Background. For families with multiple cases of bipolar disorder this study explored: attitudes towards childbearing; causal attributions for bipolar disorder, in particular the degree to which a genetic model is endorsed and its impact on the perceived stigma of bipolar disorder ; and predictors of psychological distress. Method. Two hundred individuals (95 unaffected and 105 affected with either bipolar disorder, schizo-affective disorder - manic type, or recurrent major disorder) were surveyed, using mailed, self-administered questionnaires. Results. Thirty-five (35%) participants reported being 'not at all willing to have children' or ' less willing to have children' as a result of having a strong family history of bipolar disorder. Being not at all or less willing to have children was associated with perceived stigma of bipolar disorder [odds ratio (OR) 2.42, p=0.002], endorsement of a genetic model (OR 1.76, p=0.046), and being affected (OR 2.16, p=0.01). Among unaffected participants only, endorsement of a genetic model was strongly correlated with perceived stigma (rs=0.30, p=0.004). Perceiving the family environment as an important factor in causing bipolar disorder was significantly associated with psychological distress (OR 1.58, p=0.043) among unaffected participants. Among affected participants, perceived stigma was significantly correlated with psychological distress (OR 2.44, p=0.02), controlling for severity of symptoms (p<0.001). Conclusions. Having a genetic explanation for bipolar disorder may exacerbate associative stigma among unaffected members from families with multiple cases of bipolar disorder, while it does not impact on perceived stigma among affected family members. Affected family members may benefit from interventions to ameliorate the adverse effects of perceived stigma.