Understanding how people living with bipolar disorder talk about risk on social media

Individuals living with bipolar disorder are likely to engage in behaviours which can be risky for
themselves or others [1, 2]. This includes increased prevalence of suicide and self-harm, excessive
spending, alcohol or drug use and risky sexual behaviour [3-8]. Understanding more about this
behaviour is crucial as with the right help people living with bipolar "have the potential to return
to normal function with optimal treatment"p 45 ([9]).
Current psychological models of bipolar explain risky behaviour as an attempt to avoid low mood,
a response to mood elevation or to impulsivity/sensitivity to reward [1, 10, 11]. These approaches
have informed the development of psychological interventions to improve coping strategies for
mood change. However, the effectiveness of such approaches is mixed and evidence is lacking for improvements in the functional and recovery outcomes which qualitative research has shown are
valued [12, 13]. Current research has relied on questionnaire measures of hypothesised
processes, which limits what can be learnt about the subjective experiences of people living with
bipolar. For instance, they tell us little about how such individuals define risk, why they chose to
engage in some such behaviours and how socially normative such behaviour might be. It is clear
therefore, that a mixed method approach is needed to understand the processes which underpin
risk in bipolar. This should combine in-depth qualitative approaches with methods that explore
how people describe their experiences in natural language, not constrained by typical research or
clinical settings. This is particularly important for risky behaviour that is likely to have been
stigmatised.
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