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Image by: Hammonton Photography
By Harper Finch
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.
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.
#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.
For additional information, check out the womenshealth.gov website.