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Approximately 5.7 million adult Americans are affected by bipolar disorder, according to the National Institute of Mental Health. It affects men and women in about equal numbers, but there are important differences in how it manifests in women. These gender differences can (and should) affect diagnosis and treatment of the disorder for women.
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What is Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a chronically-recurring disorder that causes moods that swing dramatically between depression and mania. Associated with these mood changes, people experience severe changes in behavior, energy, and the ability to function.
Depression is by far the most pervasive feature of the illness, especially for women. The manic phase sometimes involves euphoria, which can also be mixed with anger, depression, or irritability. Euphoria manifests as unusual energy or overconfidence.
6 Ways Bipolar Disorder Affects Women
#1) Differences In Onset
Bipolar disorder can have its onset at any time during a person’s lifetime, but it typically begins later for women than it does for men. The average age of onset for men is 18 years; for women it is 25. However women are more likely to experience late-onset, in which it manifests in middle age or later. One study reported that about 10% of cases had onset after age 50 and about 5% had onset after age 60.
Age of onset is generally correlated with severity and prognosis. Those with earlier onset have been shown to have more manic and depressive episodes, more severe episodes, more days depressed, more rapid cycling, and fewer days of normal mood.
Additionally, men typically experience mania as a first symptom of the disorder, but women typically experience depression first.
#2) More Severe Depression, Milder Mania
Research has found that women with bipolar disorder experience more depressive episodes and more mixed episodes than do men. Additionally, they have worse symptoms of depression. Women more commonly report milder, “hypomanic” episodes, which are less severe than true manic episodes.
#3) Rapid Cycling More Likely
A cycle is the period of time it takes for a person to go through one episode of mania and one episode of depression. The National Institutes of Health describe rapid cycling as the occurrence of four or more cycles in a year. Research indicates that women are three times as likely as men to experience rapid cycling. Rapid-cycling bipolar disorder has been shown to be more resistant to treatment than other forms of the illness.
#4) Women Face Misdiagnosis and Late Diagnosis
Women are likely to be misdiagnosed with depression, whereas men are more likely to be misdiagnosed with schizophrenia. Also, women are more likely to face delays in diagnosis, up to 11 years from onset, compared with seven years on average for men. This delay in diagnosis means a further delay in treatment.
#5) Comorbid Conditions More Likely
Comorbidity is the presence of additional disorder, co-occurring with a primary disorder. The two most common comorbid disorders among women are alcohol abuse and anxiety disorder. Research shows that comorbid panic disorder and obsessive-compulsive disorder are more common in women than in men. These conditions increase the risk of functional impairment for women already suffering from the debilitating effects of bipolar disorder.
#6) Reproductive Factors May Influence The Condition and its Treatment
In women, hormones play a role in the development of bipolar disorder, as well as in its severity. Women with bipolar disorder experience symptoms of premenstrual syndrome (PMS) twice as often as women without a psychiatric diagnosis.
Perhaps the greatest evidence of a hormonal association with bipolar disorder relates to pregnancy. Women with bipolar disorder who are pregnant or in the postpartum period are seven times more likely than other women to be admitted to the hopsital for bipolar symptoms.
And finally, menopause is associated with increased symptoms among women. Among women with the disorder, 20% report severe emotional disturbances during the transition into menopause.
Why Is All Of This Important?
If you or any woman in your life is suffering from bipolar disorder, it is important to know how the disorder affects women, compared to men. Understanding how it manifests differently, the effects of reproductive hormones, and the prevalence of comorbid conditions can help you manage and cope with the symptoms.
This is a pretty scary article, you have to admit. My hat is off to you for publishing this because it really can be a major problem for women. More understanding and knowledge of this disorder can go a long way is reducing the negative effects of it.
I’m surprised that men are diagnosed with bipolar disorder more frequently than women are, especially since most men take issue with seeing a general physician. I guess when women go to the doctor, their problems are often misdiagnosed as being hormonal or “just PMS.”
11 years is a long time without a proper diagnosis. I know a couple of women who are bipolar and struggled with it for a long time before they were diagnosed properly. One was previously diagnosed as depressed.
I was diagnosed with bipolar disorder when I was 17 and my swings are pretty rapid. I can go from being on top of the world to the bottom of the deepest ocean in a matter of seconds. No matter how much research is done into the matter, I will never understand why that is. And I definitely get more than 4 “episodes” a year. Its probably closer to 20 or 30.
How does diagnosis work? How were they able to distinguish the bipolar disorder from depression? I think a friend of mine is either depressed or bipolar but I’m not sure how the doctor would know which it is.
The other major factor in diagnosing bipolar disorder is that there are two common forms–bipolar I (one or more episodes of mania) and bipolar II (one or more episodes of hypomania). If you have bipolar or have lived with someone with bipolar, the differences between mania and hypomania are much, MUCH more pronounced. It’s incredibly common for women to be diagnosed as bipolar II before receiving a “true” diagnoses of bipolar I due to depression being more pronounced. Thanks for disseminating some common misconceptions!
Thanks for posting this; I have always wondered about the differences between bipolar disorder and depression. A friend of mine seems to always either be really happy and hyper or really sad; I wonder if she has bipolar disorder.
Wow! I had no idea that there is a Bipolar I and a Bipolar II distinction. That just goes to show that this condition is not well-known.
Mood disorders are incredibly complicated. Bipolar I is what people typically think of when they hear “bipolar disorder,” but there are so many different distinctions and variations. In the field, these diagnoses are referred to as “bipolar spectrum” disorders.
I think part of the problem is how mental illness is portrayed in the media. If a character is “bipolar,” they’re typically portrayed as behaving in extremes, which is not always the case. It is often very sadly misunderstood.
I have always wondered too. I have a friend who seems to be depressed often. I am now wondering if maybe she has this bipolar disorder too. I always thought being bipolar was just a joke.