or anxiety attacks that appear out of nowhere, without clear triggers.

• Periods of extreme productivity, creativity, or sleeplessness between anxious crashes

• Emotional overreactions that swing between panic and irritability or euphoria

• Chronic fear of “something bad happening” during or after energy surges

• History of trying multiple antianxiety medications with minimal or erratic results

Personal Red Flags to Watch For

• Anxiety paired with chronic insomnia, racing thoughts, or impulsive behavior.

• Feeling “charged” or “over-revved” instead of just nervous.

• Anxiety meds helping only temporarily—or make things worse.

• Frequent cycling between restlessness and exhaustion

Why Getting the Right Diagnosis Matters, treating Panic Attacks alone without addressing an underlying mood disorder can lead to:

• Repeated relapses

• Worsening depression or anxiety

• Missed medication opportunities (e.g., mood stabilizers)”

• Increased risk of suicide or dangerous behavior

Getting the correct bipolar diagnosis allows for proper treatment, safer medication use, and better long-term outcomes. It also lets families understand patterns that may go back generations.

📚 Resources

• Panic disorder and bipolar disorder
• Anxiety Sensitivity: Individuals with bipolar disorder often experience heightened anxiety sensitivity, which can lead to panic attacks during manic episodes
• Prevalence and treatment of panic disorder in bipolar disorder
• Anxiety disorders: under-diagnosed and insufficiently treated
• Anxiety and Bipolar Disorder: Can You Have Both?

Sections and individual appendices with checklists and other tools are available as both PDFs and interactive HTMLs at themisfittoyproject.com. The website offers features the book cannot — such as the ability to create a personalized Care Folder to share with healthcare professionals, psychiatrists, advocates, loved ones, or hospital teams.

These tools help capture important needs, concerns, and patterns — especially when memory is impacted by illness. Bringing a companion or using these tools during appointments can help ensure symptoms and questions are addressed effectively.

Tools will be updated regularly based on feedback from readers, professionals, advocates, and families. Suggestions, corrections, or collaborations can be submitted via the Contact page.

These materials are adapted from The Misfit Toy – A Long Winding Story to Get Help and Healing! by Ted Livernois. While the author does not hold clinical credentials, the insights shared come from lived experience with bipolar disorder and neurodivergence.