By Lynette Swedberg, an advanced practice psychiatric nurse, as told to Keri Wiginton.
I like to frame it like this: Everyone brings their own things to a relationship. Maybe it’s a medical issue or emotional baggage from your family of origin. Maybe it’s your personality.
Or maybe you happen to have a mental health issue. I tell people and their loved ones to think of bipolar disorder as just one of those things.
Bipolar disorder symptoms in a relationship can be a challenge. But the right treatment can help you make long-lasting connections.
How Can Bipolar Disorder Affect Relationships?
More serious issues tend to happen in people who have bipolar I disorder. That’s a version of the illness marked by periods of mania, or high mood and energy. Folks with bipolar I may or may not have depression.
There’s also something called bipolar II disorder. These folks are more likely to have a milder form of mania called hypomania. And compared to bipolar I, depression tends to be a bit stickier and harder to manage in this group.
Mania can trigger some serious lapses in judgment. People with bipolar disorder tend to have trouble with impulsivity. That means they make fast decisions without thinking about the negative consequences.
People who are impulsive may spend lots of money, misuse drugs, or make other risky decisions. They may get into legal trouble. Another hallmark of bipolar disorder is promiscuity, which clearly can strain a relationship.
How Can Treatment for Bipolar Disorder Help Your Relationship?
There’s no cure for bipolar disorder. But medication can go a long way to rein in impulsive behavior. But even when someone’s symptoms are well controlled for a while, life happens. And situational stressors can trump medication in certain cases.
If you have bipolar disorder, it’s easy to fall back on your old coping skills when you’re overwhelmed. But there are nondrug treatments that’ll help you manage how you think, feel, and act.
One treatment that may help is dialectical behavioral therapy, or DBT for short. That’s a skills-based training program. It can teach interpersonal effectiveness. Those are communication skills that’ll help preserve relationships.
For example, DBT can show you how to stick up for yourself while validating the other person. You can also learn to ask for what you need in the relationship in an assertive but not aggressive way.
DBT can also target emotional dysregulation. That’s when you can’t control your emotions or how you respond to others. This kind of emotional reactivity is common among people with bipolar disorder.
You may find that you get really upset over small things, such as blowing up at your partner if they criticize you or bring up any of your symptoms. DBT can help you learn to spot when this happens and what to do about it.
For instance, you may need to take a break from the argument if you feel out of control. It can help to put some time and distance between you and the situation. Maybe you and your partner can agree to put the talk on hold while you go for a walk or spend time in a safe space.
It’s also helpful to have a third party to talk to. If your loved one says something that bothers you, maybe call another person and say, “Bob just said I seem manic. What do you think? Have you noticed a difference in my behavior lately?”
Can You Prepare for Future Bipolar Episodes?
It’s hard to recognize or change troubling behavior in the moment. I suggest people create a plan of action ahead of time. And it’s best to do this when you feel like you and your relationships are in a good place.
How can you do that? Start by coming up with a list of things that signal a relapse.
Once you know what to watch for, write it down. It can be helpful to have things in black and white. That way your loved one can pull out a list of behaviors and say, “Look, I’m seeing that you’re doing this.”
Symptoms are different for everyone. But some examples might include you up your alcohol intake, stay up all night, or get angry really fast. Or maybe your telltale signs are that you talk nonstop, get distracted easily, or go out to meet new people.
You might want to consider an advance directive for mental health. That’s a legal document. It includes instructions on the kind of treatment you want if your behavior starts to change. It’s something you can do with the help of a health professional.
I think it’s a good idea to have an advance directive in place if you’ve been hospitalized for bipolar disorder in the past. But I’ve recommended that people do this within their own relationships.
You can talk about your wishes with your partner, parent, sibling, or another trusted person. Get your doctor or therapist involved. Outline how you want people to act towards you when it comes to relationship problems.
Say, “If you see me doing X, Y, or Z, I would appreciate if you’d communicate in this way.”
How Can I Better Support Someone With Bipolar Disorder?
Bipolar disorder can be particularly tricky and exhausting to deal with, especially if your loved one stops sleeping. And boundaries are important. But if you’re involved with someone who has the condition, consider how your issues may affect the relationship.
Take notice of how your anxiety, depression, or past trauma may play a role. Does your loved one’s bipolar disorder trigger your symptoms and affect your behavior? If so, you may have your own therapeutic work to do.
People with bipolar disorder need to take responsibility for their actions and their treatment. But sometimes I have clients with friends, family, or partners who don’t really understand what it’s like to live with a mental illness. In those cases, I’ll suggest they bring their loved one to therapy.
I’ll use a session to do psychoeducation. I’ll go over basics of bipolar disorder. I’ll tell the partner or loved one: This is what you may see; this is what medication may target; this is what takes more skills-based training.
And I’ll usually suggest the person with bipolar disorder sign a release. This gives their partner permission to call me if they have questions. That doesn’t mean I’m going to tell your loved one everything we talked about in session.
It might just mean you give them the OK to call me and ask, “Is this a symptom?”
Photo Credit: Rossella De Berti / Getty Images
Lynette Swedberg, APRN, Northwestern Medicine Ben Gordon Center.
Annals of General Psychiatry: “Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression.”
Bipolar Disorder: “Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history.”
Behavior Therapy: “Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder.”
Psychiatric Quarterly: “Enhancing Dialectical Behavior Therapy for the Treatment of Bipolar Disorder.”
Mayo Clinic: “Bipolar disorder.”
Cureus: “The Impact of Impulsivity and Emotional Dysregulation on Comorbid Bipolar Disorder and Borderline Personality Disorder.”
SAMHSA: “Advance Directives for Behavioral Health.”