What bipolar disorder can look like in men

Bipolar disorder (BD) is a mental health condition characterized by intense mood swings and emotional regulation challenges. In severe cases, it can lead to risky behavior, functional impairments, and an increased risk of self-harm and suicide. Fortunately, BD symptoms can be managed with the right support. Most people with BD require professional help to maintain their well-being. 

According to the National Institute of Mental Health ^[1] (NIMH), a little more than 4% of U.S. adults will experience BD in their lives. Men and women tend to experience it at about the same rate. Yet, women are diagnosed with BD much more frequently ^[2]. This is likely because BD was historically viewed as a condition experienced by women. So it hasn’t been studied as extensively in men.

Today, we know that BD can present differently depending on your gender ^[3]. Learning more about these differences can help you spot possible signs of BD in yourself and other men in your life and know when to reach out for help.

A note on gendered language: At Rula, we believe that people of all genders deserve research-backed mental health support. One of the challenges in discussing bipolar disorder (BD) in men is that much of the research on BD focuses on people assigned female at birth (AFAB individuals). 

It’s clear that gender and socialization play a role in BD presentation and diagnosis. But we’re still learning how this experience might present for different genders, as the scientific community has largely focused on BD as it presents in AFAB individuals. As new, more inclusive research is published, we’re committed to updating our content to reflect these changes.

Signs and symptoms of bipolar disorder in men

The diagnostic criteria ^[4] for BD are the same for adult men and women. But researchers have discovered that men with BD might not fit the “typical” mold of the disorder. 

Some important differences ^[5] to be aware of include:

• Age of onset: Men may begin displaying symptoms of BD earlier than women, often four or five years earlier.

• First episode: Women with BD usually have a depressive episode first. Men are more likely to display early symptoms of mania before depression. 

• Aggression: Someone experiencing a manic episode might engage in risky behavior like overspending or unprotected sex. They might also be irritable or aggressive. It might be hard to tell the difference between stereotypical “male” behaviors and symptoms of BD. 

• Prominent symptoms: BD involves a combination of manic and depressive episodes. But for men, mania shows up more often. 

• Functioning: Men with BD might have a harder time engaging socially or functioning in their jobs than women with BD.

• Co-occurring conditions: Women with BD have a greater risk of co-occurring ^[6] phobias, panic disorder, post-traumatic stress disorder (PTSD), eating disorders (EDs), and borderline personality disorder (BPD). Men with BD are more likely to have co-occurring conduct disorder or substance use disorders (SUDs).

• Self-harm: Sadly, research shows that as many as 19% of people with BD ^[7] will die from suicide.* Among this population, women are more likely to attempt suicide. But men are more likely to die from suicide ^[8].

*A note on safety: If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. Their counselors will provide confidential support and resources to help keep you safe.

How bipolar disorder differs in men

In addition to the factors listed above, BD subtypes (bipolar 1 and bipolar 2) might show up differently in men. 

Here’s what to know ^[9]: 

• Bipolar 1: To be diagnosed with this form of BD, you have to have at least one episode of mania that’s severe enough to impact your functioning. BD 1 affects women and men at about the same rate. But it’s often diagnosed later in life for women than for men. 

• Bipolar 2: To be diagnosed with this form of BD, you have to have at least one episode of less severe mania (referred to as hypomania) and at least one episode of major depression. BD 2 affects more women than men.

What causes bipolar disorder in men?

Experts are still working to identify all of the causes of bipolar disorder. 

In men, it’s likely the result of a combination of factors, including:

• Environment: Adverse childhood experiences (ACEs) and high stress levels are known to trigger first mood episodes.

• Sleep disturbance: Not getting adequate rest is a trigger for both manic and depressive episodes.

• Substance use: Substances don’t cause BD. But some men may rely on them as a coping mechanism, as this can make BD symptoms worse.

• Genetics: Research ^[10] suggests that BD is a heritable condition. This means that if you have a close relative with BD, you’re at greater risk of developing it. 

• Hormones: There’s some evidence ^[6] to suggest that abnormal testosterone levels may play a role in both depressive and manic episodes in men. 

When bipolar symptoms in men go unnoticed

Left untreated, BD can have a lasting effect on a man’s mental health, relationships, and quality of life. And unfortunately, many men don’t get the treatment they deserve. That’s because some clinicians may not have adequate training in how BD presents in men. For example, they may mistake mania for stereotypical “male aggression,” so men may get misdiagnosed or undiagnosed.

In addition, even when help is available, stigma may prevent men from seeking treatment. They might fear being perceived as unstable or weak in a culture that tells them they have to be strong. This pressure can be even greater among men whom others rely on. They may worry about disappointing their loved ones. But it’s important to remember that asking for help is a sign of strength. In taking care of yourself, you’ll have more capacity to care for others. 

Treatment options for bipolar disorder

BD is typically treated with a combination of therapy and medication. Men and women with BD tend to have similar responses to therapy ^[11]. However, research shows that men may respond differently to certain psychiatric medications ^[11]. So it’s important to find a psychiatrist who understands how gender differences can impact treatment for BD. 

Opening up about your struggles can be hard at first, especially with a new provider. But rest assured that most therapists and psychiatrists truly want to help. Providing a clear picture of your mental health can help you get the right support for your needs.

Clinician’s take

I’ve seen gender expectations make it harder for men to recognize bipolar symptoms, especially when emotional changes don’t look like sadness. When men are taught to minimize vulnerability or push through exhaustion, early signs of mood episodes can go unnoticed or unaddressed.

Brandy Chalmers, LPC

Clinical reviewer