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Complications of Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) can lead to many serious physical, economic, and emotional problems. Doctors refer to them as complications of BPD. These complications can be a heavy burden for the person with the condition and their loved ones to manage.

The most common complications of BPD include:1-7

  • Underemployment and unemployment
  • High treatment costs
  • More and harder-to-treat mood swings (sensitization)
  • Tardive dyskinesia
  • Substance use disorders
  • Increased risk of heart disease, diabetes, and stroke (metabolic syndrome)
  • Sex and intimacy problems

Work problems

Underemployment and unemployment are significant problems for people with BPD. These problems may be caused by missing more work than their peers. In fact, a single episode of bipolar depression has been linked to:1

  • Missing 4 days of work per month
  • Lack of productivity
  • Problems concentrating
  • Strained work relationships

On average, people with BPD miss 18.9 workdays per year due to their condition. Other employees average 7.4 lost work days per year due to illness.2

High treatment costs

Bipolar treatments can be expensive. There are direct costs such as medicines, doctor copays, and any part of hospital care not covered by insurance. People with BPD need insurance coverage and affordable treatment to stay healthy and reduce future episodes.3

People living with the condition may avoid taking their medicines due to cost or side effects. But when untreated, BPD leads to longer bouts of depression and mania. Untreated depression may last up to 1 year, and mania may last 6 months or longer.3

Sensitization

Sensitization is a serious complication of BPD. It is not the same as someone "being sensitive." Sensitization is a process in which certain situations lead to more and more serious bipolar episodes.4

The theory is that the brain and body remember its reaction to a past stressful event that triggered mania or depression. When that event happens again, the person reacts with another round of mania or depression. Over the long term, these reactions last longer and are harder to treat because the brain has been "rewired" to be more sensitive to stressful events.4

People who develop sensitization also are more impulsive. Being more impulsive is strongly linked to suicide attempts in people with BPD.4

Tardive dyskinesia

Tardive dyskinesia is a condition in which someone has repetitive, unwanted movements. These may include lip smacking, tongue thrusting, or rapid blinking. The condition most often occurs to muscles in the face. But it also may occur in the upper body, arms, legs, hands, and feet. It may look like twisting, dancing movements in the fingers or toes, or rocking and jerking of the hips.5

Tardive dyskinesia is often caused by the long-term use of antipsychotics. It may be months or years before symptoms develop. But when they do, symptoms can be distressing and embarrassing for the person.5

Substance use disorders

Many studies find that up to half of people with BPD also have substance use disorders. Alcohol is the most used substance, but marijuana and other street drugs are also common.6

People with BPD may use these drugs to find relief from the symptoms of both mania and depression. But alcohol and street drugs often make bipolar symptoms worse. Treatment for addiction must often accompany treatment to manage bipolar symptoms.6

Substance use also may make other bipolar complications, such as relationship issues, worse. It also leads to:5

  • Lower rates of sticking to a treatment plan
  • Increased rates of suicide
  • Longer recovery times from bipolar episodes

Obesity and metabolic syndrome

People with BPD are much more likely than the general population to have obesity or metabolic syndrome. Metabolic syndrome is a group of conditions that increase your risk of heart disease, stroke, and type 2 diabetes. The conditions are:7,8

  • High blood pressure
  • High blood sugar
  • Extra fat around the waist
  • High cholesterol levels

Studies estimate that between one-third and one-half of people with BPD have obesity or metabolic syndrome. One factor that contributes to this is long-term use of medicines used to treat BPD. Another factor is being much less physically active during periods of depression.7

Intimacy problems

The sexual issues of BPD can be challenging. During manic episodes, some people may think about sex more and want to have more sex. During depression episodes, a person may be uninterested in sex or feel undesirable. The swings between these 2 states can confuse and frustrate a partner. In addition, some bipolar medicines decrease sexual desire and make it harder to achieve an orgasm.9

Developing self-awareness and communicating openly with loved ones is essential to managing intimacy issues. You should also talk with your doctor or therapist. They will help develop a plan to manage difficulties.9

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