Bipolar Disorder affects millions of people around the world. It also affects the millions of people around those individuals. It can be a challenge to know how to best support a loved one with the diagnosis. The highs and lows can strain even the strongest of relationships. This Bipolar Awareness Day, we sat down with our head of psychotherapy, Gita Chaudhuri, to get some tips on how best to support a loved one with the diagnosis.
Bipolar disorder, formerly called manic depression, is characterized by extreme shifts in mood, energy levels, activity, and sleeping patterns. It is often characterized by high-highs (manic episodes) and low-lows (depressive episodes). Assessment considers a person’s lifetime history, because earlier hypomania or mania may have gone unrecognized. Bipolar I disorder requires at least one manic episode. Bipolar II disorder requires at least one hypomanic episode and one major depressive episode, with no history of mania. Bipolar II is not simply a less severe form of bipolar I. Mania involves a distinct period of unusually elevated or irritable mood and increased energy or activity, with other symptoms and marked impairment, a need for hospital care, or psychosis. Hypomania involves a noticeable change in mood and activity without that degree of impairment or psychosis. The episodes can last for weeks, or even months. During mania or hypomania, people may need much less sleep than usual and may act impulsively; severe episodes can put their safety at risk. The result of these episodes can be devastating. People can spend all their money, or end up in the hospital because of an accident. Depressive episodes may follow mania or hypomania, but the sequence varies and is not necessarily caused by the emotional aftermath. Some recreational drugs and prescribed medicines can mimic, worsen or trigger manic symptoms. Clinicians assess their timing and effects to distinguish bipolar disorder from substance/medication-induced symptoms. Do not stop or change prescribed medication without advice from the prescriber. It is still unknown what causes Bipolar Disorder, but research suggests that it comes from a range of factors including genetics, chemical factors, extreme stress and a life changing event.
1. Educate Yourself
If someone doesn’t understand the disorder, this can lead to a lot of shame surrounding a person’s behavior. During a manic episode, a person’s mood, activity and behavior may differ markedly from their usual self. Gita Chaudhuri says: “It’s extremely important for families and loved ones to know it’s not their fault, but rather something that can be treated. The elimination of shame comes from educating yourself around what the disorder is and how it works.” When everyone is on the same page, this also makes it much easier to spot the signs of an episode coming on and know what to do as a team.
2. Have a Plan
People should communicate outside of episodes to create an agreed upon plan of action for when they take hold. What are the steps to take? What are the professional resources we can turn to? Agree a plan with the person and their clinical team when they are well, respecting their preferences and autonomy. Include early warning signs, professional contacts and steps to take if symptoms worsen. Seek urgent professional assessment for suspected mania, severe depression or psychosis. If there is immediate danger, suicidal intent or an inability to stay safe, contact local emergency services or go to the nearest emergency department. The communication that surrounds the disorder will be different for each individual. Gita Chaudhuri notes how two of her patients with bipolar disorder needed different things: “I had a young woman who did not like being asked all the time if she was okay. She didn’t want constant check-ins. This took away her autonomy. I had a different patient, an older gentlemen, who’s wife checked in daily. That worked for them. They appreciated more communication. This is something that needs to be agreed on outside of an episode.”
3. Build a Mindful Routine
The schedule, or rhythm, of a person’s day to day is a big part of a person’s treatment program. The people surrounding them should support a healthy lifestyle, and not push them toward anything excessive. Triggers differ between people. Help your loved one protect regular sleep, manage stress, avoid recreational drugs and discuss alcohol use with their clinical team. Encourage regular meals and appropriate exercise without blaming them for symptoms or restricting everyday activities unnecessarily. We want to build a routine that is stabilizing and grounding. These habits support, rather than replace, prescribed treatment and clinical follow-up.
Bipolar Disorder is a common, often misunderstood condition. Bipolar I and bipolar II are distinct diagnoses; the wider group also includes cyclothymic disorder and other bipolar-related disorders. Bipolar I requires mania, whereas bipolar II requires hypomania and major depression without a history of mania. When supporting a loved one with bipolar disorder it is important to educate yourself around what the diagnosis is and remove the shame from the behavior that may come out during an episode. Be sure to communicate and create a plan of action before an episode starts. There should be established rules and agreements between loved ones. Individual triggers may include sleep disruption, stress, recreational drugs and alcohol. A regular routine can support stability alongside ongoing clinical treatment. Together, you can navigate the journey toward stability and well-being.
