As the world becomes more familiar with bipolar disorder—recognizing it as a mental illness that impacts a large number of lives—I’ve noticed an interesting duality. On one level, society increasingly accepts the illness, formerly known as manic depression, and seems to understand it is a condition that requires treatment in order for the person struggling with it to live a normal life. But in my work treating men in an urban setting, the stigma still appears to exist for men.

How can this be? Here’s the way I see it. In patriarchal societies such as the US, masculinity remains very much defined by self-control and emotional regulation. Gender stereotypes result in the skewed perception of symptoms. Sadly, people living with mental health conditions, such as bipolar disorder, are often marginalized by society.

Several studies have examined the relationship between quality of life and bipolar and have concluded that quality of life is distinctly impaired in people who live with bipolar. This results in stigmatization and discrimination that can interfere with recovery and social integration. One of the most successful strategies to battle stigma and discrimination is encouraging a person with bipolar to share their story and discuss their journey.

The unfortunate result of this is that men are at greater risk of being misdiagnosed and—even worse—that they are less likely to recognize the disorder in themselves. For this reason, it’s important to be aware that the symptoms of bipolar disorder in men are different than in women.

Can Bipolar Affect Men?

Mental health disorders do not discriminate by gender. According to the National Institute of Mental Health, bipolar disorder, which is characterized by significant shifts in mood and energy level such that they impact the ability to perform daily tasks, affects 2.8% of the adult population in the US. Of that group, when broken down by gender, slightly more men (2.9%) are affected than women (2.8%). Men are as vulnerable to bipolar disorder as women, in both adolescence and adulthood.

People with bipolar disorders (there are three types: bipolar I, bipolar II and cyclothymic disorder) experience intense emotional states—manic, hypomanic or depressive. They also have periods where their mood is stable.

Gender seems to play a role in how the disorder exists in the individual because the illness so strongly impacts emotional and psychological states.

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Bipolar Onset: Is Age Relevant?

The median age of onset for bipolar disorder is 25 although it can start earlier and occur later—during middle age. The same gender ratio holds true for bipolar in adolescents—there are no appreciable differences in terms of population. As to symptom differences between age groups, however, adolescent bipolar disorder often varies from the adult in terms of intensity.

When the disorder is first developing, behavioral patterns can be more erratic. The bipolar adolescent, for example, will “cycle” from a state of excitement to depression more rapidly than the adult, who maintains the specific state for longer than a day (Pipich 16-17). Age, then, is relevant only in terms of the disorder’s progression and not regarding gender or disparity in affliction.

What Does Mania Feel Like?

Mania symptoms exist in an equally wide range of forms for both men and women. It is important to understand that “mania” by no means translates to extreme behavior or physical aggression. It may, but symptoms are usually more internalized. Manic thinking and feeling sometimes veer on delusion, as in grandiose ideas of the self as having some special purpose to fulfill. During the stage of mania, the observation of the self “ego” struggles with behaviors, judgments, emotions, and actions in real time as they are manifesting and self-monitoring.  Hallucinations also occur in extreme cases, wherein the individual is unable to distinguish the real from the unreal.

Manic states are often marked by sleeplessness; the person does not have insomnia, but rather is so obsessed that they believe they require less sleep or choose to remain awake as long as possible. More commonly, however, mania “feels” like a stage of prolonged excitement. This may result in a negative or positive response; the person may be agitated and anxious for hours or days, for no cause they can name, or they may be euphoric for the same extended period. Mania is essentially a heightened state of perception, feeling, and behavior, and the bipolar person cannot contain the mania. Manic states overwhelm the personality and cognitive processes, regardless of feeling abundantly happy or sad.

Bipolar Symptoms in Men 

Unfortunately, many people refuse to acknowledge the reality of the disorder in themselves or those close to them (Pipich 40). Denial is common. In my experience, men may be more inclined to deny the problem, since it deals with emotional extremes and men are taught not to show emotion.

Gender norms additionally affect identification and treatment of the disorder. Women diagnosed as bipolar, for example, are far more likely to be prescribed anti-depressant medications and other forms of treatment. This raises the possibility that women are simply more willing to express their states of depression (Karanti et al. 305). There are, of course, other ways of identifying bipolar in men and women, but it is important to recognize this indication of gender before focusing on male symptoms, or symptoms more commonly seen with men.

While the illness and the symptoms are virtually identical in both genders, gender stereotypes sometimes incorrectly justify symptoms that would otherwise indicate the illness. For example, the manic state of euphoria translates to an ongoing and exaggerated feeling of well-being in men and women. Often for no apparent cause, the person just “feels great.” This can result in a type of extreme overconfidence, which might be harder to detect in men, as confidence is encouraged in men especially in American culture where confidence is synonymous with masculinity. As a result, it can become more difficult to see atypical behavior in a man.

Poor decision-making and risk-taking or reckless behaviors are also symptoms associated with mania in a person with bipolar. Again, American men are generally expected to act cautiously, so any recklessness might stand out more in men than in women. Risk-taking, sleeplessness, hyperactivity, and inexplicable euphoria—are all symptoms to watch out for in men with bipolar disorder.

Bipolar in Men During a Depressive State

In both genders, bipolar depression manifests itself through six behaviors: excessive sleeping, changes in eating, being withdrawn and sullen, irritability, inability to concentrate, and lack of interest in virtually anything typically enjoyed. Extremes, not surprisingly, include suicidal impulses and attempts as well as reclusive behaviors.

Bipolar disorder carries a high risk of suicide. Suicide in men is a significant social, behavioral health and medical problem. Men have a much larger rate of attempts and completed suicide rates in comparison with women. Early identification of bipolar disorder and risk factors is essential to intervene, treat, and prevent any risk-taking behavior.

Again, it can be argued that women more easily reveal their emotion and more willing to seek help. Extensive evidence supports that men are typically unwilling to admit to depression. In fact, they often take extreme measures to avoid being identified as depressed—clinically or otherwise—because depression and the symptoms that come with it defy male norms of independence and emotional control.

Clinicians increasingly report that depression and bipolar disorder are vastly underrepresented in male populations due to the pervasive association of these conditions with character weakness. What emerges when the 10 manic and depressive symptoms are noted, then, is that gender norms create greater difficulty diagnosing the illness in men. This is an illness centered on deep emotional and psychological conflicts, generated genetically and environmentally. All symptoms are behavioral, as opposed to illnesses that manifest in physical symptoms, food poisoning, for example.

Sadly, men suffering from bipolar are less easy to identify and less likely to seek assistance and treatment.

How to Help a Man Who May be Struggling

Both men and women resist seeing themselves as suffering from a clinical disorder but men tend to be even more sensitive to the suggestion that they are mentally ill.  An adolescent boy may be less antagonistic to the suggestion that they may be struggling with a mood disorder as teens are less rigidly circumscribed by gender roles. But teens must be handled with care as adolescents can be volatile and if they sense any attempt to be controlled by an adult, will likely reject an adult’s input.

If you’re concerned about a male loved one, here are some tips to help you start a conversation:

  • Seek out a private or confidential setting for your discussion. This shows respect and consideration for their privacy and will help him to feel comfortable confiding in you.
  • Start by emphasizing your care and concern for him.
  • Try to avoid becoming emotional yourself.
  • Don’t list erratic behaviors or questionable actions as that may antagonize him.
  • Point out that something beyond their control may be responsible for the concerning behaviors.
  • Explain that many mental health conditions can be treated effectively and you will assist in getting him the help he needs.

Bipolar disorder is typically a lifelong, chronic illness. In most cases, long-term help may be needed to stay well this includes sticking with treatment and developing a plan for when symptoms return, even if you have been feeling well for a long time. Setbacks can happen. But with proper support and treatment, it’s possible to return a level of quality to your life and learn to live well with bipolar disorder.

If you are in crisis, call the toll-free National  Suicide Prevention Lifeline at: 1-800-273-TALK (8255). Help is available 24 hours a day, seven days a week. All calls are confidential. 

 

 

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Last Updated: Oct 16, 2018