Bipolar disorder affects men and women in equal numbers, and the symptoms are essentially identical. But some key differences do exist—differences that might be due to biological factors, and social ones, too.
For starters, research has consistently shown that women have higher rates of bipolar II disorder, “which typically presents as a chronic depressive disorder with periods of hypomania,” according to Candida Fink, MD, a board-certified child, adolescent and adult psychiatrist with a private practice in Westchester, N.Y.
There’s a misconception that bipolar II disorder is less severe than bipolar I because mania can have devastating consequences—from bare bank accounts to broken relationships.
However, bipolar II disorder has unique characteristics and complications. The depressive episodes can be very severe, and hypomania also can come with painful consequences.
In the past, it was believed that women experience more depressive episodes than men, along with higher rates of rapid cycling (four or more episodes per year) and mixed episodes (simultaneously experiencing symptoms of mania and depression).
But today’s research is less clear, said Dr. Fink, co-author of several books on bipolar disorder.
Differences in Co-Occurring Conditions
What is clear is that differences do exist in the physical illnesses that strike women and men with bipolar disorder. Women with bipolar disorder have “three times higher rates of hypothyroidism compared to men,” and “three times the rate of migraine,” Fink said. Women also have “higher rates of co-occurring illnesses that are marked by dysregulations of inflammation responses—[such as] asthma, Crohn’s disease and multiple sclerosis.”
Currently, researchers are exploring the connection between bipolar disorder and inflammatory responses (“the body’s reaction to stress or injury”), Fink said. Women with bipolar disorder having higher rates of inflammatory disorders brings up various critical questions, which, she said, include: “Does this affect how women experience bipolar disorder in terms of severity of symptoms and how those symptoms affect their lives? Could this information be important in developing treatment approaches to women with bipolar disorder that may differ in some ways from treating men?”
The mental illness that co-occurs with bipolar disorder also seems to vary by gender. According to Fink, women with bipolar disorder are twice as likely as men to have PTSD, a personality disorder and anxiety disorders. Men with bipolar disorder have higher rates of substance use disorder than women, she said. Psychologist Cynthia G. Last, Ph.D, noted that men are more likely to abuse alcohol—and have problems with the law, landing in jail.
Women with bipolar disorder are two to three times more likely than men to attempt suicide, said Last, who specializes in treating individuals with bipolar disorder in Boca Raton, Fla. But “men [with the condition] who attempt suicide show a two to three times greater fatality rate than women.”
The Effects of Societal Perceptions
How society views emotions in men and women can influence how individuals interpret their own symptoms, how they understand bipolar disorder and whether they actually seek professional treatment, said Michael G. Pipich, MS, LMFT, a psychotherapist who specializes in mood disorders in Denver, Colo., and penned the book Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder.
Pipich shared these examples: Bipolar disorder mood swings can get dismissed in women, because they’re seen as “typically female” issues (when really the root is “an underlying, treatable disorder that should not define a woman’s more usual and healthy disposition”). Mania can get dismissed in men because it’s misinterpreted as the traits of a “hard-driving, successful alpha-male,” he said.
Men and women also may respond differently to depression. “Generally speaking, men can be less willing to discuss the desperate and vulnerable feelings associated with depression, including low self-worth, helplessness and suicidal thoughts,” Pipich said. Consequently, they’re less likely to seek help when they’re experiencing a depressive episode than women, he added.
Periods, Pregnancy, Postpartum and Menopause
The reproductive cycle plays a pivotal role in bipolar disorder. For some women, symptoms of bipolar disorder worsen around their menstrual cycle. According to Pipich, “Each situation can be different, but many women with bipolar report an increase in irritability, restlessness, racing thoughts, pressured speech and impulsivity, which typically reflects manic symptoms.” Many also “have experienced outbursts of rage and other behaviors that are not characteristic of their usual personalities,” he said.
Other women have disclosed that they become incredibly depressed during their period, and might even have suicidal thoughts (or attempts), he said.
If they’re not taking mood-stabilizing medication, women also have reported longer, more severe episodes during their cycle, Pipich added.
Fink noted that women with bipolar disorder also have a higher risk of medical complications during pregnancy (e.g., high blood pressure) and health problems for the baby (e.g., small birth weight).
Childbirth can trigger the onset of bipolar disorder in women, or trigger a new episode in women who’ve already been diagnosed with the illness, said Last, author of the book When Someone You Love is Bipolar: Help and Support for You and Your Partner.
According to perinatal psychiatrist and researcher Dr. Verinder Sharma, “We know childbirth is perhaps the most important and most potent trigger of bipolar disorder.”
As perinatal psychotherapist and maternal mental health Amy-Rose White, LCSW, noted in this piece, postpartum bipolar disorder includes depressive episodes with possible symptoms of severe sadness, sobbing, hopelessness, guilt and lack of interest in activities moms previously enjoyed. Depressive episodes also might have symptoms of anxiety and agitation. Women might seem highly functional—baby is well taken care of—but they feel completely detached.
Depressive episodes are followed by extreme energy, rapid speech, racing thoughts about baby’s health (or something else), decreased need for sleep, and odd or out-of-character behavior, according to White.
Menopause is another powerful factor. As a whole, menopause is associated with increased mood symptoms and depression in all women. Some small studies also suggest that women with bipolar disorder may have higher rates of mood episodes during menopause, Fink said, but the research has been scarce. In fact, older women in general aren’t well represented in research studies, she said.
There are both similarities and differences in men and women with bipolar disorder—and more research is needed to understand exactly what drives some of those differences. Is it hormones? Is it an inflammatory response? Is it something else? The answers may be multilayered as bipolar disorder is a complex illness.
Either way, one of the most important commonalities is that bipolar disorder is highly treatable in both genders. The key is to seek help—and to stick with it. When you find the right treatment—a combination of medication and psychotherapy and perhaps other forms of support—you might be surprised by the incredible strides you can make.