By Madeline Vann, MPH
People with any mental illness are often labeled as potentially violent, even if they have no history of violence or any apparent violent tendencies. This stigma can be particularly strong when applied against people with bipolar disorder, which can be alarming and misunderstood by others.
The truth about the risk of violence among bipolar people is complicated. By some estimates, between 11 and 16 percent of people with bipolar disorder have had a violent episode. These typically occur during extreme moods or because of drug or alcohol use. But there are many people with bipolar disorder who are never violent. Knowing which bipolar symptoms of depression and mania to watch out for may help avoid dangerous situations.
“There has been a long-standing expectation that mentally ill individuals are more likely to perpetrate violent acts. However, large population studies suggest that mental illness alone does not increase the likelihood of violence,” says psychiatrist Michael Peterson, MD, PhD, an assistant professor in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison.
Factors that Increase the Risk of Violence
While having bipolar disorder alone does not make violence more likely, there are situations which, when combined with bipolar disorder, can increase the risk of violence. These include:
Drug or alcohol abuse. Substance use is common among people with mental illness. Unfortunately, drugs and alcohol can make violent episodes more likely — and may also put people in situations where violence is the norm.
High emotional stress. Periods of great emotional stress or distress, such as losing a loved one or ending a relationship, may trigger mood swings that can increase the risk of violence.
The Danger of Self-Harm
In fact, people with bipolar disorder may be more of a threat to themselves than anyone else in their lives. Innocent bystanders may be worrying unnecessarily about their own safety when the reality is that bipolar disorder can lead to a lot more damage to the person living with it.
These risks include:
Suicide or attempted suicide. Rates of suicide are significantly higher among people with bipolar disorder than their peers. People with bipolar disorder are close to nine times more likely to commit suicide than their peers.
Drug or alcohol abuse. “People with bipolar [disorder] are also at higher risk of developing substance abuse or dependence,” explains Dr. Peterson, adding that bipolar patients are at higher risk of having manic or depressed episodes when they are abusing drugs or alcohol. Data suggest that 46 percent of people with bipolar disorder are dependent on alcohol and that 41 percent are dependent on other drugs.
Cutting. Occasionally, people with bipolar disorder cut or hurt themselves deliberately.
Non-physical damage. During manic periods, bipolar people may do a lot of “violence” to their own financial situation, relationships, and other elements of their lives as they act on impulse and pursue high risk behaviors.
If you have a loved one with bipolar disorder, Peterson says, “Be vigilant for signs of either depression or mania. Particularly during depressed or mixed episodes, when there are concurrent symptoms of both mania and depression, a real concern is suicidal thoughts and attempts.”
Peterson says signs of depression to watch out for include being more withdrawn or sad, or sleeping more than usual. Warning signs of mania include talking more, becoming more active, sleeping less, and becoming more outgoing and impulsive. Mania can lead to violence because of increased irritability and poor impulse control.
Peterson advises having “frank discussions” about these symptoms with the person who has bipolar disorder and then notifying her doctors or therapists, or even the police, if you continue to be concerned about your safety or the safety of the person with bipolar disorder. Effective medications are available that can help reduce the risk of violence and control the bipolar symptoms if urgent situations are identified in a timely way.