What Is Bipolar Disorder With Anxious Distress?

A woman with bipolar disorder.
A woman with bipolar disorder.. Peter Dazeley/Getty Images

Many people who are diagnosed with bipolar disorder also have other psychiatric conditions, including anxiety disorders. But when your anxiety doesn't quite fit into the definition of a specific, well-defined anxiety disorder, your psychiatrist might instead diagnose you has having "bipolar disorder with anxious distress."

Having bipolar disorder with anxious distress simply means you have bipolar disorder, plus anxiety that interferes with your life but doesn't meet the diagnostic criteria of an anxiety disorder.

What Is Bipolar Disorder with Anxious Distress?

Psychiatrists and other mental health professionals use the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Version Five (abbreviated DSM-V) to attach an official diagnosis to your condition.

In this case, bipolar disorder is the diagnosis, and "with anxious distress" is what's called a specifier — an add-on to the diagnosis that clarifies it or elaborates on it.

The specifier "with anxious distress" is actually new to the DSM with the fifth edition of that manual, which was published in 2013. It was added because mental health professionals thought it was needed in a variety of cases.

According to the DSM-V:

Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder in both primary care and specialty mental health settings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment.

Symptoms of Anxious Distress

For a psychiatrist to add the specifier "with anxious distress," a patient's condition needs to include at least two of these symptoms:

  • feeling tense or keyed up
  • unusual restlessness
  • worry that makes it difficult to concentrate
  • fear that something terrible may happen
  • feeling that the patient might lose control of himself

    The symptoms have to be present most days of the current or most recent bipolar episode, regardless of whether the episode involved manic, hypomanic or depressive symptoms.

    In so-called "anxious distress," severity of the condition is determined by the number of symptoms present: Two symptoms means the condition is mild, three symptoms means it's moderate, four to five symptoms means it's moderate to severe, and four to five symptoms with psychomotor agitation means it's severe.

    Someone can have bipolar I, bipolar II, or cyclothymia with anxious distress.

    Anxiety Disorders Also Possible

    Even if you have bipolar disorder with anxious distress, you also can be diagnosed with another anxiety disorder. If you get panic attacks, you can be diagnosed with panic disorder, and if you're acutely afraid of a specific object or situation (spiders or flying, for example), then you could be diagnosed with a phobia.

    When two or more illnesses not related to each other are diagnosed in a single patient, they are called "comorbid," which simply means they occur together.

    Anxiety disorders that frequently have been diagnosed together with bipolar disorder include:


    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Arlington, VA: American Psychiatric Publishing, 2013. 124-125, 156. Print.

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