Symptoms of Bipolar Disorder in Women

Societal and Gender Roles May Inform Symptoms

Bipolar
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Bipolar disorder affects men and women fairly equally, with 2.9 percent of men and 2.8 percent of women diagnosed. While women with bipolar disorder experience basically the same mania and depressive episodes as men, the expression of these episodes can often take vastly different forms. In some cases, this can be directly related to gender roles in society.

Society's Perception of Bipolar Disorder Symptoms in Women

For example, while excessive spending is a common feature of a manic episode, how a woman might spend her money (and on whom) may be diametrically opposed to how a man might spend in the same situation. Conversely, the way in which a depressive episode manifests in women and men can differ based on their relationships with others, particularly their spouses. Women in an abusive relationship, for example, will not typically respond with aggression, where a man might. 

How we, as a society, perceive symptoms of bipolar disorder can also vary. While we might take exception when a man talks excessively or emotionally, discounting him as "abnormal" or "strange," we will often ascribe the same behavior as being "typical" in women. 

Similarly, we tend to be put off by acts of aggression by women. Not so with men, who are often praised and rewarded for excessive and even violent behavior.

These perceptions can dramatically alter how bipolar women and men respond to the emotional cycles they experience. This can affect men especially if their illness is perceived as a weakness either by themselves or others.

Symptoms of Bipolar Mania

While social roles may inform the nature of a response during a manic or depressive episode, they have no bearing whatever on the severity or type of symptoms.

In both women and men, manic and hypomanic phases are characterized by the following features:

  • Decreased need for sleep
  • Talking excessively
  • Racing thoughts
  • Being easily distracted
  • Engaging in multiple activities
  • Physical agitation and relentless movement
  • Increased sexual desire
  • Impulsive risk behaviors (including gambling and lavish spending)
  • Grandiosity or inappropriate behavior
  • Bright and often inappropriate clothing
  • Irritability, hostility, or aggression
  • Delusions

Men tend to have more manic episodes than women do.

Manic Behavior in Women

In women, manic behaviors may take form in ways that society considers to be positive, such as dressing brightly or even provocatively. Conversely, we may attribute changes in behavior to "flightiness" or, worse yet, "typical" female mood swings. And even when we do notice changes, it's not unusual to hear them dismissed, rather cruelly, as symptoms of premenstrual syndrome (PMS) or menopause.

Symptoms of Bipolar Depression

As with manic behavior, the symptoms of bipolar depression usually vary little from women to men and can include:

  • Crying for no reason or prolonged periods of sadness
  • Feelings of guilt or hopelessness
  • Loss of interest in activities that usually give you pleasure
  • Extreme fatigue, including the inability to get out of bed
  • Loss of interest in your health, nutrition, or physical appearance
  • Difficulty concentrating or remembering things
  • Sleeping excessively or difficulty sleeping
  • Suicidal thoughts or an impulse to self-harm

Women tend to have more depressive episodes than men do.

Depressive Behavior in Women

In the same way that people can dismiss manic behaviors in women, the appearance of depression can lead them to callously declare a woman "premenstrual." These same sorts of beliefs can plague post-menopausal women and new mothers whose depression is often considered a normal facet of their stage of life.

Hormones and Bipolar Disorder

Hormonal changes that occur during menstruation can create some challenges for treating bipolar disorder in women. Studies have shown that a high percentage of women with bipolar disorder report more mood symptoms that are associated with the menstrual cycle. Additionally, menstrual cycles can throw off the potency of medications women use to treat their bipolar disorder, perhaps exacerbating the mood symptoms.

For perimenopausal and menopausal women with bipolar disorder, small studies have shown that depressive episodes may increase thanks to fluctuating hormones, sleep challenges, and life changes. However, more research needs to be done regarding this connection.

Take Home Message

Historically speaking, we have long embraced the idea of "melancholy" as a singularly female condition, one that is either innate or will pass given the proper time or distraction. As much as we like to think we've moved beyond these beliefs, they are rife in many cultures and only serve to distance women from accessing the mental care they need.

If you are experiencing symptoms of bipolar disorder, don't let anyone—including your doctor—minimize them or attribute them to "female troubles." If needed, get a second opinion, ideally from a qualified professional experienced in women's mental health. 

Sources:

Duerr HA. Treatment Issues for Bipolar Disorder in Women. Psychiatric Times. Modern Medicine Network. Published November 10, 2012.

National Institute of Mental Health (NIMH). Bipolar Disorder: Mental Health Information. Updated April 2016.

National Institute of Mental Health (NIMH). Bipolar Disorder: Statistics. Updated November 2017.

Parial S. Bipolar Disorder in Women. Indian Journal of Psychiatry. 2015;57(Suppl 2):S252-S263. doi:10.4103/0019-5545.161488.