This is the second in our conversation on the overlap between bipolar and ADD (or ADHD). The condition is not so much about attention deficit (as the name implies) as a failure in directing that attention. On one extreme, the brain may hyper-focus, say on a project, at the expense of awareness of the immediate world. On the other, the brain may under-focus, bouncing from one distraction to the next, failing to stay on task.

Either way, the consequences can be devastating - busted relationships, broken dreams, financial ruin - but throw bipolar into the mix and we find ourselves living extremely dangerously. Hyper-focusing on a project, for instance, may lead to losing a night’s sleep, which may trigger mania. Under-focus, meanwhile, may lead to frustration and a sense of learned helplessness, which is an open invitation to depression.

Back when I was facilitating a DBSA support group, I was struck by the number of individuals reporting co-occurring ADD. According to data from the International Mood Disorders Collaborative Project, nearly one in five individuals with bipolar experience ADD. What we really need to be aware of, though, is that we don’t have to have a full-blown ADD diagnosis to complicate our lives. Virtually all of us (“normal” people included) have attention problems of some sort. Thus, we all need to be paying attention - to attention.

Another element of ADD concerns lack of ability to rein in impulses. It works something like this: Attention is a function of the thinking parts of the brain. If you’re not thinking right, the front end of your brain is perpetually engaged in a losing battle with the back end of the brain. The back of your brain may tell you that now would be a good time to belt out “There’s No Business Like Show Business” in your best Ethel Merman voice. The front end of your brain neglects to remind you that you happen to be in the middle of a business meeting right now.

This is where hyperactivity enters the picture, a failure to apply the brakes. You almost automatically act on your distracting thought. No red tape, no delay. Next thing, you’re out of your chair and on the table ...

But wait, I hear you protesting. Isn’t this hypomania? Funny you should ask. Check out this DSM-IV symptom for hypomania:

Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

Now compare it to this symptom for ADD:

Is often easily distracted by extraneous stimuli.

The interchangeability doesn’t stop there. Can you tell which of the symptoms below belongs to which diagnosis?

• “Is often ‘on the go’ or often acts as if ‘driven by a motor.’”
• “... persistently increased activity or energy ...” (from the DSM-5 proposed revision).
• “Increase in goal-directed activity ...”
• “Flight of ideas or subjective experience that thoughts are racing.”
• “... subjective feelings of restlessness.”
• “Often talks excessively.”
• “More talkative than usual or pressure to keep talking.”
• “Excessive involvement in pleasurable activities.”
• “... makes careless mistakes ...”

So here you are, singing your heart out, doing your best Ethel Merman, unfortunately during an important business meeting with no regard for the other people in the room. Is it hypomania or is it ADD? Your boss is unlikely to take the time to make a differential diagnosis. It’s all the same to him or her - you’re fired.