The "Risky Business" of Risk-Taking in Bipolar Disorder

For my master’s thesis, I am collecting information about risk-taking behaviors in Bipolar Disorder (BD) along with my supervisor, Dr. Guillermo Perez-Algorta (see Bipolar and Risk-Taking Behaviors: New Research, by Anna Chiara Sicilia). As a part of my research, I have been reading and thinking a lot about risk-taking.

Risk-taking can be defined as this: “Excessive involvement in activities that have a high potential for painful consequences.” It is one of the key symptoms of manic episodes in BD. Substance use¹, heightened risk for violent crime², alcohol abuse³, increased sexual promiscuity⁴, and unwise financial activities⁵ are some examples commonly associated with BD. The results of these risky behaviors may have incredibly negative consequences on well-being and relationships.

But risk may not be as simple as we think. As you will read, risk is unavoidable, risk is not always negative, and how risky something is varies depending on our health. So, we may as well give it some more attention. The following blog post presents some misconceptions regarding the concept of “risk” in our daily lives and mental health.

Myth 1: Risk is completely avoidable!

Risk is actually a decision-making process made up of three components: external circumstances (certainty), uncertainty, and subjectivity. Every situation has circumstances we know of (certainty), and circumstances we do not know of (uncertainty). The interpretation of these circumstances is our very own, based on our feelings and thoughts (subjectivity). Of course, the final step is our decision to engage or not engage with the situation. This means that there is some risk in every situation.

Take for example, eating at a restaurant with our family. Imagine the following mental conversation as you choose your meal:

Voice 1: Ah! Lasagna! My favorite dish!

Voice 2: I always get lasagna; I should try something new. The mushroom risotto also looks nice!

Voice 1: But what if the mushroom risotto is no good? I’ve never had that dish. And I remember the last time I had a dish with mushrooms. It did not go well. I mean- I’d rather stick with what I know.

Voice 2: But the mushroom risotto might also be fantastic… I won’t ever know until I try. I just don’t want to miss out on having some variety in my life!

This may look somewhat familiar, although exaggerated. The risk of trying the mushroom risotto is that it might not be good (emphasis on the word “might” = uncertainty). The risk of sticking with our classic choice of lasagna is that we might miss out on a delicious dish, perhaps our new favorite (emphasis again on the word “might” = uncertainty)! As this example shows, even picking our dinner is a risk; risk is all around us.

Myth 2: The consequences of risk-taking are always negative!

If a young professional, diagnosed with bipolar disorder, takes the last of their savings and starts their own entrepreneurial experiment, many would call that a risk. If they fail, their friends and family may have to help them out financially, and they may attribute the failure to emotional instability, rash decision-making, and lack of consideration for the consequences of their actions. But if they succeed, their friends and family would attribute the success of the venture to their unique vision, creativity, drive, and the “leap of faith”(read: risk) that they took.

In other words, we have a “negativity bias” when it comes to the word “risk.” Negativity biases refer to our tendency to give more weight to negative events and information than positive ones. It is unfair to categorize all risk as negative. Sometimes it is positive, particularly when it results in positive results! A word we often use for a risk that goes well is an “opportunity.”

Myth 3: Mental health diagnoses make you more susceptible to all risks OR Mental health diagnoses do not affect your susceptibility to any risks.

This narrative has two extremes, and the most appropriate understanding is probably somewhere in between. During my studies, I had an acquaintance diagnosed with major depression. The University told them that they should not apply to study abroad because the adjustment would be too difficult considering their diagnosis (they had sought treatment at the University clinic). On the other hand, plenty of other acquaintances went on study abroad without any trouble and no one even questioned the risk to their mental health in going abroad.

Similarly, a choice to go mountain biking may be considered a risky behavior for someone who is diagnosed with BD as opposed to someone without a diagnosis. Even though the chances of you getting injured while going mountain biking are probably equal whether or not you have a diagnosis of BD, an outside perspective may not view them as equal.

These two examples demonstrate how individuals with mental health diagnoses are often judged to be more fragile, which is certainly not always true. However, it also shows how some behavior that is not considered a risk for individuals considered “healthy” is sometimes considered a risk for individuals considered “ill”.

So what does this mean, particularly when it comes to BD?

This means that we need to learn how to individually deal with risk and decision-making, according to our own needs and diagnoses. Unhealthy risky behaviors could be avoided with an accurate understanding of ourselves and judgment of the potential consequences of our actions. In BD, this understanding can be compromised, particularly during mood episodes. However, a good decision-making process should effectively identify healthy and positive risks (or opportunities), and avoid unhealthy and negative risks.

So, do individuals with BD take more unhealthy risks because there is something different about how they make decisions? In fact, how do individuals with BD make decisions about risks?

We don’t know the answers to these questions yet, but we want to find out. This is where our study comes in. Our survey asks individuals with a diagnosis of BD about their decision-making processes and how they think and feel about risk. Perhaps if we can understand decision-making in BD, then we can help individuals with diagnoses to make better decisions and engage with risk-taking in a healthy and positive way.

If you are over the age of 18, speak English, and have a diagnosis of bipolar disorder, you can help us answer these questions. If you are interested in completing in our survey, please click on the following link:

https://redcap.lancaster.ac.uk/surveys/?s=XXWY9JXECX

If you would like more information about the project or this article, please contact the author of this post, Julia Lukacs, at j.lukacs@lancaster.ac.uk.

¹Wilens, T. E., Biederman, J., Millstein, R. B., Wozniak, J., Hahesy, A. L., & Spencer, T. J. (1999). Risk for Substance Use Disorders in Youths With Child-and Adolescent‐Onset Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 38(6), 680-685.

²Fazel, S., Lichtenstein, P., Grann, M., Goodwin, G. M., & Långström, N. (2010). Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. Archives of general psychiatry, 67(9), 931-938.

³Kathleen Holmes, M., Bearden, C. E., Barguil, M., Fonseca, M., Serap Monkul, E., Nery, F. G., … & Glahn, D. C. (2009). Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse. Bipolar Disorders, 11(1), 33-40.

⁴Kopeykina, I., Kim, H. J., Khatun, T., Boland, J., Haeri, S., Cohen, L. J., & Galynker, I. I. (2016). Hypersexuality and couple relationships in bipolar disorder: A review. Journal of affective disorders, 195, 1-14.

⁵McIntyre, R. S., McElroy, S. L., Konarski, J. Z., Soczynska, J. K., Wilkins, K., & Kennedy, S. H. (2007). Problem gambling in bipolar disorder: Results from the Canadian Community Health Survey. Journal of affective disorders, 102(1), 27-34.