Rehab DischargeLiving with someone with a mental illness can present a unique set of challenges, and bipolar disorder is no exception. Depending on whether he is manic or depressed, your loved one might feel like a completely different person. You may become stressed or strained by the disruption his illness causes in your life. Health, relationship, and financial problems can follow.

It’s normal to want to get involved. After all, his decisions affect you – if he goes on a spending spree or stops going to work for a week, you’re the one who has to come up with rent at the end of the month. Fortunately, there are a number of strategies you can take to help your loved one as well as return order to your own life.

Protect yourself first

tab05In order to help your loved one, first you have to take care of yourself. If you’re worn thin and running on empty, you won’t have any reserves left to offer. Make sure to tend to your own needs – for example, if your loved one’s erratic behaviors have made friends start to keep their distance, find time to see them on your own. Don’t forget about hobbies or neglect your usual healthy habits. Sleep is particularly important, especially if your loved one’s mania has her up at all hours. If you’re also not sleeping well, you’ll be less prepared to deal with the challenges that bipolar disorder presents.

It’s also important to safeguard your own physical and financial safety. For example, if your loved one’s driving grows risky during a manic episode, then insist on driving or decline to be a passenger in her car. Money can also be a major problem. If you are dependent upon your loved one in order to pay rent or bills, then secure your payment ahead of time. Set up automatic deposits from an account that isn’t easily accessed, or if finances are coming from a third person, arrange to get the money from them directly. If you have access to joint accounts, consider placing limits on credit cards purchases or cash withdrawals. If your loved one was contributing needed income but loses hours or her position due to her condition, start making alternative plans now. The Primary Care Companion to The Journal of Clinical Psychiatry reports that people with bipolar disorder are almost twice as likely to get fired or laid off from their job. It may be quite some time before your loved one is stable enough to begin contributing again.

After tending to your body, don’t neglect your spirit. Many people who watch a loved one develop bipolar disorder feel guilt or shame, thinking that their actions (or lack thereof) might have caused the person to become ill. This couldn’t be farther from the truth – bipolar disorder is a condition caused by the biology of the brain with a strong genetic basis. Release yourself from the burden you carry; you haven’t done anything wrong.

Understanding that bipolar disorder is a medical condition and nobody’s fault can help you weather the tough times. You may also feel frustration or resentment, and blame yourself for not being up to the task of dealing with your loved one. Remember that you’re doing your best with the resources you have available.

It’s normal to sometimes feel anger towards your loved one, especially if she has refused to get medical treatment for her condition. The National Institute of Mental Health (NIMH) reports that 78 percent of people with bipolar disorder are not even receiving minimally adequate treatment, and that 44 percent of people with bipolar disorder are not receiving any treatment at all.

Lack of insight and lack of self-awareness into the nature of the condition are very common symptoms of the manic stage of bipolar disorder. Many people don’t have the ability to understand what is wrong while they are in that state. It’s not their fault. Wait until mania passes to have conversations about getting treatment. That is also the right time to express how their actions made you feel.

Finally, figure out where your limit lies. You’ll do what you can, but past a certain point, you have to choose to protect yourself. From the start, make it very clear to your loved one what lines absolutely cannot be crossed if she wants your continued support. Have an exit strategy prepared.

Figure out your level of involvement

How involved are you in your loved one’s life? Dealing with a bipolar spouse with whom you have already built a life is a very different situation than dealing with a bipolar housemate. Evaluate both how much support is needed and how much you are realistically able to offer.

Minimal involvement might start and end with holding onto a list of emergency contacts and offering to get in touch with someone who is better able to help when things get bad. Increased levels of involvement could include helping the person spot when he is beginning to enter into a manic or depressed state, helping him remember to take his medication, or driving him to the doctor. If you have his permission, you might even speak with his therapist yourself – the outside perspective you can offer can be invaluable for a treatment provider to more fully understand what’s going on.

After living with your loved one and her illness for as long as you have, you may be in the best position to detect the signs of a mood cycle beginning.

  • Signs of an oncoming manic episode:
    • Sleeping less or frequently being awake at night
    • Talking too quickly or jumping to tangential topics
    • Starting several new projects at the same time
    • Taking more risks or acting more impulsively than usual
    • Spending impulsively or without regard for finances
    • Unrealistic belief in one’s own abilities or importance
    • Impaired grasp of personal limitations
    • Inappropriate or unrealistic good mood
    • Short temper or irritability
  • Signs of an oncoming depressive episode:
    • Sleeping more than usual or during the day
    • Losing interest in activities or abandoning projects
    • Mentioning or complaining about pain more often, such as muscle aches, stomach pains, and headaches
    • Talking about having suicidal feelings or preoccupation with death
    • Withdrawing from social functions
    • Unexplained crying spells
    • Changes in eating patterns, such as frequently overeating or forgetting to eat
    • Lethargy or loss of motivation
    • Feelings of guilt, shame, or worthlessness
    • Sad mood without apparent cause

While you might be the first person to spot these changes, it’s also important not to read signs of mania or depression into every action your loved one makes. Not only can this come across as patronizing, but it also redefines your relationship with your loved one to be only about her illness. Whatever your relationship, this is a person that you independently value for reasons far beyond anything to do with her condition.

Also, keep in mind that many people with bipolar disorder have co-occurring conditions like ADHD and anxiety, which can cause additional symptoms or aggravate the bipolar symptoms. Substance abuse is also common. The Primary Care Companion to The Journal of Clinical Psychiatry reports that 56 percent of people with bipolar disorder abuse or are dependent on drugs, and 44 percent abuse alcohol.

Come up with a contract

doctor_02Don’t wait until your loved one becomes symptomatic to talk to them. Mania can reduce his self-awareness, and depression can impair their ability to take action as well as make him more likely to feel that he is being criticized. Instead, approach him during one of the in-between states, when he is closest to his most stable.

Remind your loved one that you support him, and while you may not understand what he is going through, you’re here for him and want to help. By working together, you can form an alliance that is better able to face bipolar disorder than your loved one is alone.

Essentially, you want to create a contract with your loved one. You and he will agree together that if a certain warning sign appears, it’s time to take a certain action. It may be symptom-specific, such as locking away firearms if suicidal feelings appear, or agreeing to hand over car keys if impulsivity worsens. Or, you may work out a colored light system, with each color corresponding to a level of concern:

  • Green light: All is well.
  • Yellow light: I’m seeing a few small signs of mania or depression. Try to keep this in mind and be particularly careful.
  • Amber light: I’m seeing worrying warning signs. It’s time for you to go in and see your doctor.
  • Red light: I’m extremely worried that something bad will happen, right now. You’re coming with me to the emergency room and/or I’m calling 911.

Whatever system works best for you and your loved one, it may be useful to make a tape recording or video of the person to play later. In effect, he should remind his future self that he has been through this before, that he knows listening to himself is a good idea, that he promised he would get help when he showed certain signs, and that he knows he needs it. Hearing these things in his own voice can be a powerful reminder to honor the contract and get help.

To learn more about how to deal with bipolar disorder in children and adolescents, visit the National Institute of Mental Health website.

If you’re trying to find treatment for your loved one, you’ve come to the right place. Call the number above to learn more about what we have to offer.

Advice on Living With a Loved One With Bipolar Disorder
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