How Gender Affects the Course of Bipolar Disorder

While mental illness is far reaching and indiscriminate, its effects vary depending on identity traits such as gender, race, and class. While Major Depressive Disorder and anxiety disorders have notably higher prevalence rates in females than in males, the majority of epidemiologic investigations into prevalence rates of Bipolar patients show no gender differences.1 Although symptoms may present similarly across genders, key differences exist. The differences may be attributed to underlying biological processes, as well as a number of sociocultural factors. Examining these differences is essential to fully understand how gender impacts one’s experience of Bipolar disorder: the course of illness, rates of diagnosis, common barriers to recovery, in addition to the best directions for individualized treatment. 

Bipolar disorder can display itself differently in men and women in compelling ways. For starters, the mental illnesses that co-occur with BD may vary substantially by gender. Research shows men’s initial depressive episodes present, on average, five years earlier than in women (22 y.o. for men, 27 y.o. for women). Men tend to experience more frequent and more intense manic episodes, as well higher rates of comorbid alcohol & drug abuse/dependence and conduct disorder.  On the other hand, women tend to have higher frequencies of PTSD, comorbid anxiety disorders, eating disorders, insomnia, increased severity of mood episodes overtime, and higher rates of hospitalization.2 Though relatively little is known regarding the causes of these differences, researchers suspect distinct biological processes underlie the presentation of these gender differences in BD.3  

The reproductive cycle also plays a powerful role for women struggling with BD. Women are at particular risk of experiencing depressive episodes and exacerbated symptoms related to hormonal imbalances during menstruation, pregnancy, postpartum, perimenopause, and menopause.4 Higher rates of women also experience Late Onset Bipolar Disorder. LOBD is a form of BD that is diagnosed from age 40 and up; it is believed that the vast majority of these cases in women are associated with menopause. Keeping a close eye on the relationship between one’s reproductive cycles and moods can be beneficial, given the higher likelihood of experiencing exacerbated symptoms in connection with hormonal shifts. 

Stigma surrounding mental illness continues to be pervasive and omnipresent throughout society in the 21st century. Present day ways of thinking are often ridden with outdated relics of past generations’ taboos, discomfort and fears, particularly when pertaining to men’s experiences with mental illness. As a result, men face unique pressures to avoid engaging in help-seeking behaviors. These socially prescribed rules and perceived masculine norms lead men to delay, avoid, or refuse getting help, making them significantly less likely to voluntarily seek psychiatric care.5 A large percentage of men fall prey to the mistaken notion they should be “tough enough” to be the answer to their own suffering, directly attributed to the all-too-pervasive phenomenon of toxic masculinity.6 Left unaddressed, men suffering from mental illness tend to experience exacerbated symptoms as a direct result of feeling so isolated.7

Optimal treatment plans for individuals struggling with BD cannot be reduced to gender or even consider it the main factor in deciding treatments and paths moving forward. In reality, it comes down to each individual’s unique background and specific needs. Ideally, an optimal treatment plan takes into account a variety of factors including the individual’s personal history, age at onset, predominant symptoms, noted triggers, daily environment, and support system.8 Gender differences in the presentation of Bipolar episodes may inform specific elements of one’s treatment plan, but likely will not define it. Thus, it is critical to promote holistic treatment across the board to best amplify one’s system of care and quality of life. Despite the noted gender-based differences, more research is needed to understand exactly what physiological processes drive some of these differences. The answers are likely multilayered, as BD is a complex illness. Regardless, one of the most paramount commonalities between males and females is that BD can be very treatable in both genders, as soon as the individuals combatting the illness receive appropriate psychological care and ample personal support.9