Can Anxiety Be a Sign of Bipolar Disorder?
Adults with teenage children have a tendency to blame social media for every behavior they don’t like to see in their teens. They cite excess social media use for changes in the way their kids dress and talk. They say it leads to changes in their interests and personality. Whether parents are right or wrong, headlines and opinions from experts on adolescent development fuel the fire. Some articles connect the well-documented increase in depression, anxiety, suicide, and suicidal ideation over the past twenty years directly to the arrival of social media in our lives a little over ten years ago.
That’s not an illogical connection to make.
In fact, it makes perfect sense: the two trends appear to correlate almost exactly.
However, the available data don’t support an unequivocal causal connection between social media and an increase in mental health symptoms in adolescents, despite the fact that at first blush, the connection seems obvious.
The data do support some correlation between social media use and mental health, but those correlations are not always negative. In some situations, social media can help teens connect to their peers, seek help with mental health issues, practice social interaction in safe spaces, and boost self-esteem and feelings of peer connectedness and wellbeing.
While the final word on the relationship between social media and mental health problems is not in, there are specific groups of teens for whom increased screen time may be related to anxiety and depressive disorders.
These groups include:
- Tween girls age 10-14
- Teens with preexisting mental health conditions
- Teens who experience bullying
- Tweens and teens who frequently engage in negative self-talk
Before we explore these relationships – and discuss the connection between anxiety and bipolar disorder – we’ll address the increase in mental health issues among teens over the past twenty years.
treatment programs for teens
Teens and Mental Health: Trends in the Data
Parents are influenced by experts who share their opinions in widely circulated articles that, in turn, shape public opinion. The reason experts and parents alike default to the position that social media is an inherently negative force in teen mental health doesn’t come out of thin air. The position has roots in real data, but not data that proves the connections many experts make in public, which parents and the general public then espouse.
For instance, let’s take a look at the increase in mental health issues among adolescents since around the year 2005. First, we’ll look at depression and suicide.
Trends in Depression and Suicide: Adolescents and Young Adults
- Depression among girls 14-17 increased by 4 percentage points.
- Depression among boys 14-17 increased by 1.2 percentage points.
- Suicide among girls 10-14 increased fourfold
- Suicide among people 10-24 increased 56% percent
- Over 1,400 girls 10-14 died by suicide
- Over 5,000 boys 10-14 died by suicide
- Suicide is the second leading cause of death among people 10-24.
Now let’s have a look at the anxiety data.
The National Institute of Mental Health reports that:
- 31.9% of adolescents have clinical anxiety
- 8.33 % have anxiety with severe impairment as a result.
- 38% of girls have clinical anxiety
- 26.1% of boys have clinical anxiety
In addition, the Child Mind Institute reports that:
- 19.3% of adolescents have a specific phobia
- 9.1% have social anxiety disorder
- 7.6% have separation anxiety
- 2.3% have a panic disorder
- 2.2% have generalized anxiety disorder
The thing about those anxiety numbers is that they’ve remained relatively stable since 2005. They skyrocketed in 2020 and 2021 but we all know why: the pandemic. Therefore, although the increase in anxiety among adolescents from 2019-2021 may be peripherally related to social media, social media is certainly not the main culprit.
Let’s sum up all this data:
- Rates of mental health issues in teens increased over the past 20 years.
- The most significant increases occurred in rates of depression, suicidal ideation, and suicide.
- These increases coincide with the increase in social media use among teens.
- Rates of anxiety among adolescents remained relatively stable from 2005-2019, then jumped in 2020-2021.
- Research shows that for mental health issues among adolescents, there is no causal connection to social media use, however, for some teens, social media use can lead to or exacerbate anxiety.
Let’s focus on those at-risk teens now.
Social Media and Mental Health: Who’s at Risk
Reliable, peer-reviewed data from Common-Sense Media shows the teens at-risk of negative mental health outcomes from social media use include tween girls (10-14), teens with preexisting mental health conditions, teens who experience bullying, and teens prone to negative self-talk.
This is important information for parents to understand. For teens with no mental health issues, data shows that social media is not a significant problem. However, the at-risk teens mentioned above often visit social media sites and engage in behavior and/or have experiences that are detrimental to their mental health and overall wellbeing.
Several studies cited in this meta-analysis show that the type of interaction and the reason for going on social media are what can lead to anxiety. For teens at-risk, specific types of interaction and social media use can have an adverse impact.
Social Media Use with Negative Consequences
- Social comparing: visiting social media sites to assess social status
- Appearance comparing: visiting social media sites to assess looks and clothes
- Negative interactions: comment exchanges, direct message exchanges, and reactions to posts that are not supportive
- Heavy use: spending more than two hours per day on social media sites
All those behaviors correlate with increased anxiety in teens. Therefore, parents of teens in the at-risk categories mentioned above should monitor three things:
- How their teens use social media: social and appearance comparing are associated with increased anxiety
- The types of interactions they have: negative comments, direct messages, and reactions are associated with increased anxiety
- Time on social media: spending more than two hours a day on social media is associated with increased anxiety.
If an at-risk teen engages in or experiences those behaviors, then parents should teach their teens how to use social media productively, since data shows that when teens use social media for support and connection, they can improve their overall mental health, as opposed exacerbate their mental health problems.
Now it’s time to answer the question posed at the beginning of this article:
Can teen anxiety be a sign of bipolar disorder?
The short answer: in some cases, yes.
Anxiety and Bipolar Disorder: The Connection
A study published in 2019 shows that almost fifty percent of people with bipolar disorder (BD) will also develop an anxiety disorder during their lives. Here are the types of anxiety disorders that most commonly co-occur with BD, along with their prevalence rates:
- Panic disorder: 19.5%
- Generalized anxiety disorder (GAD): 16.5%
- Social phobia: 20%
- Post-traumatic stress disorder (PTSD): 14%
- Social anxiety disorder (SAD): 13%)
- Obsessive-compulsive disorder (OCD): 12%
- Specific phobias: 11%
- Agoraphobia: 8%
Now let’s compare the symptoms of anxiety with the symptoms of bipolar disorder.
Here are the emotional symptoms of anxiety:
- Heightened fear of regular daily situations
- Extreme irritability and/or restlessness
- Always assuming the most negative outcome for any future event
- Extreme agitation or nervousness
Next, the physical symptoms of anxiety:
- Increased heart rate and/or hyperventilating
- Insomnia, fatigue, headaches
- Twitching, sweating, or tremors
- Frequent trips to the bathroom
Here an abbreviated list of the symptoms of the manic phase of bipolar disorder:
- Temper tantrums/outbursts of anger
- Pressured or rapid speech
- Racing thoughts
- Intrusive thoughts
- Very high energy levels
- Difficulty sleeping
- Difficulty concentrating
Next, an abbreviated list of the symptoms of the depressive phase of bipolar disorder:
- Decreased self-confidence or self-esteem
- Excessive sleeping
- Difficulty falling or staying asleep
- Changes in appetite
- Agitation or restlessness
- Difficulty starting or completing tasks
- Lack of motivation
- Loss of interest in favorite activities
It’s clear from reading these lists that there is a significant overlap between the symptoms of anxiety and the symptoms of bipolar disorder. Each disorder, when it occurs alone, can severely disrupt day-to-day functioning and prevent an adolescent from participating in family, school, social, and extracurricular activities. When the two disorders co-occur, the co-occurrence can exacerbate both disorders, and have a negative impact on “almost all aspects of the course and outcome of the illness[es].”
Anxiety Disorders and Bipolar Disorder: Consequences of Co-Occurrence
Here’s what can happen when an anxiety disorder and bipolar disorder co-occur. People with both disorders may experience:
- More symptoms, more often, and more intensely
- Longer episodes of both the manic and depressive phases of BD
- Decreased rates of remission and recovery for both disorders
- Elevated impairment of functioning and decreased overall quality of life
- Decrease in successful response to treatment for both disorders
- Increased risk of suicide
One thing we want to point out here is that bipolar disorder in adolescents is often misdiagnosed as something different. Clinicians may identify depression, anxiety, a behavior disorder, or psychosis. This misdiagnosis often leads to an exacerbation of the symptoms of bipolar disorder. When the two disorders are present simultaneously – anxiety and BD – a misdiagnosis can lead to an exacerbation of the symptoms of both disorders, which can lead to a host of other problems.
That’s why parents of teens with any kind of mental health disorder should pay close attention this year, more than any other year. There’s a potential storm brewing for teens. The stress of the pandemic, the increase in social media use related to an entire school year spent online (for millions of teens, but not all), and the relationship between isolation, stress, and mental health disorders like anxiety and bipolar disorder have the potential to push any at-risk teen from the preliminary stages of mental illness to full-blown mental illness.
Let’s be clear. We’re not saying social media causes anxiety which may be a sign your teen is in the early stages of bipolar disorder. What we’re saying is that teens at-risk – meaning tween girls, teens with preexisting mental health conditions, teens who experience bullying, and teens prone to negative self-talk – are in a particularly vulnerable place right now.
Parents: If You See the Symptoms, Seek Professional Support
If you’re the parent of a teen in the at-risk category, we recommend paying very close attention to the way your teen uses social media. It’s a double-edged sword: the teens most likely to experience the negative effects of social media are the same teens that can benefit most from the positive effects of social media. Used productively, teens can make peer connections, boost self-esteem, and improve their overall sense of wellbeing. On the other hand, social media can increase symptoms of depression and anxiety, which can have an adverse impact on any mental health issue a teen already has. An increase in symptoms can lead to decreased self-esteem, an increased sense of isolation, and a decreased sense of wellbeing.
If your teen shows any of the signs of anxiety or bipolar disorder we list above – and you know they’re heavy social media users or use social media in the negative ways we identify above – we recommend seeking a full evaluation with a licensed mental health professional. If they identify a mental health disorder, they may recommend treatment at one of the following levels of care:
- Outpatient treatment
- Intensive outpatient program (IOP)
- Partial hospitalization program (PHP)
- Residential treatment center (RTC)
Programs to help adolescents with anxiety and/or bipolar disorder typically occur at residential treatment centers for youth, adolescent inpatient treatment centers, or adolescent psychiatric residential treatment centers.
During treatment at any level of care, your teen can learn the tools and practical skills they need to manage their anxiety, bipolar disorder, or any other mental health issue a clinician identifies and diagnoses.
Treatment is work – but treatment can and does work for millions of teens every year.
Finding Help: Resources
If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.
In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.