Dr Tom Richardson, Principal Clinical Psychologist, Solent NHS Trust and Visiting Academic, University of Southampton
Bipolar disorder and financial difficulties: some preliminary findings
In the world of mental health I wear many hats. I’m a clinical psychologist. I’m an academic. And I’m a service-user, I have a diagnosis of bipolar disorder myself.
So my latest research, on the links between bipolar disorder and spending, is something very close to my heart.
Bipolar disorder is a mental health problem characterised by episodes of depression and hypomania or mania. When people are hypomanic or manic, they may have symptoms such as grandiosity, elevated mood, decreased need for sleep and an increase in ‘goal directed activity’ – that is, activities focused on very specific projects or ambitions.
It has been shown that people with bipolar can be impulsive, especially when manic. Indeed a potential symptom, according to the diagnostic criteria for the condition, is ‘excessive involvement in pleasurable activities with high potential for painful consequence’ (for example, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Those with bipolar disorder are also at higher risk of gambling and compulsive spending, and caregivers often report that this causes them stress.
However, despite excessive spending being included in the diagnostic criteria and many screening questionnaires for the condition, there is very little research on it in bipolar disorder. Research has shown that those with depression are more than twice as likely to be in debt, and research with students suggests a vicious cycle between financial difficulties and mental health problems. However there is little research on the impact of debt on mental health in bipolar disorder specifically.
Themes in the current study
A study I conducted in Portsmouth, which is in press in the journal Clinical Psychology Forum, asked 44 people with bipolar disorder how they saw their finances as related to their mental health and found a number of themes:
- Overspending, and within this impulse shopping and excessive generosity: for example giving all money to charity when high
- Anxiety and depression, and within this suicidality: for example feeling depressed when people realise how much debt they are in
- Regret/Guilt: for example regretting overspending when manic
- Poor planning/avoidant coping: for example ignoring bills
- Vicious cycle: For example realising in that they are debt and feeling depressed, and then comfort spending to cope
- Poor employment: For example having to take pay cuts due to mental health problems
- Comfort spending: For example buying things to feel better when down
The relationship over time
A simultaneous study I conducted in Portsmouth (both papers of which are being written up, so results are preliminary) gave 54 clients with bipolar disorder questionnaires about finances, compulsive shopping, mood and psychological variables such as mindfulness. 40 clients also completed these again at a second time point four months later.
This found that, across one time point (baseline results not controlled for):
- Greater impulsivity led to greater financial difficulties over time
- Poorer perceived financial wellness lowered self-esteem over time
- Being in greater financial difficulty at the beginning of the study increased the likelihood of later hypomanic thoughts around a need to achieve and being goal focused
After baseline scores were controlled for:
- Poorer perceived financial wellness increased anxiety and stress over time
- How clients saw their finances subjectively was more important than objective measures such as the number of loans.
- Compulsive shopping got worse over time with higher symptoms of depression anxiety and stress, as well as lower mindfulness, higher dependency on others and a greater focus on achieving specific goals. Dependency and anxiety were also increased by compulsive spending suggesting a vicious cycle.
A preliminary psychological model
From these findings, a preliminary psychological model is being developed to try and map the complex relationships between finances and mental health in bipolar disorder.
Essentially, we find a potential cycle between financial difficulties, worry about finances, anxiety, depression and suicidality, and compulsive spending. Financial difficulties lead to anxiety and low self-esteem as people worry about their finances. This low-self esteem can also lead to depression. Anxiety and depression can then cause people to comfort spend. These mental health problems can also worsen financial difficulties, as people avoid financial management, struggle with financial planning and struggle to find and maintain stable employment. Low mood and anxiety can also lead to higher spending, creating another pathway to financial difficulties. When people are depressed they can be less mindful or aware, which makes them more vulnerable to compulsive shopping, buying things in an attempt to feel better. When people have low self-esteem they can also feel more dependent on others, and need to feel approved by those close to them, in some cases offering gifts to try and win this approval. In both cases,this spending can create a vicious cycle when fuelling guilt and regret, which exacerbates anxiety. Financial difficulties can also trigger hypomanic symptoms and thoughts around a need to achieve – the ideas about how to achieve can sometimes include ideas about how to get themselves out of their financial hole. In some cases, this might mean a plan to try and spend money to make money, which fuels compulsive shopping and ultimately ends up increasing financial difficulties.
Not everyone with bipolar disorder will experience financial difficulties or changes in spending behaviour, and where these are experienced they will not always follow these routes. For some the goal focus might be key, for others avoiding their finances when anxious might be important. But understanding how these issues are connected will make it easier to ensure people receive the right support.
This study suggested that:
- Finances affect mental health and vice versa in people with bipolar disorder: there is a vicious cycle.
- Compulsive spending is a key factor: This is not always random, there are potential themes and it is goal-focused, that is, directed towards specific ideas and projects that a person may fixate on
- Many psychological mechanisms are important and psychological therapies such as CBT and mindfulness might help break the link
- Future research is needed to help test the model and develop interventions to help.