When you hear the word disability, chances are you think it applies to a physical injury rather than a mental illness. But does bipolar disorder qualify as a disability? Can you get the financial help you need if you are unable to work because of your bipolar symptoms? According to Stuart Gitlow, MD, associate clinical professor of psychiatry at Mount Sinai School of Medicine in New York City, the answer to both questions is yes.

Bipolar Disorder: Why Is It Disabling?

Dr. Gitlow, who has worked with the Social Security Administration as a consultant and medical expert for 20 years, explains that most people with bipolar disorder can work: Many find that they can return to their jobs once they receive proper medical care. However, certain people with this condition have such extreme episodes of depression and mania that they are unable to function, despite ongoing treatment. Severe depression, for instance, impairs the ability to focus, to attend to tasks, and to respond at reasonable speed to others. And mania symptoms such as racing thoughts, rapid speech, and difficulties with concentration make relating to others or completing job-related tasks that much harder. The more frequent the cycling of mania or depression episodes, the greater the difficulty in keeping a job.

Bipolar Disorder Disability: Who's Qualified?

To be eligible for disability, you must meet a number of specific medical and psychosocial requirements.

Accurate diagnosis. In order for someone with bipolar disorder to qualify for Social Security disability benefits, the first order of priority is an accurate diagnosis. "Mood variations are normal," Gitlow says. "We all have highs and lows, and we all sometimes swing quickly from one to the other in response to life stressors. We don't want to see normal human emotions turned into a disease state. Sometimes mood variations are the result of medications, drug use, or medical difficulties — these must be ruled out as possible causes before bipolar disorder can be diagnosed."

History of both manic and depressive syndromes. Besides an accurate diagnosis of bipolar disorder, there are additional requirements to qualify for benefits, says Gitlow. "You must have bipolar disorder with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes." At least two of the following statements must also be true:

  • You find it difficult to carry out the normal activities of daily living.
  • You are unable to focus your attention long enough to complete tasks on time.
  • You have a hard time getting along with other people.
  • You have extended episodes of decompensation — meaning that your bipolar symptoms worsen and your ability to function in your daily life lessens during these periods.

Activities of daily living. Gitlow notes that you would fail to meet the disability criteria if you've never been hospitalized and if you are still able to perform such daily tasks as cooking, shopping, and cleaning; caring for children; spending time with family and friends; and keeping up with the news. You would also fail if your difficulties in these areas are only mild or moderate. However, circumstances vary, and there are other criteria that the examiners may consider when reviewing your application.

Applying for Disability Benefits

Going through the disability application process takes both time and persistence. To begin, you need to contact the Social Security Administration (SSA) either online, in-office, or over the phone. Their Web site has plenty of information on what to do and how to do it, but here's a very general idea on how it works:

Step 1. SSA gets the application and makes certain that you qualify. If there's an obvious technical reason not to even look at your medical records — for example, if you don't meet the citizenship qualifications for legal residence — your application may not go beyond this point.

Step 2. If you do meet the requirements, your application is sent to a state agency (Disability Determination Services), which will gather all your pertinent medical records. If there isn't enough information available from your prior health-care providers, the agency may ask you to undergo a medical examination. You will not have to pay for this exam.

Step 3. After your medical records and/or your examination results are reviewed, a decision will be made by the Disability Determination Services. If you're approved, there's about a five- month waiting period before you'll get the first payment from the SSA. If you were denied benefits, you can appeal the decision.

Bipolar Disorder and Disability: Some Facts to Keep in Mind

Gitlow has some additional recommendations as you make your way through the application process:

  • See a specialist. A truly disabled person doesn't want disability; they want to get better. Demonstrate that this is your true goal by seeking help from an appropriate physician specialist, by being compliant with treatment recommendations, and by being willing to try several different therapeutic options as necessary to get the best possible outcome. Just as you would want to see a cardiologist if you suffer from heart disease, see a psychiatrist for treatment of bipolar disorder.
  • Retain an attorney. If your application is denied and you apply for a hearing before an administrative law judge, retain the services of an attorney specializing in disability. While this is not a requirement, it will allow the process to go more smoothly and ultimately will improve your chances to be found disabled. The attorney can also discuss with you what other medical evidence might be important to obtain.
  • Request medical records. Maintain your own copies of your medical records from every treatment source. While the physician creates the medical record, the content is yours. All you need to do is request a copy, and you should always keep copies of your records, particularly in the case of a chronic disease like bipolar disorder.
  • Show up. If your state Disability Determination Service arranges for you to go to a consultative evaluation, don't miss it. Your state agency will always assist if you have difficulty with transportation. Says Gitlow: "In my experience, having been scheduled to provide psychiatric evaluations for over 3,000 Social Security applicants, I am amazed that the no-show rate is one out of three."