My mother-in-law has bipolar 1 and she has a lot of self-care issues. She lives with us so we are pretty aware of them. I don't think she feels dirty ever, either. But, she does feel embarrassed. One thing she does is she will shower before she has to leave the house for doctor's appointments.

At least 3 times that I'm aware of, she didn't wash or brush her hair to the point that it became a big giant mat on the back of her head and we had to cut all of her hair off.