What Is Bipolar Disorder?

Take our Bipolar Disorder Test

Find a therapist to treat bipolar disorder

by Dr Elizabeth Tyler

Older people have faced ageism in mental health services, including the belief that emotional difficulties are simply a part of ageing or that change is less possible later in life. This can delay appropriate assessment, diagnosis and support.

Common misconceptions are that bipolar disorder is a condition that only starts in younger people. However, there is a subset of people who have late-onset bipolar disorder and have their first episode after age 50.

The complexity of diagnosis in later life

Bipolar disorder can be difficult to recognise in older adults. It is not uncommon for someone to receive multiple diagnoses before they are diagnosed with bipolar. Late-life bipolar will often present primarily with depressive symptoms, and therefore may be diagnosed as depression.

Alongside this, people are often more likely to seek help when they feel low, rather than when their mood is elevated. In later life, symptoms such as impulsivity, irritability or agitation may be misattributed to other difficulties, including cognitive decline or dementia.

Older people are also more likely to have additional physical health comorbidities, which may complicate the clinical picture. They may also be less likely to seek help due to the perceived stigma of having a mental health condition.

Hormones and women’s mental health

For women, hormonal changes can add another layer of complexity. Hormonal shift may play a role in the development of late-onset bipolar disorder, but more research is needed in this area.

There is an overlap in symptoms, and this can be difficult to disentangle. Symptoms of bipolar disorder and natural hormonal changes, such as those experienced during mensuration, perimenopause and menopause can be very similar. Both can involve mood swings, irritability, sleep disruption, fatigue and difficulty concentrating.

Hormonal fluctuations can also act as triggers for mood episodes in those with bipolar disorder. We often see this during menstruation, pregnancy and menopause.

Moving beyond stereotypes

Bipolar disorder doesn’t always look the way people expect.

It is often portrayed as involving extreme highs and lows, but it is more helpful to understand bipolar as a condition that exists on a spectrum. At one end are everyday mood fluctuations, while at the other are more severe states such as mania or depression.

This approach shifts away from the traditional ‘all or nothing’ representation of mental health conditions and can be helpful when people are first diagnosed to reduce stigma and normalise experiences. Irritability, for example, is a common symptom that doesn’t fit the classic image of mania. Rather than feeling euphoric, someone may feel highly agitated and frustrated when they are manic.

People with a diagnosis also report periods of increased energy, productivity or creativity, particularly during hypomania. These experiences can be viewed positively by the person, and they may not always want to engage in treatments that take these away.

When should you seek support?

Many people experience temporary changes in mood during stressful periods or life transitions. These often improve as circumstances change. It is important to look at the impact of these mood changes.

What Is Bipolar Disorder?

Take our Bipolar Disorder Test

Find a therapist to treat bipolar disorder

If mood changes are affecting your work, relationships or ability to carry out daily tasks, it may be time to seek support.

Signs to look out for include changes in sleep or appetite patterns, withdrawing from social activities, struggling to maintain routines or personal care, or using substances to cope.

Stigma around bipolar disorder remains a significant issue. Negative portrayals can lead people to worry about being judged or misunderstood, which may affect whether they seek help or disclose a diagnosis. Some individuals also internalise these beliefs, leading to feelings of shame and low self-worth.

For many, receiving a diagnosis in later life can bring complex emotions. There is often relief in finally understanding years of confusing experiences, but this can be accompanied by concerns about living with a potentially lifelong condition as well as the label of “bipolar disorder” and the associated stigma.

However, with the right support, people with bipolar disorder can live full, meaningful and productive lives. A diagnosis can be an important turning point. It provides a framework for understanding past experiences and may open the door to psychological treatment.

Psychological therapies, such as cognitive behavioural therapy (CBT), play a key role in helping individuals recognise early warning signs, manage mood changes, improve relationships and establish stable routines.

Connecting with others — whether through peer support groups or wider communities — can also be incredibly powerful in reducing isolation and helping people make sense of their experiences.

Later life can bring significant shifts — retirement, relocation, changes in social circles and more time alone. This can lead to increased rumination and, for some, difficult feelings of guilt or shame about past experiences whilst manic or depressed. In my clinical work, I have found that reflecting on and making sense of behaviours during past episodes is a key step in therapy, helping to reduce feelings of shame and guilt.

A broader conversation

As awareness of mental health in later life grows, it is vital that we broaden the conversation. Not all mood changes are simply a part of ageing or, for some women, hormonal shift. For some people, recognising this can be life-changing.

The more we understand about how bipolar disorder can present, particularly in later life, the better equipped we will be to ensure people receive the support they need.

Elizabeth Tyler is a Clinical Lecturer in Psychology and a Chartered Clinical Psychologist at the University of Manchester. She has worked clinically and in research settings with people living with bipolar disorder for over 20 years.

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