Bipolar disorder is a mood disorder affecting both women and men. It is characterized by alternating periods of depression and mania. However, bipolar disorder in women often looks different than in men—both in terms of symptoms and when it often shows up. For example, women are particularly vulnerable to bipolar episodes certain times of the month and after giving birth.
Likewise, there are different forms of bipolar disorder, and some forms show up in women more than men. Bipolar I disorder is roughly equally present in men as women. However, multiple studies show that women are more likely to develop bipolar II disorder.
Differences in bipolar symptoms in women and men call for modified approaches. It’s also important to be aware of these differences so that you can notice the signs of bipolar disorder in yourself or in a loved one. If you have only ever seen the disorder in a man, you might not recognize it in a woman.
But first, let’s take a look at the different types of bipolar disorder.
Types of Bipolar Disorder
Bipolar I disorder: In bipolar I disorder, you experience one or more manic episodes or mixed episodes (symptoms of both mania and depression). One episode lasts at least seven days. Typically, you will also experience periods of depression with symptoms lasting at least two weeks. It is common for episodes to be so severe that a mental health professional will recommend inpatient bipolar treatment. That may mean you stay in a hospital for a time, allowing you to receive round-the-clock care.
Bipolar II disorder: This is characterized by a pattern of one or more major depressive episodes and at least one hypomanic episode. A hypomanic episode is less severe than full-blown mania. Mental health professionals sometimes misdiagnose this condition as major depression. This is especially a risk if they do not witness a hypomanic episode and you do not report hypomanic symptoms.
Cyclothymic disorder: This is a milder type of bipolar disorder, defined by chronic periods of hypomanic or depressive symptoms. If you’re an adult, then the episodes generally last least two years. For children and adolescents, however, they will last for one year. The severity of cyclothymic disorder may change over time.
Bipolar Signs & Symptoms in Women
As a woman, you may experience bipolar disorder differently from men in a number of ways. In general, women experience:
- Later onset than men. This means that you are more likely to develop bipolar disorder at a later age than men.
- Higher incidence of depressive episodes.
- Higher likelihood of experiencing simultaneous symptoms of mania and depression (mixed episodes or mixed mania).
- Greater comorbidity of physical conditions. This means you are more likely to experience a health condition alongside your bipolar disorder. For instance, as a woman with bipolar disorder, you are more likely to also suffer from thyroid disease.
- Greater comorbidity of other mental illnesses, including eating disorders and anxiety.
- More likely to experience rapid cycling. This is characterized by four or more episodes of depression or mania in a year. In fact, you could experience such fast mood swings between mania and depression that you sometimes experience both states in a single day. Rapid cycling bipolar disorder also appears to be more resistant to treatment.
- More likely to seek help for treatment of bipolar disorder.
- More likely to receive an incorrect diagnosis of depression.
Bipolar Signs & Symptoms in Men
In contrast, men with bipolar disorder are more likely to experience:
- Earlier onset than women
- More severe symptoms than women
- Higher incidence of manic episodes and mixed episodes
- More prone to aggressive behavior during manic episodes
- More common comorbid alcohol and drug abuse
- Less likely to seek support
Suicide Risk in Women with Bipolar Disorder
In a study published in PLOS One, researchers found differences in suicide risk in men and women with bipolar disorder. For instance, a strong predictor of suicide risk in men was substance abuse. The predictors of suicide risk in women, in contrast, were different. They included:
- Having many mixed episodes
- Bipolar symptoms starting earlier in life
- Having a co-occurring personality disorder, such as borderline personality disorder (BPD)
- Problems in one’s social life
Women with bipolar disorder attempt suicide more often than their male counterparts. They also attempt to take their own lives two to three times more often than men in the general population.
Post-Partum Bipolar Disorder
Childbirth can trigger bipolar symptoms in women. When this occurs, it is known as postpartum bipolar disorder. For example, a study published in the journal JAMA found that childbirth increased the risk of a severe bipolar episode. Researchers from the same study noted that fathers did not experience the same risk.
Experts aren’t exactly sure why pregnancy increases the risk of postpartum episodes in women. Possible causes may include hormonal changes, problems with sleep and other life changes that happen as a result of pregnancy. At an intuitive level, there’s no question that there’s hardly a more demanding life change in a woman’s life than becoming a mother.
As a new mother, you might wonder what’s going on with your thoughts. What’s normal to new motherhood? And what is a sign of a postpartum mental health disorder? Moreover, most of the advocacy and awareness efforts have focused on postpartum depression or, to a lesser degree, postpartum anxiety. Postpartum bipolar disorder might not be on your radar.
Symptoms of Postpartum
Postpartum depression and bipolar disorder can look very similar. During a depressive episode of bipolar disorder, you may wonder if you’re experiencing postpartum depression. But postpartum bipolar disorder is different from other postpartum disorders, such as postpartum depression or anxiety. With postpartum bipolar disorder, a new mother will experience extreme up-swings. This mania or hypomania, as discussed earlier, includes symptoms not present in depression, such as:
- Grandiose self-image
- High irritability
- Decreased need to sleep
- Racing thoughts
- Impulsive and destructive behavior
Postpartum bipolar disorder is also distinct from postpartum anxiety. The latter is an anxiety disorder, which means fear, panic and anxiety are the center of the problem. If you have postpartum bipolar disorder, you may not experience the following symptoms of postpartum anxiety:
- Constant worrying that your baby is in danger
- Imagining your baby coming to harm
- Concerns about your baby’s safety affecting your daily life
- Experiencing panic attacks
- Difficulty breathing
- Feeling faint
- Muscle tension
- Excess sweating
- Needing to go to the toilet more often
- Avoidance of situations that make you anxious
It’s important to remember that symptoms of postpartum bipolar disorder do not always start straight after birth. Sometimes the symptoms of postpartum bipolar disorder develop in the weeks and months after delivery. This can make a diagnosis for you difficult. You may not immediately make the connection between these later symptoms and your birth.
Treatment for Postpartum
Many women with postpartum mood disorders do not seek treatment. It’s hard to prioritize yourself after having a baby, and it can feel selfish. You may not want others to know that you’re struggling as a new mother, or you may feel guilty for some of the darker feelings you have during depressed episodes. However, having a postpartum mood disorder doesn’t make you a bad mom—even if your mind has started thinking about ways of hurting your child.
If you feel that your moods are alternating between extreme highs and lows after childbirth, get help. If you’re considering hurting yourself or your child, you can’t wait. There’s no shame. Your body, your hormones and your life have all changed drastically. Choosing to get help is what makes you a good mom.
A diagnosis of bipolar disorder (or any other postpartum mental health disorder) may be the first step to taking the best care of both you and your baby.
The Role of the Menstrual Cycle in Bipolar Symptoms
Living with bipolar disorder should be enough, but women with bipolar disorder often face the additional challenge of increased struggles with their moods as part of their premenstrual symptoms (PMS). Researchers believe estrogen plays a role in bipolar disorder in women. This is because the menstrual cycle, which results in a drop in estrogen, often leads to a worsening of bipolar symptoms in the premenstrual period. However, the link between menstruation and bipolar disorder is much weaker than it is for childbirth.
Some scientists speculate that the hormonal changes that take place during menstruation may lessen the effects of lithium. Lithium is a common medication that patients take to reduce the symptoms of bipolar disorder.
The drop in estrogen during menopause also means that middle-aged women are more likely to experience depressive episodes as part of bipolar disorder.
Treatment for Women with Bipolar Disorder
Differences in bipolar symptoms between women and men mean that one size doesn’t fit all. Treatment plans will need to match the unique experiences and symptoms of women. For example, close attention needs to be paid to pregnant women. This is due to the fact that some medication for bipolar disorder present risks to the unborn child. Also, if you’re a woman who has recently given birth, especially if you have a history of bipolar disorder, your doctor should monitor your moods carefully.
Most importantly, understand that a mental disorder is a health disorder. Getting help is for mental health is no more shameful than getting help for a physical health disorder. If you are swinging between manic or depressed episodes, get help now. Today, therapy and medication are very successful at treating bipolar disorder.