Does Bipolar Disorder Run in the Family?

“I just met a woman in her early 20s who I really like.  She seems very together but she told me that her parents and two brothers are all diagnosed and on medication for bipolar disorder.  I am wondering if something like this will also happen to her.  What are her chances of getting bipolar disorder?”

First a question of my own:  Has anyone found the true cause of bipolar disorder?  Wouldn’t it be wonderful to know that X or Y was the cause, but the answer is not that simple.  Most scientists believe that mental illnesses are caused by a combination of several factors working together.  In bipolar disorder, these factors are usually divided into biological and psychological causes.  In plain English, the main reasons mental illness develops are physical (biological) and environmental.

The first question in relation to what you are asking is:  Is bipolar disorder inherited?

This question has been addressed in many studies.  In families of persons with bipolar disorder, first degree relatives (parents, children, siblings) are more likely to have a mood disorder than the relatives of those who do not have bipolar disorder.  The closer the relationship, the greater the odds; for instance, in studies of twins, identical twins are three times more likely to develop bipolar disorder than a fraternal twin.  The rate is 80% for identical twins and only 16% for fraternal twins.  So, there is overwhelming evidence that bipolar disorder can be inherited and that there is a genetic vulnerability to developing the illness.  There is also strong evidence that just because there are first degree relatives with bipolar disorder, it does not automatically mean that you will develop the illness.

As far as the biological factors, researchers are quite certain that the neurotransmitter section of the brain is at least part of the cause of bipolar disorder.  However, more research is needed to define its exact role.  Suffice it to say that every individual is different, so the inherited biological factors may or may not be present.  It is, however, important to note that your lady friend has both parents and two siblings with bipolar disorder.  There is a strong indication that she would be quite vulnerable to developing bipolar disorder.

For mental, emotional, and environmental issues, stressful life events are thought to be the main element in the development of bipolar disorder.  These can range from a death in the family, loss of a job, the birth of a child, or making a physical move, such as moving to a new home, or even going to college.  It can be pretty much anything, but it cannot be precisely defined, since one person’s stress may be another’s pleasure.

So, research has found that life events can lead to the development of symptoms of bipolar disorder.   However, once the disorder is triggered and progresses, psychological and/or biological processes take over and keep the illness active.

The best explanation of what causes bipolar disorder is that each person inherits certain physical vulnerabilities to problems that may or may not appear, depending on what stresses occur in his or her life.  Durand and Barlow (2000) define this as the theory that both an inherited tendency and specific stressful conditions are required to produce the disorder.

So, according to current thinking, your lady friend may have been born with a stronger likelihood than the “average” person of developing bipolar disorder and some stressful event in her life could cause the illness to “kick in.”  She may or may not have already experienced significantly stressful life events.  If she has, she may be someone who has the emotional resiliency to remain stable in the face of heavy stress.  It is then possible that she may never develop bipolar disorder, but her chances, due to heredity, do put her in a high risk category.

So, the evidence does strongly suggest that she is in a high risk category.  Might she develop bipolar disorder?  Nobody knows for sure.  Can she do anything to maintain a sense of stability and avoid development of symptoms?  There is much evidence that resilient and active people who lead a healthy life style are at less risk.  Exercise, a healthy diet, adequate sleep, avoidance of and/or development of techniques to handle such stress, spirituality and healthy relationships with others are all important factors in your lady friend maintaining her mental health.

The worst case scenario is that she does indeed develop symptoms of bipolar disorder.  If this occurs, early intervention and treatment are most important.  In point of fact, early diagnosis and appropriate treatment, often including both medication and psychotherapy, can allow persons with bipolar to lead full and productive lives.  John Preston and Julie Fast have written a book entitled: Loving someone with bipolar disorder.  Dr Jan Fawcett and his coauthors have written:  New Hope for People with Bipolar Disorder.  Either or both of these might be most helpful to you in your potential relationship.  I wish you the best of luck in your pursuit of happiness.

~Dr. Manuel S. Silverman, PhD