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Background: Over the past decade there have been rapid advances in psychiatry genetics and there is a growing concern about the clinical and practical relevance of this knowledge. Efforts are being made to know the perspectives of patients and family members regarding family risk and genetic counselling. However, the area remains largely unexplored in psychiatric research from Asian countries. Aim: The primary purpose of the study was to explore the perceptions related to family risk among Indian patients with bipolar disorder and their family members. The study also aimed to explore the related perceptions for etiology of bipolar disorder. Method: Patients with bipolar disorder type I and family members of patients with bipolar disorder type I were invited to take part in in-depth interviews after informed consent, targeting a sample of diversity. The qualitative data were analysed using thematic analysis. Results: Eight key themes emerged: (1) higher emphasis on external or situational causes; (2) causal explanations are governed by cultural beliefs; (3) help-seeking is a shared, rather than a personal, decision; (4) the perceived genetic risk is low but worrisome; (5) worries and apprehensions are focused mainly on future generations; (6) there is a desire to modify the perceived genetic risk; (7) knowledge of precise risk can be beneficial as well as anxiety provoking; and (8) there is a need for information on preventive measures. Conclusion: The study provides culture-specific perspectives on the causation of illness and explores a sensitive and personal matter of perceived family risk in an Indian sample. It emphasizes the need to further explore the perceptions of family risk in a given cultural context. [ABSTRACT FROM AUTHOR]