Quality of Life Research

, Volume 27, Issue 6, pp 1493–1500 | Cite as

The ‘new normal’: relativity of quality of life judgments in individuals with bipolar disorder—a qualitative study

  • Emma Morton
  • Erin Michalak
  • Rachelle Hole
  • Simone Buzwell
  • Greg MurrayEmail author



Quality of life (QoL) is increasingly a target of interventions for bipolar disorders (BD). While the subjective experience of consumers is often elevated as central to the construct of QoL in BD, limited investigation in this area means subjective QoL remains poorly understood. The present qualitative study seeks to address this by investigating how people with BD appraise the quality of their lives in the context of a QoL self-management intervention.


Semi-structured interviews were conducted with 43 individuals who had participated in a self-management intervention for improving QoL in BD. Individuals were questioned about experiences of the intervention and perceptions of their QoL. Thematic analysis was used to explore participants’ appraisal of their QoL.


An overarching theme concerned the intrinsic relativity of subjective QoL: individuals located QoL as relative to self, others and possible futures. Incorporating illness-related reference points for QoL (‘given my circumstances…’) was associated with perceptions of improved QoL. Deliberately modifying reference points for QoL was perceived as self-compassionate.


The present study generates novel hypotheses about how individuals with BD make sense of their QoL. Data suggest that individuals located their QoL relative to a variety of reference points, use of which was flexible. In accord with gap theories of QoL, individuals experienced acceptance of illness impacts as improving subjective sense of QoL. Rather than ‘settling for’ a lower standard of QoL, individuals experienced these changes as adaptive and positive. Findings are discussed in relation to the measurement and amelioration of QoL in BD.


Bipolar disorder Psychiatric Recovery model Response shift Quality of life Qualitative 



Quality of life


Bipolar disorder



This study was funded by the Canadian Institute of Health Research Knowledge to Action Grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of HealthArts and Design Swinburne UniversityMelbourneAustralia
  2. 2.Division of Mood Disorders, Department of PsychiatryUniversity of British ColumbiaVancouverCanada
  3. 3.School of Social WorkUniversity of British Columbia OkanaganKelownaCanada
  4. 4.Department of Psychological SciencesSwinburne University of TechnologyHawthornAustralia

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