Bipolar Disorder in Women: Prevalence, Symptoms, and Treatment

Bipolar disorder in women can be difficult to recognize, especially when symptoms are mistaken for depression, anxiety, trauma responses, or the exhaustion of trying to hold everything together. While overall rates are similar among women and men, women may experience certain patterns differently, including more depressive episodes, rapid cycling, hormonal mood shifts, and co-occurring conditions.

This page will cover:

• What bipolar disorder is and how common it is in women
• When bipolar disorder symptoms often begin
• Symptoms of mania, hypomania, and depression
• Why bipolar disorder may look different in women
• Common co-occurring conditions, including anxiety, PTSD, eating disorders, and substance use

What Is Bipolar Disorder?

Bipolar disorder is a mental health condition that causes significant shifts in mood, energy, activity level, sleep, and concentration.¹ These shifts are more intense than ordinary emotional ups and downs and can affect relationships, work, school, parenting, recovery, and daily routines.

There are several types of bipolar disorder, including:

• Bipolar I disorder: Involves at least one manic episode. Depressive episodes may also occur, but they are not required for diagnosis.
• Bipolar II disorder: Involves depressive episodes and hypomanic episodes, but not full manic episodes.
• Cyclothymic disorder: Involves ongoing periods of hypomanic and depressive symptoms that do not fully meet the criteria for bipolar I or bipolar II.

For many women, bipolar disorder is not recognized right away. A woman may seek help during depression, anxiety, emotional overwhelm, or substance use struggles, while past hypomanic symptoms may be remembered as “finally feeling good,” “being productive,” or “pushing through.” This can delay an accurate diagnosis and the right treatment plan.

How Common Is Bipolar Disorder in Women?

Bipolar disorder doesn’t appear to be dramatically more common in adult women overall, but women may experience certain types and patterns more often. The National Institute of Mental Health reports that an estimated 2.8 percent of U.S. adults had bipolar disorder in the past year. Past-year prevalence was similar among females and males, at 2.8 percent and 2.9 percent, respectively.²

However, those numbers don’t tell the whole story. Bipolar II disorder appears to be diagnosed more often in women than men, while bipolar I disorder is generally more evenly distributed.³ Women may also be more likely to experience depressive episodes, mixed symptoms, and rapid cycling, which means having four or more mood episodes in one year.

SAMHSA data also show that many people with mental illness live with co-occurring substance use disorders.⁴ For women with bipolar disorder, this overlap is important because alcohol or drug use may begin as an attempt to cope with depression, anxiety, trauma memories, insomnia, or emotional intensity.

When Does Bipolar Disorder Usually Begin?

Bipolar disorder most often begins in the teen years or early adulthood, although symptoms can appear earlier or later.⁵ Some women first notice mood symptoms during major life transitions, such as leaving home, entering relationships, pregnancy, postpartum recovery, grief, trauma, substance use escalation, or long periods of stress.

Age of onset matters because untreated bipolar disorder can shape how a woman sees herself. She may blame herself for emotional intensity, impulsive decisions, unfinished goals, relationship strain, or repeated cycles of burnout and depression. A compassionate diagnosis can help her understand that these patterns are treatable. 

Symptoms of Bipolar Disorder in Women

Bipolar disorder symptoms vary by person and by episode. Women may experience mania, hypomania, depression, mixed symptoms, or rapid cycling. Symptoms may also be shaped by trauma, substance use, sleep disruption, hormonal changes, and co-occurring mental health concerns.

Manic symptoms

Mania is a period of elevated, expansive, or irritable mood with increased energy or activity.⁶ It is more severe than hypomania and may cause major impairment, hospitalization, risky behavior, or symptoms of psychosis.

Manic symptoms may include:

• Needing much less sleep without feeling tired
• Feeling unusually energized, powerful, or invincible
• Racing thoughts
• Talking more quickly or more often than usual
• Taking major risks with money, sex, driving, substances, or relationships
• Increased irritability or agitation
• Feeling unusually confident or grandiose
• Difficulty slowing down
• Hallucinations or delusions in severe episodes

Mania can be frightening after it passes. Treatment should address both mood stabilization and the emotional aftermath of what happened.

Hypomanic symptoms

Hypomania is similar to mania but less severe. Though it might be less severe, it can still disrupt a woman’s life. Because hypomania may come with energy, confidence, creativity, or productivity, it can be harder to recognize as part of bipolar disorder.

Hypomanic symptoms may include:

• Taking on too many projects
• Feeling unusually social, talkative, or driven
• Increased impulsivity
• Irritability or impatience
• More intense emotions
• Racing thoughts
• Making decisions that feel out of character later

Some women only seek help when the depressive crash arrives. This is one reason bipolar II disorder may be misdiagnosed as depression.

Depressive symptoms

Depressive episodes are often a major part of bipolar disorder in women. These episodes can feel heavy, isolating, and difficult to explain.

Depressive symptoms may include⁷:

• Persistent sadness, emptiness, or hopelessness
• Loss of interest in relationships, hobbies, or responsibilities
• Fatigue or feeling physically slowed down
• Sleeping too much or too little
• Appetite or weight changes
• Difficulty concentrating
• Feelings of guilt, worthlessness, or shame
• Thoughts of death or suicide

If suicidal thoughts are present, immediate support matters. Call or text 988 for the Suicide & Crisis Lifeline, or call 911 if there is immediate danger.

Why Bipolar Disorder Can Look Different in Women

Bipolar disorder can look different in women because symptoms often overlap with depression, anxiety, trauma, eating disorders, substance use, and hormonal changes. These overlapping experiences do not make symptoms less real. They make the full picture more important.

Women may be more likely to experience depressive episodes, rapid cycling, mixed symptoms, and co-occurring anxiety disorders. Some women also notice mood changes around menstruation, pregnancy, postpartum recovery, perimenopause, or menopause. These transitions can affect sleep, energy, emotional sensitivity, and stress tolerance.

This is why women deserve treatment that looks beyond symptoms on a checklist. The right care asks deeper questions: What has happened to you? What helps you feel safe? What patterns keep repeating? What support do you need to stabilize your mood without losing yourself?

Co-Occurring Conditions in Women With Bipolar Disorder

Many women with bipolar disorder also live with other mental health or substance use concerns. These co-occurring conditions can intensify symptoms, complicate diagnosis, and make treatment feel more difficult without integrated support.

Anxiety disorders

Anxiety is common among people with bipolar disorder.⁸ For women, anxiety may show up as racing thoughts, panic, social fear, perfectionism, irritability, muscle tension, or a constant sense that something bad is about to happen. Anxiety can also worsen sleep, and poor sleep can increase the risk of mood episodes.

Eating disorders

Eating disorders and bipolar disorder can overlap, especially when mood shifts affect appetite, body image, impulsivity, control, shame, or emotional regulation.⁹ Some women may restrict food, binge, purge, or cycle through disordered eating patterns as a way to cope with distress. 

PTSD and trauma symptoms

Trauma can affect the nervous system, relationships, sleep, self-worth, and emotional regulation. PTSD symptoms may include nightmares, flashbacks, avoidance, hypervigilance, numbness, or feeling easily triggered. When trauma and bipolar disorder occur together, women need care that is stabilizing and trauma-informed. Moving too quickly into painful memories without enough safety can feel overwhelming, so pacing matters.

Substance use

Some women use alcohol or drugs to manage depression, anxiety, insomnia, trauma memories, or the intensity of mood episodes. This isn’t a character flaw. It’s often an attempt to survive discomfort without enough support. However, substances can worsen mood instability over time and may increase the risk of depression, impulsivity, and unsafe situations.

How Casa Serena Supports Women With Bipolar Disorder

Casa Serena offers trauma-informed care in a women-only setting in Santa Barbara, minutes from the beach. Our programs support women navigating mental health concerns, substance use disorders, trauma, and dual diagnosis through a full continuum of care, including:

• Sub-acute detox
• Residential treatment
• Partial hospitalization program
• Intensive outpatient
• Outpatient care
• Transitional living

Treatment may include individual and group therapy, cognitive behavioral therapy, dialectical behavior therapy, Eye Movement Desensitization and Reprocessing, somatic experiencing, mental wellness programming, and holistic supports such as garden therapy, ecotherapy, equine-assisted therapy, and Tai Chi.

At Casa Serena, women find safety, community, and compassionate support. If bipolar disorder, substance use, or emotional instability is affecting your life, contact Casa Serena today to learn how our women-supporting-women treatment community can help you begin healing.

FAQs About Bipolar Disorder in Women

References:

1. SAMHSA. (2024, April 23). What is Bipolar Disorder? https://www.samhsa.gov/mental-health/what-is-mental-health/conditions/bipolar
2. National Institute of Mental Health (NIMH). (n.d.). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder
3. U.S. Department of Health & Human Services. (2025, February 3). Bipolar Disorder | Office on Women’s Health. OASH | Office on Women’s Health. https://womenshealth.gov/mental-health/mental-health-conditions/bipolar-disorder-manic-depressive-illness
4. Substance Abuse and Mental Health Services Administration. (2023, April 24). Mental Health and Substance Use Co-Occurring Disorders. https://www.samhsa.gov/mental-health/what-is-mental-health/conditions/co-occurring-disorders
5. Baldessarini, R. J., Tondo, L., Vazquez, G. H., Undurraga, J., Bolzani, L., Yildiz, A., Khalsa, H. K., Lai, M., Lepri, B., Lolich, M., Maffei, P. M., Salvatore, P., Faedda, G. L., Vieta, E., & Mauricio, T. (2012). Age at onset versus family history and clinical outcomes in 1,665 international bipolar‐I disorder patients. World Psychiatry, 11(1), 40–46. https://doi.org/10.1016/j.wpsyc.2012.01.006
6. Dailey, M. W., & Saadabadi, A. (2023, July 17). Mania. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493168/
7. Frank, C. (2024, November 21). Depression symptoms: Recognizing common and lesser-known symptoms. Harvard Health. https://www.health.harvard.edu/mind-and-mood/depression-symptoms-recognizing-common-and-lesser-known-symptoms
8. Spoorthy, M. S., Chakrabarti, S., & Grover, S. (2018). Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World Journal of Psychiatry, 9(1), 7–29. https://doi.org/10.5498/wjp.v9.i1.7
9. McElroy, S. L., Kotwal, R., Keck, P. E., & Akiskal, H. S. (2005). Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? Journal of Affective Disorders, 86(2–3), 107–127. https://doi.org/10.1016/j.jad.2004.11.008