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Section 7
Symptom Outcomes

Question 7 | Test | Table of Contents

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In the last section, we discussed the traits of the sleep-wake cycle and how it affects bipolar clients:  social Zeitstorers, social Zeitgeber, and a regulated sleep pattern.

As you know, men and women take different paths when it comes to relating to themselves and others.  Women tend to focus more on emotions and men on actions.

In this section, we will discuss the differences found between men and women with bipolar disorder: differences in suicide rates; effect of PMS on bipolar and unipolar women; and mania in men.

3 Differences Between Bipolar Men and Woman

♦ 1. Suicide
The first difference we will discuss is suicide.  In 2003, a study conducted by Cornell University found that four times as many men than women commit suicide, yet two to three times more women attempt suicide.  As you may know, this statistic stems from the method that men and women commonly choose to commit suicide. Women choose methods, such as ingesting a severe amount of pills, which take a long time to come into effect. During that time, they can be discovered by loved ones or the victim has rethought her decision and calls for help. Men, on the other hand, choose a more immediate method such as a gun or by hanging

As you are probably aware, the reason that women are much more likely than men to attempt suicide stems from the fact that bipolar women are twice as likely to suffer from major depression than men. Surprisingly, depressed clients are at a higher risk when they are at the end of a depressive episode rather than deeply depressed. This is a result of the extra energy they feel coming out of a depressive state. 

During this tumultuous period, I recommend extreme vigilance on the part of the client’s spouse or family members, especially if the client has a history of suicide attempts.  We will discuss suicide and techniques to counter it more thoroughly in a later section.

♦ 2. Effect on Women (PMS)
The second difference we will discuss is bipolar disorder’s effect on women. The Department of Psychology at the University of Cincinnati has found that bipolar disorder becomes diagnosed much later in women, around 35 years of age. In addition, women are more likely to develop eating disorders such as anorexia, bulimia, and overeating. Also, women experience depressive episodes, mixed mania, and rapid cycling more often than men.

One characteristic of women can also negatively affect their depressive states: premenstrual syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD) which involves symptoms of PMS, but much more severe.  Obviously, this characteristic is unique to women.  The fluctuations of the hormones estrogen and progesterone already affect women without the disorder. 

Those female clients who do suffer from bipolar disorder often find that the depressive state that PMS would incite normally increases their risks of slipping into a depressive state.  Studies have shown that women’s suicide attempts and threats increase premenstrual and they’re also more likely to be admitted to a psychiatric hospital at this point.  Keep in mind that over two-thirds of women with unipolar disorder experience premenstrual lows and that women who suffer from premenstrual mood changes frequently have family histories of depression.

Technique:  PMS Emotion Chart
Joan, age 39 and a unipolar client of mine complained that her husband frequently diagnosed her with PMS and said that her moods changed rapidly at this time. Joan was an independent young professional woman and refused to be labeled as a woman who gave into her feelings. To help Joan keep track of her PMS patterns, I asked her to complete a "PMS Emotion Chart".  Because Joan could already predict her menstrual periods to the date, I asked her to monitor her mood changes two to three days before her expected period.  I gave her a list of symptoms to note which included the following:
1. Anxiety
2. Nervousness
3. Depressing thoughts
4. Fatigue
5. Listlessness
6. Mood swings that occur within a few hours of each other
7. Irritability

While calculating her PMS emotion chart, Joan noticed that her depressing thoughts such as "no one loves me", and "I should be alone" occurred more frequently prior to menstruation.  Also, her impatience increased and she found herself snapping at those she loved. 

To help Joan with her PMS emotional roller coaster, I suggested lifestyle modification which included reducing her intake of caffeine, sugar, and sodium prior to menstruation which will help decrease the rapid mood swings.  Also, I suggested a regular exercise regimen which helps to battle depression and anxiety by producing endorphins.

Think of your unipolar female client. Could her menstrual cycle be affecting her likeliness of slipping into depression?

♦ 3. Mania in Men
In addition to the differences in suicide rates and the effects of PMS, a third difference is the affect of bipolar disorder in men. As we discussed earlier, women develop bipolar disorder later than men, with men being diagnosed at the average age of 30. About one-half reported episodes of mania at the age of 25. There has also been found a link between early childhood antisocial behavior and early onset bipolar disorder in men.

Also, men tend to have more episodes of mania than depression. This might be a result of the hormone testosterone, which gives men an extra burst of energy and strength. For male clients with a history of manic episodes, I recommend emphasizing the need for sleep, as men are more prone to go without rest and thereby succumb to exhaustion. I have found that regulating sleep patterns is an effective way of preventing manic episodes. To learn more about regulating sleep patterns, refer to section 6 of this course.

In this section, we discussed the differences found between men and women with bipolar disorder.  These were differences in suicide rates; effect of PMS on bipolar and unipolar women; and mania in men.

In the next section, we will examine three temperamental disturbances and how these affect a client’s vulnerability for bipolar disorder related to  hyperthymic, cyclothymic, and dysthymic.
Reviewed 2023

Peer-Reviewed Journal Article References:
Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145(4), 390–409.

Hogarth, L., Hardy, L., Mathew, A. R., & Hitsman, B. (2018). Negative mood-induced alcohol-seeking is greater in young adults who report depression symptoms, drinking to cope, and subjective reactivity. Experimental and Clinical Psychopharmacology, 26(2), 138–146.

Johnson, S. L., Cuellar, A. K., Ruggero, C., Winett-Perlman, C., Goodnick, P., White, R., & Miller, I. (2008). "Life events as predictors of mania and depression in bipolar I disorder": Correction to Johnson et al. (2008). Journal of Abnormal Psychology, 117(3), 698.

Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of Abnormal Psychology, 125(1), 40–52.

Swartz-Vanetik, M., Zeevin, M., & Barak, Y. (2018). Scope and characteristics of suicide attempts among manic patients with bipolar disorder. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 489–492.


What are three differences found between men and women with bipolar disorder? To select and enter your answer go to Test.

Section 8
Table of Contents