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Prevalence and Course of Bipolar Disorder

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

graph Prevalence of Bipolar Disorder

The term lifetime prevalence (LTP) describes the number of people within a population who are expected to develop a particular disorder at some time in their lives. The number is generally listed as a percentage of "at risk" people out of a larger population. If there are 1000 people in the total population, and 100 of them get a particular illness at some point during their lifetimes, then the LTP for that illness is 10%, as 10% of the people within the population came down with that illness at some point in their lives.

For bipolar disorder, the LTP is estimated to be about 4%. The World Health Organization states that over 60 million people worldwide have bipolar disorder. According to several studies, a significant proportion of the children and adolescents with depression may actually be experiencing the early onset of adolescent bipolar disorder, but have not yet experienced the manic phase of the illness. It is also suspected that a significant number of children diagnosed with attention-deficit disorder with hyperactivity (ADHD) actually have early-onset bipolar disorder instead of or alongside of ADHD. For example, an elementary school age child who seems difficult to settle in a classroom and cannot concentrate or refuses to do so might actually be showing the first adolescent bipolar disorder signs.

Course of Bipolar Disorder

Bipolar disorder typically develops in late adolescence or early adulthood. The average age of onset for Bipolar Disorder I is 18 and for Bipolar Disorder II is the mid-20s for both men and women. However, there is some variation in the age of onset. Some people have their first bipolar disorder symptoms during childhood, and some develop them later in life. The symptoms are often not recognized as a bipolar disorder right away. People may suffer for years before the condition is properly diagnosed and treated.

Bipolar disorder is ongoing condition. More than 90% of individuals who have a single manic episode go on to have future episodes. About 60-70% of manic or hypomanic episodes occur before or after a major depressive episode. The frequency of swings during a lifetime is typically increased in those with bipolar II disorder compared to other bipolar conditions. Approximately, 5-15% of these patients become rapid-cyclers with a poorer treatment outcomes.

Females with Bipolar Disorder I tend to have more rapid cycling and mixed feature episodes than males do. Females also tend to have co-occurring eating disorders. Females with bipolar I and bipolar II are more likely than males to experience depressive episodes, have a higher risk of alcohol use disorder.

Once bipolar disorder signs have established themselves, episodes of mania and depression often recur across the life span. Bipolar disorders have no cure and are chronic, long-term conditions. The risk of suicide is high among those with bipolar disorder. The rate is estimated to be at least 15 times the rate of those in the general population without bipolar disorder. According to the DSM, bipolar disorder may account for 25% of all completed suicides. Bipolar patients are also at heightened risk for engaging in impulsive and risky acts other than suicide such as violent outbursts, domestic abuse, substance abuse, etc.

Fortunately, the worst (e.g., most dangerous) symptoms can be controlled and stabilized in most cases provided that proper bipolar disorder medications are prescribed and taken regularly. Approximately 20-30% of individuals with bipolar I disorder and 15% of individuals with bipolar II disorder will continue to show changing moods and challenges with school, work and relationships despite following treatment guidelines. Ongoing protective treatment is generally recommended for patients even when they have not shown evidence of mood swings for extended periods of time. This can help prevent the possible recurrence of suicidal thoughts and other risky, impulsive self-destructive behaviors.