Bipolar disorder risk factors: who is more likely to develop it

What bipolar disorder is

Bipolar disorder (once called manic-depressive illness or manic depression) is a mental illness that causes clear shifts in a person's mood, energy, activity levels and concentration. People with it often have periods of extremely "up," elated, irritable or energized behavior (manic episodes) and very "down," sad, indifferent or hopeless periods (depressive episodes) (NIMH). Some people have hypomanic episodes, which are like manic episodes but less severe (NIMH).

NIMH describes three basic types (NIMH):

• Bipolar I disorder: manic episodes that last at least 7 days, or manic symptoms so severe that hospital care is needed. Separate depressive episodes, typically lasting at least 2 weeks, usually occur as well.
• Bipolar II disorder: a pattern of depressive and hypomanic episodes, without the full manic episodes of bipolar I.
• Cyclothymic disorder (cyclothymia): recurrent hypomanic and depressive symptoms that are not intense enough or long enough to count as episodes. MedlinePlus says the symptoms usually last at least 2 years in adults and 1 year in children and teenagers (MedlinePlus).

Four or more episodes of mania or depression within a year is called rapid cycling (NIMH). There is no score or calculator on this page; the factors below are the ones NIMH and MedlinePlus name.

Who is more likely to develop bipolar disorder

The exact cause of bipolar disorder is unknown, but research suggests a combination of factors may contribute (NIMH). MedlinePlus names genetics, brain structure and function, and your environment (MedlinePlus).

• A close relative with bipolar disorder. You are at higher risk if you have a close relative who has it (MedlinePlus). NIMH says it often runs in families, mostly explained by heredity: many genes are involved, and no one gene causes it (NIMH).
• Trauma or stressful life events. Going through trauma or stressful life events may raise the risk even more (MedlinePlus). NIMH says people with a genetic risk may be more likely to develop bipolar disorder after trauma or other stressful life events (NIMH).
• Brain structure and function. Research shows the brain structure and function of people with bipolar disorder may differ from those of people without it (NIMH).

Genes are not the whole story. Studies of identical twins show one twin can develop bipolar disorder while the other does not, and not everyone with a parent or sibling with bipolar disorder will develop it (NIMH).

When it usually starts

Most of the time, symptoms start during late adolescence or early adulthood. Occasionally, children may have symptoms (NIMH).

Signs and symptoms

Mood episodes cause symptoms that last a week or two, or sometimes longer, and during an episode the symptoms last every day for most of the day (NIMH). Signs of a manic episode can include (NIMH) (MedlinePlus):

• feeling very up, high, elated, or extremely irritable or touchy;
• feeling jumpy or wired, or more active than usual;
• racing thoughts and talking fast about many different things;
• needing less sleep;
• feeling unusually important, talented or powerful;
• doing risky things that show poor judgment, such as spending or giving away a lot of money.

Signs of a depressive episode can include (NIMH) (MedlinePlus):

• feeling very down, sad, hopeless or worthless;
• feeling slowed down or restless, or having little energy;
• trouble concentrating or making decisions;
• trouble falling asleep, waking up too early, or sleeping too much;
• losing interest in almost all activities;
• thinking about death or suicide.

A mixed episode has both manic and depressive symptoms together (MedlinePlus). With hypomania, a person may feel very good and productive and not feel that anything is wrong, while family and friends notice the mood swings (NIMH).

How bipolar disorder is diagnosed

A health care provider may do a physical exam, order medical tests to rule out other illnesses, and refer you for an evaluation by a mental health professional. The diagnosis is based on the severity, length and frequency of symptoms over your lifetime, and your family history (NIMH).

Some health conditions, such as thyroid disease, can cause symptoms like those of bipolar disorder, and some prescribed, recreational or illicit drugs can mimic or worsen mood symptoms (NIMH). Many people with bipolar disorder also have other conditions, such as anxiety disorders, ADHD, misuse of drugs or alcohol, or eating disorders (NIMH). See anxiety risk factors and depression risk factors.

Treatment and getting help

Treatment helps many people, even those with the most severe forms. Mental health professionals treat bipolar disorder with medicines, psychotherapy, or both (NIMH). Bipolar disorder usually needs lifelong treatment, but an effective treatment plan can help people manage symptoms and improve quality of life (NIMH). Do not stop a medicine without talking with your health care provider first (NIMH).

NIMH lists ways to help yourself: get treatment and stick with it, keep a routine for eating, sleeping and exercising, avoid drugs and alcohol, and keep a life chart or mood journal to help recognize mood swings (NIMH). If you have concerns about your mental health, talk to a primary care provider, who can refer you to a qualified mental health professional (NIMH).

The 988 Lifeline is free and confidential and available 24/7 (988 Lifeline).

Related guide: schizophrenia risk factors.

Common questions

Is bipolar disorder hereditary?

It often runs in families, and research suggests this is mostly explained by heredity. But many genes are involved, and not everyone with a parent or sibling with bipolar disorder will develop it (NIMH).

At what age does bipolar disorder start?

Most often in late adolescence or early adulthood, and occasionally in children (NIMH).

Can stress cause bipolar disorder?

The exact cause is unknown. Trauma or stressful life events may raise the risk, especially in people who already have a close relative with it or a genetic risk (MedlinePlus) (NIMH).