Helping News                                                   June, 2020   Issue 144

8 Ways Bipolar Is Different For Men and Women
While men and women may be diagnosed with bipolar in similar numbers, their experiences are different.

Article by: Holly Pevzner; Reviewed by: Henry A. Montero, MS, LMHC

Somewhere between 3 percent and 4.4 percent of all adults in the United States have dealt with bipolar disorder at some point in their lifetime. That includes the approximately 5.7 million who’ve been affected just in the last year alone. And while bipolar disorder affects both men and women in equal numbers, symptoms; comorbidities; rate of diagnosis; and other factors are actually quite different among the sexes.

#1: Bipolar May Surface Earlier In Men
The first onset of bipolar disorder symptoms (depression and mania) often surface when you are in your twenties, regardless of sex. However, research shows that the initial depressive episode in men tends to arise about 5 years earlier than in women. That’s about 22 years old in men versus about 27 years old in women. The same holds true for mania, with the average age-of-onset for women being 25.9 years old and for men it’s just shy of 22.

#2: Women Are More Likely To Experience Late-Onset Bipolar
Another age-related difference in bipolar disorder: More women than men experience what’s called late-onset bipolar, or LOBD. While many researchers consider LOBD to be bipolar that’s diagnosed at age of 50 or older, some use the term to describe those diagnosed at 40 and up. “It’s thought that many cases of late-onset bipolar in women may be associated with menopause,” says Henry Montero, MSW of Alquimedez Mental Health Counseling in New York City. “Among women with bipolar, one in five report difficulties when transitioning into menopause.”

#3: Women’s Bipolar Moves In Cycles
“Women with bipolar disorder are encouraged to keep a close eye on their cycles and moods,” says Sanam Hafeez, PsyD, a teaching faculty member at Columbia University Teachers College in New York City. The reason? Bipolar disorder can worsen during certain phases of the reproductive cycle, such as the postpartum period, which can last up to 6 months after baby is born.

This period is not only associated with a higher risk of bipolar onset, but also relapse, with one report noting that 25 to 40 percent of women with bipolar disorder experience a relapse during this time. Bipolar can also worsen during pre menstruation and during both perimenopause and menopause. In fact, “depression is more pronounced during this period because of the reduced levels of estrogen,” says Montero.

#4: Men Are Less Likely To Seek Treatment
“Women tend to be more open to seeking therapy than men, in general, so it stands to reason that they’re more likely to get treatment for bipolar disorder, too,” notes Hafeez. And early treatment is essential: A 2016 report in the International Journal of Bipolar Disorders found that psychological and pharmacological treatment in the early stages of bipolar is more effective than when first initiated in the later stages.

#5: Women Are More Frequently Misdiagnosed
While women are more apt to seek treatment for their bipolar disorder, their road to getting help is filled with more obstacles than men. “Misdiagnosis is one of the primary reasons women tend to get diagnosed later than men,” says Montero. 

Research shows that women often experience diagnosis delays of up to 11 years from initial symptoms due to being mis- or undiagnosed. (Men generally experience an also-unfortunate 7-year delay.) The likely reason? Women are often getting diagnosed with unipolar depression, aka major depressive disorder, instead, notes Hafeez.

Among individuals who’ve been misdiagnosed, women are 25 percent more likely to have received diagnosis of major depressive disorder. “This kind of incorrect diagnosis carries the risk of inappropriate treatment with antidepressants, which can result in manic episodes and trigger rapid cycling,” says Hafeez. (Rapid cycling is when a person with bipolar experiences four or more mood episodes within a twelve-month period.)

#6: Women Are More Likely To Have Bipolar II Disorder
There are three types of bipolar disorder: First, there’s bipolar I, which involves manic episodes that last at least a week, or the manic symptoms are so intense that immediate care is needed. Depressive episodes often occur as well, lasting about 2 weeks. The second type is bipolar II. “Women are more apt to experience bipolar II, which is characterized by episodes of depression and hypomania, which is a milder form of mania,” says Montero. (The third type is Cyclothymic Disorder, which involves hypomanic and depressive symptoms lasting for at least 2 years in adults.)

#7: Mania Can Be More Difficult To Detect In Men
That exaggerated feeling of well-being and over-confidence that goes along with a manic episode doesn’t raise the same flag in men as it does in women. The problem isn’t that the symptom is any different between the two genders, it’s more about gender stereotypes. Seeing a super bold, extremely confident man is more normalized in our culture than the same behavior is in a woman. The result: it can be more difficult to pick up on a manic episode in men.

#8: Even The Comorbidities Are Different For Women 
When compared to men, women with bipolar disorder are more likely to experience additional health conditions, such as thyroid disease, obesity and migraines. For instance, a study published in the Journal of Clinical Psychiatry found that women with bipolar disorder are three times more likely to get migraine. ”Most of these disorders, much like bipolar, have some hormonal components, making women more prone,” says Hafeez.

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