Managing the Highs and Lows of Bipolar Disorder and Relationships

By Matthew Goldenberg, D.O. Board Certified Psychiatry and Addiction Psychiatry Associate Medical Director, Promises Professionals Treatment Program Do you love a person with bipolar disorder? Do you suffer from this mental health condition yourself? If so, you likely have found that navigating relationships can be a roller coaster ride. For those who suffer from bipolar disorder, sometimes referred to as manic depression, the cycle of mood fluctuations may include high episodes of “mania” or “hypomania” and low episodes of depression, or even “mixed” episodes where features of both moods are present at the same time. Often when these episodes of extreme “ups” and “downs” occur, they can push the relationships with those closest to the individual to the breaking point.

Relationships in Bipolar Disorder Require Extra Care

Roughly 2.6% of U.S. adults have bipolar disorder, and 82.9% of these cases are classified as severe. For these individuals, one of the most challenging aspects of living with the condition is holding onto friendships and successfully managing long-term relationships. “Bipolar relationships” — where at least one of the partners in the relationship has bipolar disorder — can be difficult. In some cases, the person with bipolar disorder is trying to manage relationships with friends and partners who do not have the disorder. In other cases, they are trying to manage relationships with people who also have bipolar disorder. In fact, there is a phenomenon known as “assortative mating” which refers to the pattern of people with bipolar marrying each other to a statistically disproportionate degree. This may explain why studies show that bipolar disorder has a strong genetic component and often runs in families. Therefore, there is a strong possibility that people with bipolar disorder are trying to manage relationships with family members who also have bipolar disorder. We know that seeking accurate diagnosis and appropriate treatment, usually a combination of medication and talk therapy, can help people with bipolar disorder gain better control over their mood swings and other symptoms. However, since this is a lifelong chronic illness (episodes of mania and depression will likely recur throughout the individual’s lifetime) continuous treatment helps to manage the condition over the long term. Even with treatment, people with bipolar disorder can have trouble with relationships, and I often hear heartbreaking stories of cherished connections that were lost due to some of the most problematic behaviors that stem from their illness. However, with proper education, care and management, healthy relationships are possible, and can be nurturing and rewarding.

3 Tips for Nurturing Healthy Bipolar Relationships

Whether you are trying to repair a broken relationship or manage an ongoing “bipolar relationship” with a loved one, friend or coworker, here are a few tips to help you navigate this tricky terrain: #1 Get educated about bipolar disorder. My father always said, “It takes two to tango.” In this case, that means that both people in the relationship need to know what to expect in terms of the symptoms of bipolar disorder, behaviors that go along with the condition, and the treatment options available. They should both also be aware of potential triggers for the low and high episodes to help mitigate potential avoidable negative consequences. In some of the more severe and challenging cases, I may recommend a spouse or significant other and my patient agree to a “treatment contract.” This can help establish healthy boundaries, expectations and communication. This may involve sharing information such as mood charts, a joint formulation of a treatment regime (including medications and individual and couples therapy) and, in some cases, visiting the care providers together. #2 Engage in pre-emptive damage control. Manic episodes may lead to destructive and risky behaviors, including alcohol and drug use, gambling, infidelity, extravagant shopping sprees that strain a family’s finances, or other behaviors that have the potential to harm relationships. Knowing when these occur and how to spot the early warning signs are necessary to heading them off. Also, knowing how to better manage them when they do occur can be a boon to the relationship. For example, both parties can learn to identify triggers (i.e., lack of sleep, increased stress, specific times of year, travel, etc.) and where to go for help (psychiatrist or therapist) before the episode becomes severe. In addition, depressive episodes can lead to isolation, hopelessness, emptiness and thoughts of suicide, among other symptoms, so watching for warning signs of these low episodes can help both partners take early measures (such as contacting a care provider) to avoid distress. #3 Practice acceptance and forgiveness. If terrible things have been said or done, it can be difficult for both sides to forgive and move on. While a friend or partner should not accept being mistreated by someone with bipolar who is cycling out of control, it can help if they are able to recognize when it is due to the illness and be ready to forgive. At the same time, the person with bipolar can get into the practice of going back to those they have hurt, being accountable and apologizing for destructive behavior related to their illness, even when they could not “help it.” They must also be prepared to cope with the disappointment and loss of those who cannot handle dealing with the illness — not everyone can. Accepting that the illness is part of them and something they cannot always control allows people with bipolar to move forward in a positive and productive way when there is damage they cannot undo and/or relationships they cannot hold onto or repair, despite how hard they may try.   Sources: When You’re Married to Someone with Bipolar Disorder. International Bipolar Foundation. Bipolar Romantic Relationships: Dating and Marriage. WebMD. Bipolar Disorder Among Adults. National Institute of Mental Health (NIMH). Bipolar Disorder. National Institute of Mental Health (NIMH). When Someone You Love Is Bipolar: Help and Support for You and Your Partner. Cynthia Last. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Vol. 1, 2nd Edition. Frederick K. Goodwin, Kay Redfield Jamison. (Oxford University Press, 2007)

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