Of individuals with BP, 30–50% also meet criteria for substance misuse or personality
disorders, which usually predict poorer response to medication alone. Many of these
disorders precede the diagnosis of BP. Bipolar disorder has a median age of onset in the
mid-20s, but most individuals report that they experienced symptoms or problems up to
10 years before diagnosis. Thus, the early evolution of BP may impair the process of
normal personality development or may lead the person to employ maladaptive
behaviours from adolescence onwards. Comorbid anxiety disorders (including panic and
PTSD) and other mental health problems are common accompaniments of BP, whilst 40–
50% of subjects may have interepisode sub-syndromal depression (Judd et al., 2002).
Although many individuals manage to complete tertiary education and establish a career
path, they may then experience loss of status or employment after repeated relapses. A
period of 1 year after an episode of BP, only 30% of individuals have returned to their
previous level of social and vocational functioning. Interpersonal relationships may be
damaged or lost as a consequence of behaviours during a manic episode and/or the
individual may struggle to overcome guilt or shame related to such acts. The above
psychological and social sequelae identify a need for general psychological support for an
individual with BP.