Gender and bipolar illness

Background: For major depression and schizophrenia, gender differences have been reported in symptom expression and course of illness. Gender differen ces in bipolar disorder are becoming increasingly apparent, but have been l ess studied. Research data on these differences will help determine whether gender is important in influencing illness variables such as course, sympt om expression, and likelihood of comorbidity. Method: Charts of 131 patients (63 women and 68 men) with a DSM-IV diagnosi s of bipolar disorder admitted to the University of California Los Angeles Mood Disorders Program over a 3-year period were reviewed to gather data on demographic variables and course of illness and to assess differences in t he illness across genders. Results: No significant gender differences were found in the rate of bipola r I or bipolar II diagnoses, although women were overrepresented in the lat ter category. Also, no significant gender differences emerged in age at ons et, number of depressive or manic episodes, and number of hospitalizations for depression. Women, however, had been hospitalized significantly more of ten than men for mania. Further, whereas bipolar men were significantly mor e likely than bipolar women to have a comorbid substance use disorder, wome n with bipolar disorder had 4 times the rate of alcohol use disorders and 7 times the rate of other substance use disorders than reported in women fro m community-derived samples. Conclusion: For bipolar disorder, course of illness variables such as age a t onset and number of affective episodes of each polarity do not seem to di ffer across genders. Women, however, may be more likely than men to be hosp italized for manic episodes. While both men and women with the illness have high rates of comorbidity with alcohol and other substance use disorders, women with bipolar disorder are at a particularly high risk for comorbidity with these conditions.