Bipolar disorder and the family
Living with a person who has bipolar disorder can cause stress and tension in the family. On top of the challenge of dealing with symptoms and their consequences, family members often struggle with feelings of guilt, fear, anger, and helplessness. Ultimately, the strain can cause serious relationship problems. But families can successfully deal with bipolar disorder if they learn to accept the illness and its difficulties.
When you’re feeling frustrated or guilty, it’s important to remember that bipolar disorder isn’t anyone’s fault.
Accepting bipolar disorder involves acknowledging that things may never again be “normal.” Treatment can make a huge difference for your loved one, but it may not take care of all symptoms or impairments. To avoid disappointment and resentments, it’s important to have realistic expectations. Expecting too much of your family member is a recipe for failure. On the other hand, expecting too little can also hinder recovery, so try to find a balance between encouraging independence and providing support.
Tips for coping with bipolar disorder in the family
- Accept your loved one’s limits – People with bipolar disorder can’t control their moods. They can’t just snap out of a depression or get a hold of themselves during a manic episode. Neither depression nor mania can be overcome through self-control, willpower, or reasoning. Telling a person to “Stop acting crazy” or “Look on the bright side” won’t help.
- Accept your own limits – You can’t rescue a person with bipolar disorder, nor can you force someone to take responsibility for getting better. You can offer support, but ultimately, recovery is in the hands of the person with the illness.
- Reduce stress – Stress makes bipolar disorder worse, so try to find ways to reduce stress in your family member’s life. Ask how you can help and volunteer to take over some of the person’s responsibilities if needed. Establishing and enforcing a daily routine— with regular times for getting up, having meals, and going to bed—can also reduce family stress.
- Communicate – Open and honest communication is essential to coping with bipolar disorder in the family. Share your concerns in a loving way, ask the person how he or she is feeling, and make an effort to truly listen—even if you disagree with your loved one or don’t relate to what’s being said.
Supporting a person with bipolar disorder
What you can say that helps:
Adapted from: The Depression and Bipolar Support Alliance
Convincing a person with bipolar disorder to see a doctor
Aside from offering emotional support, the best way to help someone with bipolar disorder is by encouraging and supporting treatment. However, people with bipolar disorder tend to lack insight into their condition, so it’s not always easy to get them to a doctor. When they’re manic, they feel great and don’t realize there’s a problem. When they’re depressed, they may recognize something’s wrong, but lack the energy to seek help.
If your loved one won’t acknowledge the possibility of bipolar disorder, don’t argue about it. The idea may be frightening to the person, so be sensitive. Suggest a routine medical checkup instead, or a doctor’s visit for a specific symptom, such as insomnia, irritability, or fatigue (you can call ahead to tell the doctor of your bipolar disorder concerns).
Things you can say that might help:
- Bipolar disorder is a real illness, like diabetes. It requires medical treatment.
- You’re not to blame for bipolar disorder. You didn’t cause it. It’s not your fault.
- You can feel better. There are many treatments that can help.
- When bipolar disorder isn’t treated, it usually gets worse.
Supporting a loved one during bipolar disorder treatment
Once your friend or family member agrees to see a doctor, you can help by being a partner in treatment. Your support can make a big difference in treatment success, so offer to be involved in any way the person with bipolar disorder wants or needs.
Things you can do to support a loved one’s bipolar disorder treatment:
- Find qualified doctors and therapists
- Set up appointments and going along
- Offer your insight to the doctor
- Monitor your loved one’s moods
- Learn about the person’s medications
- Track treatment progress
- Watch for signs of relapse
- Alert the doctor to problems
Encourage the person to take bipolar disorder medication
Medication is the cornerstone of treatment for bipolar disorder, and most people need it to regulate their moods and avoid relapse. Despite the need for medication, many people with bipolar disorder stop taking it. Some quit because they’re feeling better, others because of side effects, and still others because they enjoy the symptoms of mania. People who don’t think they have a problem are particularly likely to stop taking medication.
You can help a person with bipolar disorder stay on track by emphasizing the importance of medication and making sure all prescriptions are being taken as directed. Also encourage the person to speak to the doctor about any bothersome side effects. Side effects can be very unpleasant if the dose of the medication is too low or too high, but a change in medication or dosage may solve the problem. Remind the person that abruptly stopping medication is dangerous.
Watch for warning signs of bipolar disorder relapse
Even if a person with bipolar disorder is committed to treatment, there may be times when symptoms get worse. Take action right away if you notice any troubling symptoms or mood changes. Point out the emerging bipolar symptoms to your loved one and alert the doctor. With swift intervention, you may be able to prevent an episode of mania or depression from developing fully.
Mania warning signs and symptoms:
- Sleeping less
- Elevated mood
- Speaking rapidly
- Increase in activity level
- Irritability or aggression
Depression warning signs and symptoms
- Fatigue and lethargy
- Sleeping more
- Trouble concentrating
- Loss of interest in activities
- Withdrawing from others
- Change in appetite
Coping with mania and depression: Tips for family and friends
If relapse can’t be prevented, there are things you can do to cope during a manic or depressive episode.
- Don’t take bipolar symptoms personally. When in the midst of a bipolar episode, people often say or do things that are hurtful or embarrassing. When manic, they may be reckless, cruel, critical, and aggressive. When depressed, they may be rejecting, irritable, hostile, and moody. It’s hard not to take such behaviors personally, but try to remember that they’re symptoms of a mental illness, not the result of selfishness or immaturity.
- Be prepared for destructive behaviors. When manic or depressed, people with bipolar disorder may behave in destructive or irresponsible ways. Planning ahead for how to handle such behavior can help. When your loved one is well, negotiate a treatment contract that gives you advance approval for protecting him or her when symptoms flare up. Agree on specific steps you’ll take, such as removing credit cards or car keys, going together to the doctor, or taking charge of household finances.
- Know what to do in a crisis. It’s important to plan ahead for times of crisis so you can act quickly and effectively when it occurs. Having a crisis plan can help. Make sure to include a list of emergency contact information for doctors, therapists, and other loved ones who will help. Also include the address and phone number of the hospital you will take the person to if necessary.
- Call 911 in an emergency. If a person with bipolar disorder is suicidal or violent, don’t try to handle the situation alone. If you’re worried that your loved one may hurt you, get to safety and then call the police. If the person is suicidal, don’t leave him or her alone. Call 911 and stay with the person until an ambulance arrives.
Supporting someone who is manic
- Spend time with the person. People who are manic often feel isolated from other people. Spending even short periods of time with them helps. If the person has a lot of energy, walk together, which allows the person to keep on the move but share your company.
- Answer questions honestly. However, do not argue or debate with a person during a manic episode. Avoid intense conversation.
- Don’t take any comments personally. During periods of high energy, a person often says and does things that he or she would not usually say or do, including focusing on negative aspects of others. If needed, stay away from the person and avoid arguments.
- Prepare easy-to-eat foods and drinks (such as peanut butter and jelly sandwiches, apples, cheese crackers, and juices), because it is difficult for the person to sit down to a meal during periods of high energy.
- Avoid subjecting the person to a lot of activity and stimulation. It is best to keep surroundings as quiet as possible.
- Allow the person to sleep whenever possible. During periods of high energy, sleeping is difficult and short naps may be taken throughout the day. Sometimes the person feels rested after only 2 to 3 hours of sleep.
Adapted from: The Palo Alto Medical Foundation
Taking care of yourself when a loved one is bipolar
It's easy to neglect your own needs when you're supporting someone else. But if you don't take care of yourself, you run the risk of burnout. To cope with the stress of caring for someone with bipolar disorder, you have to take care of yourself both emotionally and physically.
- Focus on your own life. Supporting your loved one may involve some life adjustments, but make sure you don't lose sight of your own goals and priorities. Don't give up friendships, plans, or activities that bring you joy.
- Seek support. Dealing with a loved one's mental illness can be painful and isolating. Make sure you're getting the emotional support you need to cope. Talk to someone you trust about what you're going through. It can also help to get your own therapy or join a support group.
- Set boundaries. Be realistic about the amount of care you're able to provide without feeling overwhelmed and resentful. Set limits on what you're willing and able to do, and stick to them. Letting bipolar disorder take over your life isn't healthy for you or your loved one.
- Manage stress. Stress takes a toll on the body and mind, so find ways to keep it in check. Make sure you're eating right and getting enough sleep and exercise. You can also keep stress under control by practicing relaxation techniques such as meditation.
Ask for help. If your friend or family member needs more assistance than you can give, ask for help from others. Turn to other relatives or close friends, or contact one of the organizations listed under Resources and References.