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Special Populations

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

Bipolar disorder (BPD) is a complex and challenging mental health condition that affects about 2.3 million people in the United States. It occurs in all genders, racial groups, and social classes around the world, making it one of the leading causes of disability worldwide.1,2

However, some groups of people experience this condition differently. Better understanding of how BPD impacts different ages and ethnicities can lead to early detection, improve treatments, and help maintain quality of life.

Children and teens

BPD is less common in children than in older teens and adults, but it does occur. Symptoms also may look a bit different in children. For example, children with mania may express rage or appear extremely irritable. Children and teens with mania are also more likely to be disruptive, while adults tend to be more excited or intensely happy.3

Children with BPD may demonstrate the following more frequently:3

  • Feel ill more often than peers or use school health services frequently
  • Have problems in school
  • Do poorly in the classroom and on tests
  • Try to run away from home
  • Have problems making or keeping friends

Children may develop symptoms of attention deficit/hyperactivity disorder (ADHD) or conduct disorder before bipolar symptoms appear. Young people who show signs of mood swings, depression, and ADHD should be screened for bipolar disorder by a psychiatrist or psychologist, especially if there is a family history of the condition.3

Older adults

Most people are diagnosed with BPD before they reach 30 years old. However, some people may not be diagnosed until later in life. These people may have had bipolar symptoms all their life and had not been experiencing problems related to their symptoms. Or other factors may have recently triggered or mimicked bipolar symptoms.3

If BPD is diagnosed for the first time in a person over age 50, it may be called late onset bipolar disorder, geriatric bipolar disorder, or older age bipolar disorder. Fewer than 1 in 10 people with BPD develop symptoms later in life. Late onset bipolar disorder is often linked to conditions that affect the brain, like Alzheimer’s disease, stroke, head trauma, or drug side effects.4

Certain racial and ethnic groups

Many studies have shown that BPD occurs in equal numbers among people of different racial and ethnic backgrounds and socioeconomic groups. But there are differences in how quickly and accurately different groups are diagnosed with the condition.1,5

People with African ancestry are more likely to go undiagnosed or be misdiagnosed with a different mental health condition, especially schizophrenia. Two studies found that Black people may face a delay of up to 10 years before being correctly diagnosed.5

Similarly, a few studies suggest that Hispanic people in the United States who have BPD are often misdiagnosed with schizophrenia.5

An inaccurate diagnosis can lead to serious consequences. For example, a person misdiagnosed with major depression will be treated with antidepressants. These drugs will not stabilize their moods and could trigger mania. If they are misdiagnosed with schizophrenia, they likely will not receive the mood-stabilizing drugs they need.5,6

Overall, delays in correct treatment may result in:5,6

  • More and more severe mood swings
  • Increased insomnia
  • Increased irritability
  • Poorer long-term outcomes

The LGBTQ+ community

Some studies have found that people who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) have higher rates of mental health conditions, including bipolar disorder. Research points to possible differences in brain structure among LGBTQ people. The stresses of social rejection and stigma may make LGBTQ people more vulnerable to mental health conditions, too.7,8

More research is needed to fully understand how BPD and its treatments affect children, older adults, and Black, Hispanic, and LGBTQ+ populations.

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