Surreal brain illustration symbolizing the comorbidity of anxiety and bipolar disorder.

Bipolar Disorder and Anxiety: Unveiling the Comorbidity Connection

Avery Sinclair in Health & Wellness November 2025 • 5 min read.

"Decoding the risk factors that link anxiety disorders with bipolar disorder in Thai patients, offering insights into early detection and personalized care."

Bipolar disorder (BD) is a significant mental health challenge, affecting approximately 2.4% of the global population. Characterized by alternating episodes of mania and depression, BD often presents with a complex clinical course that can span a patient's lifetime. The challenges of managing BD are further compounded by its frequent co-occurrence with other psychiatric and medical conditions. Among these comorbidities, anxiety disorders (AD) stand out as particularly prevalent, impacting the well-being and treatment outcomes of individuals with BD.

The coexistence of anxiety and bipolar disorder can create a more challenging clinical landscape. Studies reveal that individuals with both BD and an anxiety disorder often experience a greater severity of BD symptoms, prolonged mood episodes, and a diminished quality of life. These combined challenges can lead to increased difficulties in social and occupational functioning, as well as a higher risk of suicidal attempts. Despite the significant impact of this comorbidity, many individuals do not receive the appropriate treatment, highlighting the need for improved understanding and targeted interventions.

To address this critical gap, researchers have sought to identify the specific risk factors that contribute to the co-occurrence of anxiety disorders in individuals with bipolar disorder. A recent study, drawing data from the Thai Bipolar Disorder Registry (TBDR), aimed to determine the clinical and demographic characteristics associated with AD comorbidity in Thai patients with BD. By examining a large sample within a naturalistic clinical setting, the study sheds light on potential risk factors that can inform early detection and personalized treatment strategies.

Key Findings: Unmasking the Risk Factors

Surreal brain illustration symbolizing the comorbidity of anxiety and bipolar disorder.

The study, conducted across 24 psychiatric units in Thailand, involved 424 participants diagnosed with bipolar disorder. The research team analyzed a range of variables, including demographic details, illness history, current BD status, comorbid psychiatric conditions, and quality of life measures. The analysis revealed several significant risk factors associated with current AD comorbidity in Thai patients with BD:

The multivariate analysis highlighted three key factors:

Early-Age Onset of BD: Being diagnosed with BD at a younger age significantly increases the risk of developing a comorbid anxiety disorder. The study found that for each passing year of age at the onset of BD, the likelihood of AD comorbidity decreases by 5%.
Family History of SUD: A family history of substance use disorder (SUD) emerged as a strong predictor of AD comorbidity in individuals with BD. This finding underscores the significant impact of familial factors on mental health outcomes.
Higher MADRS Score: A higher score on the Thai Montgomery-Åsberg Depression Rating Scale (MADRS) indicated a greater intensity of current depressive symptoms, which was also associated with a higher risk of AD comorbidity.

These findings emphasize the importance of considering early-age onset, family history of SUD, and current depressive symptoms when assessing the risk of anxiety disorders in individuals with bipolar disorder. By identifying these risk factors, clinicians can implement targeted interventions and provide more comprehensive care.

Implications and Future Directions

This study's findings offer valuable insights for clinicians and researchers seeking to improve the care of individuals with bipolar disorder. By recognizing the increased risk of anxiety disorders in those with early-age onset BD, a family history of SUD, and greater depressive symptoms, healthcare professionals can implement targeted screening and interventions. Further research is needed to explore the underlying mechanisms linking these risk factors to AD comorbidity and to develop effective strategies for prevention and treatment. Ultimately, a comprehensive approach that addresses both bipolar disorder and comorbid anxiety can lead to improved outcomes and a better quality of life for affected individuals.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/ndt.s57019, Alternate LINK

Title: Risk Factors For An Anxiety Disorder Comorbidity Among Thai Patients With Bipolar Disorder: Results From The Thai Bipolar Disorder Registry

Subject: Biological Psychiatry

Journal: Neuropsychiatric Disease and Treatment

Publisher: Informa UK Limited

Authors: Suchat Paholpak, Ronnachai Kongsakon, Wasana Pattanakumjorn, Wiroj Wongsuriyadech, Manit Srisurapanont, Roongsang Kanokvut

Published: 2014-05-01

Everything You Need To Know

What is bipolar disorder, and how is it connected to anxiety?

Bipolar disorder, or BD, is a mental health condition characterized by alternating episodes of mania and depression. It affects approximately 2.4% of the global population and often co-occurs with other psychiatric conditions, most notably anxiety disorders (AD). The challenges in managing BD are exacerbated by these co-existing conditions, leading to more severe symptoms and diminished quality of life. Early identification and appropriate treatment of both BD and AD are crucial for improving patient outcomes.

How does the coexistence of anxiety disorders affect individuals with bipolar disorder?

The co-occurrence of anxiety disorders (AD) in individuals with bipolar disorder (BD) can significantly worsen the clinical course. Studies indicate that individuals with both BD and AD experience more severe BD symptoms, prolonged mood episodes, and a reduced quality of life. This combination increases difficulties in social and occupational functioning, as well as elevating the risk of suicidal attempts. Many affected individuals do not receive adequate treatment, highlighting the urgent need for improved understanding and targeted interventions.

What are the key risk factors identified in the study that contribute to anxiety disorders in Thai patients with bipolar disorder?

The study identified three key risk factors: early-age onset of bipolar disorder (BD), a family history of substance use disorder (SUD), and a higher score on the Thai Montgomery-Åsberg Depression Rating Scale (MADRS). Specifically, the likelihood of anxiety disorder (AD) comorbidity decreases by 5% for each year of age at BD onset. A family history of SUD and elevated MADRS scores, indicating greater depressive symptoms, also significantly increase the risk of AD comorbidity in individuals with BD.

What implications do the study's findings have for clinicians treating individuals with bipolar disorder?

The findings suggest that clinicians should consider early-age onset of bipolar disorder (BD), family history of substance use disorder (SUD), and current depressive symptoms (indicated by Thai Montgomery-Åsberg Depression Rating Scale or MADRS score) when assessing the risk of anxiety disorders (AD) in individuals with BD. By recognizing these risk factors, healthcare professionals can implement targeted screening and interventions. This approach enables more comprehensive care that addresses both BD and comorbid anxiety, leading to improved outcomes and better quality of life.

What future research directions are recommended based on the study's findings regarding bipolar disorder and anxiety?

Future research should focus on exploring the underlying mechanisms that link early-age onset bipolar disorder (BD), family history of substance use disorder (SUD), and depressive symptoms (measured by Thai Montgomery-Åsberg Depression Rating Scale, or MADRS) to anxiety disorder (AD) comorbidity. Developing effective prevention and treatment strategies tailored to these specific risk factors is essential. A comprehensive approach that addresses both bipolar disorder and comorbid anxiety can lead to improved outcomes and a better quality of life for affected individuals. Further investigation could also explore cultural factors specific to Thai patients that may influence these relationships.