Illness perceptions, treatment attitudes, and social relationships among clinic-attending adults with bipolar disorder in Kerman, Iran: a qualitative study

Bipolar disorder is a chronic psychiatric condition with significant impacts on quality of life, yet little is known about how patients in non‑Western, collectivistic contexts—particularly in southeastern Iran—perceive their illness, form treatment attitudes, and navigate social relationships. This qualitative study explored illness perceptions, treatment attitudes, and social relationships among clinic‑attending adults with bipolar disorder in Kerman, Iran. A descriptive phenomenological approach was employed, using Colaizzi’s seven‑step method. Data were collected through in‑depth semi‑structured interviews with twelve participants (six women and six men, aged 22–41 years) recruited from six specialized mental health clinics in Kerman. Participants met DSM‑5 criteria for bipolar disorder, had experienced at least two mood episodes requiring treatment, and were in remission at the time of the study. Interviews were conducted between October 2024 and May 2025. Saturation was assessed through team discussions based on code repetition and the absence of new information across consecutive interviews. Data analysis followed the seven‑step Colaizzi method. Four main themes emerged: (1) psychosocial processes of adaptation—moving from denial through acceptance to legitimation; (2) individual meaning‑making structures—including moral, supernatural, and contextual attributions; (3) conflict with the treatment system and society—marked by ambivalence toward medication and societal pressures for forced normalization; and (4) the context of interpersonal and social relationships—highlighting the dual role of family as both supportive and restrictive, alongside gendered pressures and fragile support networks. A fundamental structure of the lived experience was identified, characterized by a continuous dialectical tension between acceptance and concealment, the paradox of support and control, and the interplay between individual agency and social structure. Social stigma emerged as a central, pervasive force uniting all themes and shaping participants’ identities, relationships, and treatment engagement. Living with bipolar disorder in this context involves navigating complex socio‑cultural challenges that significantly affect treatment engagement and social functioning. The findings underscore the need for culturally sensitive interventions focused on stigma reduction, family education, and structured support systems. Future models of care should integrate biomedical approaches with community‑based mechanisms tailored to the cultural context of southeastern Iran.