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Bipolar 1 and relationships


Bipolar Relationships: What to Expect

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Ups and downs are natural in any romantic relationship, but when your partner has bipolar disorder it can feel like you’re on an emotional rollercoaster. Not knowing what to expect each day is stressful and tiring. Over time, it wears on the relationship.

Understanding why your partner acts out sometimes or becomes withdrawn is the first supportive step you can take in strengthening your relationship. Learn exactly what a bipolar diagnosis means, how it could affect your partner’s behavior and what you can do to foster a healthy, stable relationship.

What does it mean if your partner is bipolar?

Bipolar disorder is a mental health condition marked by intense mood changes. People with the illness switch back and forth from mania or hypomania (an emotional state of being energetic and gleeful or sometimes aggressive or delusional) to having episodes of depression.

The lifelong condition tends to run in families, although the cause of bipolar disease is unknown. However, it can often be successfully managed through treatment. There are two primary types of bipolar disorder:

Bipolar 1

Bipolar 1 is a more severe form of the illness and is defined by manic episodes that have one of these characteristics:

  • Hallucinations, delusions or paranoia
  • Hospitalization required for safety
  • Impulsive behavior with significant consequences

“When people are manic, they pursue pleasurable activities with great enthusiasm and with no regard for the consequences,” says Jennifer Payne, M.D., psychiatrist and director of the Women’s Mood Disorders Center at Johns Hopkins Medicine. “They may gamble, spend excessive amounts of money, use drugs or become promiscuous.”

Bipolar 2

People with bipolar 2 experience hypomanic episodes, which still include out-of-character behavior but aren’t as extreme as those with bipolar 1. Hypomanic episodes may include:

  • Increased energy and drive.
  • Rapid speech.
  • Decreased need for sleep.

“During hypomanic episodes, a partner with bipolar 2 may obsessively pursue sex with you or others,” says Payne. “They may stay up all night and have lots of wonderful ideas they want to tell you about at 3 a.m.”

Treatment Challenges

Bipolar disorder is usually treated with a combination of medications and therapy. However, successful treatment can be a challenge since many people miss the euphoria and energy of manic episodes.

Often people with bipolar disorder view these elevated mood states as their best selves — when they’re the most productive or creative — and will stop treatment in order to experience that again. Sometimes those with bipolar disorder will even intentionally trigger a manic episode.

“Lack of sleep is a trigger of manic episodes for a lot of people,” says Payne. “Sometimes patients with bipolar disorder will deliberately skip getting the sleep they need in order to initiate an elevated mood state. For example, a person might want the high energy that comes with a manic episode to get a project done.”

The key to your partner’s successful management of the illness is a commitment to continuing treatment and ongoing communication with their psychiatrist. This can take place at therapy sessions, during regular checkups or whenever necessary to discuss troubling symptoms.

Many people with bipolar 1 do well on lithium, a mood-stabilizing drug. Those with bipolar 2 may not fully respond to medications often used to treat bipolar disorder. If that’s the case for your partner, it’s important for them to continue to work with their psychiatrist to find an effective treatment.

Being in a Relationship with Someone Who Is Bipolar

There are certainly challenges in any romantic relationship, but bipolar disorder can make things especially difficult in various aspects of life:

Intimacy

It’s common for people with bipolar disorder to desire frequent sex during manic or hypomanic phases. Your partner may initiate intimacy much more than normal, or masturbate or use pornography more frequently than usual. Those with bipolar disorder may also engage in risky behaviors such as unprotected sex or extramarital affairs while manic.

During episodes of depression, your partner may avoid sexual contact altogether. This can be confusing or feel like rejection, especially if your partner recently desired lots of sexual activity during a manic or hypomanic period. Many medications for bipolar disorder can also lower sex drive.

Work

Your partner’s ability to perform well at work can be affected by bipolar disorder. Severe mood swings, along with manic symptoms such as poor judgement and impulsivity, or depressive symptoms such as low energy and disinterest make it tough to find and maintain a job. Stressors at work may also trigger or exacerbate your partner’s symptoms. If your partner can’t hold down a job, this could put more pressure on you to provide financial support until their illness is well-managed.

Parenting

Many people consider parenting the most stressful (albeit rewarding) job of their lives. But any kind of stressor — good or bad — has potential to trigger manic or depressive episodes for people with bipolar disorder.

In addition, the erratic behavior associated with bipolar disorder can be confusing and scary to children, who look to parents to provide stability. Helping your partner get and maintain treatment to control symptoms is crucial for providing a safe and secure home for children.

How to Make a Bipolar Relationship Work

It takes effort to keep any relationship strong, but it can be especially challenging when your partner has bipolar disorder. Payne offers these recommendations:

Go to Couples Counseling

Couples counseling is essential for working through upset over a bipolar partner’s actions. It’s common for someone with bipolar disorder to hurt and offend their partner. When someone is first diagnosed, there are often relationship issues that need to be addressed. Couples counseling can help you:

  • Understand that there’s an illness involved in the hurtful behavior.
  • Forgive the behavior that happened during an altered mood state.
  • Set boundaries with a partner about maintaining treatment.

Get Involved with Treatment

Ask if you can be involved with your partner’s treatment, which may include occasionally going to the psychiatrist together. Being a part of your partner’s treatment has multiple benefits, including:

  • Gaining a better understanding of the illness.
  • Providing additional insight for the psychiatrist.
  • Learning to spot signs of impending episodes.
  • Alerting the psychiatrist about mood changes.

Even if your partner hasn’t signed off on you exchanging information with their psychiatrist, you can still report worrisome signs (the doctor just won’t be able to tell you anything). This gives the doctor a chance to make quick medication changes that may help your partner avoid being hospitalized.

Practice Self-Care

Self-care gets a lot of buzz these days, but nowhere is it more important than when you’re caring for someone with a serious illness such as bipolar disorder. It’s essential to dedicate time to your own physical and mental health, whether that’s going to a support group, talking to a therapist or attending a yoga class.

Being in a healthy relationship with someone with bipolar disorder requires not only careful management of their illness, but also setting aside time to take good care of yourself.

Bipolar Disorder and Relationships — Talkspace

Updated 5/17/2022

Bipolar disorder can sometimes seem devastating, not only for the person who’s diagnosed with it but also for their loved one, friends, and family members. Bipolar is a brain disorder that causes a mood shift such as extreme highs and lows that can be difficult to navigate.  

A bipolar disorder diagnosis can result in a struggle to maintain more than just daily life functions. It can affect relationships too. But with the right treatment, you can manage your bipolar disorder and relationships. Read on to learn how. 

Is It Hard to Maintain Relationships With Bipolar Disorder?

Though bipolar relationship patterns may seem more challenging when one partner has bipolar disorder, they’re not impossible. 

There are a number of ways to develop healthy patterns so bipolar relationships can be fulfilling and satisfying on both sides. It may take some work, but all relationships need effort and care, and this is no different.   

The most important part of establishing functional bipolar disorder relationships is keeping the lines of communication open and being willing to do the work. Being honest and upfront and making an effort to learn are key components in creating a positive, trusting dynamic. Whether it’s you who is bipolar or you have a bipolar partner, the following are important aspects to keep in mind:

  • A combination of treatment and medication for bipolar disorder is typically very helpful.
  • Being able to recognize bipolar symptoms of mania, hypomania, bipolar depression, and mixed mood episodes are essential. Learn the difference between bipolar disorder vs. depression or borderline personality disorder vs. bipolar disorder.
  • Discovering (and looking for) triggers before they happen can be a game-changer. Triggers are circumstances that can encourage or increase the likelihood of a depressive or manic episode. 
  • Having a support plan in place can help manage bipolar disorder symptoms. Support plans can detail activities and list out contacts. For example, you should have a therapist or psychiatrist who would be helpful in the event of a manic or depressive episode. A support plan can also predetermine each person’s role and ensure you both have the tools you need, like how to alter daily routines if necessary.

“When someone experiences bipolar disorder symptoms, it is important for their support system to be involved and infrequent communication. People diagnosed with bipolar disorders can benefit from having a therapist, a psychiatrist, and if they are in a relationship, even a couples therapist.” 

Talkspace therapist Cynthia V. Catchings, LCSW-S

Internal struggles of having bipolar disorder in a relationship

For those that have bipolar disorder, you may face internal struggles that can end up affecting your current or future relationship.

Self-stigma

The first thing that may challenge a person with bipolar disorder to create relationships is self-stigma (or internalized stigma), leading to self-created isolation. Self-stigma is where a person internalizes the negative messages he or she receives about those with a mental condition. It is a state where people feel bad about themselves and have low self-esteem because society’s messages about bipolar disorder and other mental health conditions tend to be so derogatory. 

When a person feels bad about themselves, it can be very difficult to initiate connections with others. A bipolar person may avoid relationships because they don’t feel good enough for other people. Sometimes these feelings come on quickly and cause those with mental health conditions to push away others in existing relationships. This can lead to social isolation.

Routine

The second thing that may impact the ability of a person with bipolar disorder to have relationships is routine. Those with a mental health condition may rely heavily on a routine for wellness. This may mean:

  • Going to bed early
  • Sleeping longer than average
  • Scheduling meals precisely
  • Not being able to skip exercising

A strict schedule may force the person with bipolar symptoms to forgo nighttime gatherings, parties, places where alcohol is served, and other events that don’t fit into their timetable.

Mood change

It’s also important to remember that the symptoms of a mood disorder – uncontrolled periods of severe mood shift – can also cause breaks, either temporary or long-term, in relationships.

Bipolar Relationship Patterns

There are a number of bipolar relationship patterns to be aware of. Each of these can have a direct impact on the health and wellbeing of your partnership. Parenting issues, intimacy, and work stresses can all be affected when you have a bipolar partner.

Parenting issues

Parenting can be stressful at the best of times. Since stress can trigger a mood episode, parenting may be a factor when one parent is bipolar. Learning to spot triggers and having a plan in place to manage stress will be important when kids are part of the equation. 

Intimacy issues 

Intimacy issues are very common in relationships when bipolar disorder is present. Sex drives can increase dramatically during a manic episode and a hypomanic episode. Also common is an increase in the urge to engage in risky behavior, like unprotected sex with multiple partners. Sometimes this can even include the inclination to go outside the relationship for sex.  

Alternatively, depressive episodes may result in a decrease in sexual desire. Understanding this from the beginning can help avoid some of the fears that typically might result after an interruption in sexual norms in the romantic relationship. Finally, it’s incredibly important to note that some emotional regulation medications may decrease sex drive, as well. 

Work stresses

Mood swings and other symptoms related to bipolar disorder can have a negative impact on work environments and relationships. Symptoms specific to manic mood swings (like impulsivity or an inflated sense of self-worth) or depressive swings (like lack of energy and motivation) can lead to difficulty in maintaining stability at work. These types of stressors at work can also trigger a hypomanic episode or a depressive episode. 

“Understanding mood swings and other behavioral patterns can help the person cope with work stressors and reduce negative self-views. A good way to identify or keep track of your moods is to keep a journal. Write down your emotions, events, interactions with others, medication and side effects, etc. Mindfulness, meditation, exercise, and maintaining a good diet and sleeping habits can also make a difference in our mood.”

Talkspace therapist Cynthia V. Catchings, LCSW-S

How to Manage Relationships With Bipolar Disorder

The single most important part of making a bipolar relationship work is being willing to put the time and effort into managing the condition and nurturing your loved one. There are numerous healthy ways to go about this. All of the following suggestions are strategies that can help each of you successfully navigate your platonic or romantic relationships.

Counseling

Therapy in the form of couples counseling is exceptionally helpful in guiding bipolar relationships. Understanding each other’s point of view and having an unbiased mediator who can help both of you see the other side is beyond just helpful. It can be the difference between maintaining successful bipolar relationships or not. Specifically, counseling can help you identify hurtful and destructive behaviors that may have occurred in the past, find ways to forgive those behaviors, and finally, set firm boundaries for your relationship moving forward, so you don’t continue to repeat the same bipolar relationship patterns. 

If the relationship isn’t romantic, then both parties may benefit from individual therapy to learn how to navigate the relationship.

Self-care

Self-care is important in any relationship, but it’s even more necessary when one person has bipolar disorder. Taking time for one another, working out together, journaling, meditating, eating healthy, taking regular date nights, and maintaining a healthy sleep pattern are all things that can benefit any couple, including bipolar relationships.  

Additional treatment

Getting treatment is critical in managing bipolar and relationships. In an ideal situation, both people will be motivated to remain involved in a treatment plan. When two people are both invested in treatment for bipolar disorder, the results are beneficial and striking. A better understanding of the symptoms, insight into how to communicate, and a better ability to see triggers are all positive results from seeking treatment together. 

What Treatment Options Are Available?

With the right bipolar disorder treatment, it’s easier to navigate the good times, and the difficult ones. Both of you will be able to gain a better understanding of bipolar disorder and relationships on a higher level. Treatment typically needs to be an ongoing commitment, and it can include a number of different styles and approaches. In some cases, a combination of treatment techniques is the best option. 

Medication: There are several medication options for treating bipolar disorder that are often prescribed by an in-person or online psychiatrist.  

  • Antidepressants must be used with caution, as they’re not always effective and have been known to trigger mania for some.
  • Lithium can be an effective mood stabilizer used to curb the highs and lows that are common with bipolar disorder. 
  • Second-generation antipsychotics (SGAs) are also common and are typically used with other emotional regulation medications such as mood stabilizers. They can be helpful during a manic episode and depressive episode.
  • Anticonvulsants are yet another mood stabilizer that may be prescribed. 

Any medication needs to be used with caution and under the guidance of a licensed mental health care provider or psychiatrist. There are side effects you should be aware of, and you should never stop taking bipolar medication without the supervision of a doctor.

Psychotherapy: Psychotherapy is almost always recommended when seeking treatment for bipolar disorder. Cognitive behavioral therapy helps people with bipolar disorder recognize negative thought patterns to replace them with more positive, effective coping techniques.

Psychoeducation and family-focused therapy: Making an effort to learn about bipolar disorder can be hugely beneficial for both people in a bipolar relationship. Not only can it help you understand more about the realities of the condition, but it can also help you be able to identify issues more quickly. 

Electroconvulsive therapy (ECT): ECT works by sending rapid electronic impulses to the brain. While it’s not as common these days, sometimes ECT is still used as a short-term treatment for bipolar disorder when other types of therapy and medication haven’t worked. 

Getting Help for Bipolar Disorder

Whether you have bipolar disorder or you’re in a relationship with someone who does, finding help doesn’t have to be difficult. The first step is learning more about what bipolar disorder looks like. Then, you can find a therapist you both trust and make a commitment to sticking to treatment. 

A few other resources available include finding a local or online support group, getting a referral from your primary care physician, reaching out to a mental health clinic in your area, or considering in-person or online therapy. 

With the right support and guidance, your bipolar disorder relationships can thrive. You can live the life you’ve always wanted in a successful, loving, mutually supportive relationship. 

In a relationship and wondering how to know if you are bipolar? Take our free bipolar disorder test to get started. 

Bipolar affective disorder and everything you need to know about it

More than 60 million people in the world suffer from bipolar affective disorder (BAD). The essence of the disease is that a person has alternating periods of altered mood throughout his life: from a state with a minus sign to a state with a plus sign. How and why is this happening?

Marina KINKULKINA, psychiatrist of the highest category, head of the department of psychiatry and narcology, director of the Institute of Electronic Medical Education, First Moscow State Medical University. I. M. Sechenova, Corresponding Member of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences

Moreover, it is often not just about sadness or fun, as is often the case with emotional people, but about extreme degrees of either despair or euphoria. The change in these moods can take place both gradually and suddenly, and often for no apparent reason. This disease is attributed to Byron and Hemingway, Virginia Woolf and Edgar Poe, Van Gogh, Schumann, Vivien Leigh and many others. There is an assumption that even “our everything” suffered from a mild degree of BAD (contemporaries often mentioned mood swings) A. S. Pushkin. Modern stars - Catherine Zeta-Jones and Mel Gibson - openly admit to having this mental disorder. And rapper Kanye West even put the inscription on the cover of his album: "I hate being bipolar, it's amazing." A very accurate description of the essence of this disease.

Genetics does not solve everything

BAD affects both men and women, but the weaker sex - more often. As for the age of onset of the disease, this disorder can also appear in a teenager (especially if there is an appropriate heredity), and in an adult, and even in an elderly person. Everything is individual. The main risk factor is genetics, but a specific gene that would be responsible for the development of bipolar disorder has not been identified. This is a polygenic disorder, and it makes no sense to take genetic tests to find out how great the risk of getting sick is, because scientists still do not have a consensus on what specific combination of genes can lead to a violation. But even if there is a genetic predisposition, it is not certain that the disease will develop. This was proven by studies on identical twins, one of which developed bipolar disorder over the years, while the other did not. Accordingly, there must be some other predisposing moments. Science knows about some of them: life at the limit of possibilities with constant hands-on work, stress and chronic lack of sleep, as well as night shift work, frequent flights with a significant change in hourly flights and, of course, the use of psychoactive substances contribute to the development of the disease. Therefore, they should be avoided. Scientists have yet to learn about other factors.

But not boring?

The number of people suffering from bipolar disorder among the population, according to various estimates, varies from fractions of one percent to several percent. Recently, psychiatrists note, the proportion of affective disorders has increased significantly, which can be explained by improved diagnostics. At first glance, the BAR does not look like something scary and dangerous. To ignorant people, this disorder even seems attractive - sometimes sad, sometimes fun, in general, you won’t get bored. In addition, being different from everyone else is now fashionable. And then, there is an opinion that people with BAD have higher intelligence and creative abilities than the “gray masses”. But even if this is so, then none of those who suffer from it will definitely call BAD a pleasant thing. It is especially difficult for those patients who do not seek medical help on time. Without treatment, both phases of bipolar disorder can last for months (although sometimes the disorder occurs with frequently alternating phases). Moreover, it is impossible to say which of the periods of the disease is more difficult, manic or depressive.

Bad when very bad

Those who have experienced real depression say that this is the worst thing that can happen in life. In this state, the whole world is seen in black, the mood is depressed, self-esteem drops, life loses its meaning. A person suffering from BAD in the depressive phase perceives his very existence as a chain of tragic mistakes, constantly blaming himself for all the troubles and sins, even those that do not even exist. In addition to mental suffering, physical ones also arise: a person even moves with difficulty, as if swimming against the current, it is difficult for him to perform the most familiar actions. In addition, he can feel tension throughout the body, experience various pain sensations. With an average degree of depression, people often complain of debilitating pain in the abdomen and other parts of the body. On this occasion, they turn to doctors, but the diagnosis cannot be made. And the daily pain continues to harass. Psychiatrists call this somatoform symptomatology. With severe depression, many have the so-called atrial depression. Patients complain of pain and heaviness in the chest, they say that "a stone lies on the heart." But even an in-depth examination does not reveal cardiac causes.

Often, with depression, patients (especially the elderly) complain of difficulty in thinking, memory impairment, they say that they have become stupid, they believe that they are developing dementia, they are afraid of “losing their mind”. In fact, affective disorders do not destroy the intellect. When treated with antidepressants, when the mood stabilizes, abilities are restored.

But the worst consequence of depression is suicide. Most suicide attempts are made in this state. Sometimes people in a very pronounced depression, believing that they have done something irreparable, and believing that the consequences of their actions can harm loved ones, decide on extended suicides, in which they settle scores not only with their lives, but also take their loved ones with them ( more often children).

Bad when too good

The manic stage of BAD is subjectively more pleasant. Patients are not just in a very good, but in a great mood: they love the whole world and themselves in it. The reflection in the mirror pleases, there is not the slightest doubt about one’s own talents and mind, there is more than enough strength and energy, a bonus is accelerated mental activity. Many in this stage sleep for an hour a day, but do not experience fatigue. Sometimes they don’t sleep for whole days - and at least they are cheerful, like an “energizer”. It seems to be great. But no. With mania, desires and new ideas arise too quickly, so a person grabs at each new business, but, as a rule, does not bring any to the end. So productivity at this stage is no more than during depression. But it would be nice if that was the only thing.

The main danger of mania is that a person has no criticism at this moment, and he can do things that he will later regret very much. For example, he can give away all his property to others (sometimes to unfamiliar people or scammers who specifically use this state of his). Or, say, take out loans to go on a trip to the other side of the world, and take a bunch of friends with him. Maybe even steal something - for example, to make an expensive gift. Many patients at these moments enter into hasty intimate relationships, mistaking a chance meeting for the love of their life (and completely “forgetting” that family and children are waiting at home). Finally, often with mania, people, experiencing euphoria, ignore their severe somatic symptoms, as a result, they do not go to the doctor for a long time, and thus trigger a serious illness (pneumonia, for example). In addition, not all patients in the manic phase are "darlings." Often they show unreasonable aggression if, for example, others do not agree with their "brilliant" advice. As a result of such “angry mania”, conflicts and even situations arise that require the intervention of law enforcement agencies and the hospitalization of the patient without his consent in a psychiatric hospital.

Good intentions…

The worst thing that relatives and friends of a person with bipolar disorder can do is ignore his problem, devalue suffering, while blaming the patient himself and appealing to his conscience. For example, they can call on a depressed person to “pull himself together, not become limp”, say that he is “mad with fat”, etc. A patient at the stage of mania is most often accused of immorality, irresponsibility, frivolity, promiscuity in relationships, etc. However, doing so is like blaming a person with diabetes for not being able to eat sweet cake, or a patient with heart failure for not running a marathon. BAD is a disease like many others. And she needs to be treated. The sooner you start the right therapy, the sooner you can stabilize the patient's condition and the better the further prognosis will be.

Psychiatrists don't bite

Despite the fact that recently people (especially young people) have ceased to be afraid to turn to psychiatrists, not everyone still decides to go to the doctor. Indeed, on the Internet in the public domain, you can find hundreds of questionnaires to test yourself for any mental disorder. And then, after reading various tips, you can also “cure”. Doctors strongly advise against doing this. The smallest harm of self-treatment is that it will not help or lead to incomplete improvement, but it can also worsen the condition. For example, inadequate intake of antidepressants in bipolar disorder can lead from a depressive phase into a severe manic state, from which it will then be difficult to get out. Only a psychiatrist (and not a psychologist, neurologist or doctor of any other somatic profile) can identify bipolar disorder and choose the right treatment. Treatment should be strictly individual, that is, the doctor selects it based on the characteristics of a particular patient and taking into account a specific moment in the course of the disease. The goal of therapy is not only to equalize the patient's mood, but also to prevent recurrence. In the treatment of bipolar disorder, the main role is played by drugs for stabilizing mood - mood stabilizers (lithium salts, some anticonvulsants (anticonvulsants) and antipsychotics of new generations). Modern drugs are much better tolerated than their predecessors, have fewer side effects, as they are designed for long-term use over many years. Against the background of their intake, women can even become pregnant and give birth. In depression, antidepressants are prescribed in exceptional cases, given the danger of changing the depressive stage to manic.

You won't be able to forget

The insidiousness of BAD is that this disease cannot be cured once and for all. But, alas, often, when the patient's mood can be balanced by medication and he begins to feel good (such a state - intermission - is completely indistinguishable from a state of complete health), he can stop taking the drugs. This is a big mistake that does not allow to achieve a stable result of treatment. Sometimes it is required to use medicines (necessarily under the supervision of a doctor) for several months, but more often for years (with periodic visits to the doctor). It is the long-term use of maintenance therapy individually selected by the doctor that allows patients to achieve a stable good condition and feel the joy of life for many years.

Link to publication: www.kiz.ru