Supporting a Loved One with Bipolar Disorder
How can familial and non-familial relationships affect those with Bipolar disorder?
Having a strong support system is crucial in the road of remission for people diagnosed with Bipolar disorder (BD). One study, which was looking to understand how social relationships impact someone with Bipolar disorder, found that those with little to no support are likely to have more frequent and severe episodes of depression over time (Miklowitz & Johnson, 2009). Specifically, a BD person’s depressive symptoms are worsened when their social circle is openly critical, hostile, as well as overly involved with the course of the disorder. It was also found that relationships that are prone to conflict can negatively impact someone’s course with Bipolar disorder (Miklowitz & Johnson, 2009).
On the other hand, those who are strong communicators and problem-solvers with their loved one diagnosed can positively impact the depression symptoms they experience. These positive effects include a person with Bipolar disorder experiencing fewer and milder depressive episodes (Simoneau, Miklowitz, Richards, Saleem, and George, 1999 as cited in Miklowitz & Johnson, 2009). However, it was also found that negative social support can lead to more manic or hypomanic relapses along with depressive relapses in people with Bipolar disorder. Overall, research has determined that social support plays a large role in shaping the course of Bipolar disorder, with the potential to either positively promote stability and recovery or contribute to frequent and severe relapses.
How can you support someone diagnosed with Bipolar disorder?
Understanding that social support does have a large impact on people diagnosed with BD, how can you provide effective support for your loved one? Multiple studies have outlined the following strategies to provide effective support for people with Bipolar disorder:
1. Active listening
Actively listening is crucial for someone with Bipolar disorder to feel supported. Being an active listener means “giving [your] full attention to what the speaker is saying, without interrupt[ing] or judg[ing] (Dutra et al., 2018 as cited in Webb, 2023). It is critical to keep an open mind when your loved one is sharing their experience or struggles with the disorder. When you are openly judgemental or critical of the information they are sharing with you, a person with Bipolar disorder may feel like nobody is truly listening to them and may shy away from sharing in the future.
There was a time when I was letting someone in my life know that I was diagnosed with BD, and they told me that it wasn’t an excuse for me to act the way that I was acting toward people. I remember feeling caught off guard by that, and I had no idea how to respond. After that conversation, I have shied away from sharing anything with them because of that experience. It is important to remember when someone with BD is sharing information with you, they are being vulnerable. So, it is crucial to handle the conversation with care and empathy so that they feel supported and cared for.
While you may not be able to relate or fully understand what they are going through, taking the time to listen helps them to feel validated and acknowledged. Not only that, but it can help you to determine what your loved one’s needs are when they are experiencing times of depression and hypomania or mania.
2. Patience and understanding
With the nature of Bipolar disorder, relationships can be impacted. People with the disorder are known to be cycling through emotional states. There may be times when your loved one is feeling on top of the world and is more active. However, there may also be times when your loved one becomes emotionally withdrawn and struggles to complete basic tasks. There are also periods when your loved one isn’t experiencing either of these states and is emotionally balanced. This cycling of emotional states does have a direct impact on how they interact with you (Webb, 2023).
For example, there was a time when I was experiencing an emotional high. During that time, I was making a lot of plans with my family for the next week, one of the plans included going to the movies. The day came when we were supposed to go to the movies. However, I ended up falling into a depressive episode. All I wanted to do was cry and go to sleep. I felt emotionally drained, and I immediately knew I wasn't going to be able to go out. I felt a lot of guilt, but I knew I would ruin everyone’s time if I went out in a bad mood. So, I ended up letting one of my family members know that I wasn’t going to go. They ended up getting upset with me because I was the one who made the plan. I already felt guilty before I said anything, and I ended up feeling even more guilty. I told them that I was struggling emotionally and I didn’t want it to affect everyone’s time out. They continued to tell me how upset they were that I was “flaking” and that I needed to stop making plans if I was not going to follow through on them. After they left, I ended up crying and getting frustrated at myself for not being able to snap out of the mood I was in.
It can be challenging when your loved one acts in ways that are upsetting or frustrating, but try to remember–they’re not doing it on purpose. These behaviors are part of the disorder and should be met with compassion and patience. It’s okay to feel frustrated but try not to express those feelings at the moment. Wait until your loved one is more emotionally stable before talking about it. Bringing it up in the moment can increase emotional instability (e.g. feelings of guilt, sadness, or anger), making the situation more difficult for both of you.
3. Provide encouragement
As mentioned above, people who provide support and encouragement to their loved one diagnosed can decrease the frequency and severity of their mood episodes. One of the ways you can provide encouragement is by acknowledging the efforts they are making. For example, statements such as “I admire the steps you are taking to try and work through this,” or “I’m proud of you for sticking with your daily routine despite you not feeling your best today.” Statements like these not only help loved ones to feel accomplished, but improves relationship dynamics by reminding them that they do have people in their corner (Bauwens et al., 2017 as cited in Webb, 2023).
Something to avoid in supporting your loved one is toxic positivity. Examples of toxic positivity include “Just think positive!” and “Look on the bright side!” While you may have good intentions with these statements, they minimize or dismiss your loved one’s struggles. Instead, simply provide your loved one a listening ear and reassurance that these feelings will pass eventually and that you are here for them if they need anything.
4. Be flexible with support needs
When someone is experiencing symptoms of depression
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When someone is experiencing symptoms of hypomania or mania
5. Act early
One study looking to understand the support needs of people diagnosed with Bipolar disorder found that “be[ing] aware of, and acting on, early warning signs” was key in providing effective and meaningful support (Billsborough et al., 2014). Understanding your loved one’s warning signs before a depressive and hypomanic or manic episode is beneficial to not only know when to intervene but also prevent it from reaching a point of crisis. Identifying warning signs is especially important with hypomania and mania as “there may be only a short window of [time]” to take action before the mania turns into a crisis situation (Billsborough et al., 2014).
It is important to take time to talk with your loved one about what warning signs they have identified when a mood episode is coming on, while also recognizing that they may not always be aware of every sign themselves. So, it is equally important to observe your loved one and make note of any warning signs you notice, as your outside perspective can help catch patterns or changes they might not see.
To be prepared, it may be beneficial to develop a crisis plan with your loved one to know what steps need to be taken when they are experiencing a manic episode. Click the button below to access a sample crisis plan developed by the Depression and Bipolar Support Alliance.
6. Balance your level of involvement
It is important to strike a balance between checking in regularly with your loved one and giving them space. This shows respect for their independence while continuing to offer consistent support. One interviewee from a study looking to understand the support needs of people diagnosed with Bipolar disorder discussed the following when asked about receiving check-ins from loved ones:
“What I don’t like is to be bombarded by people checking up on me, being worried, because then I feel guilty about them being worried.” (Billsborough et al., 2014).
Another study looking to understand the experiences of informal caregivers supporting those diagnosed with Bipolar disorder determined that there are negative consequences to being overly involved:
“My mother was…or we all, were constantly on top of him…It must have felt quite oppressive for my father…that he might have thought that we should back off and leave him alone for a while…but my mother, she was all over him, telling…no, summoning him to take the medication that he needed for his own sake” (van den Heuvel et al., 2018).
With the nature of Bipolar disorder, it can be an isolating experience. Having support can make a meaningful difference in managing these struggles, but it is important to recognize that there are times where your loved one needs space to process and cope on their own. Being overly opinionated or too involved in their diagnosis can feel intrusive and may lead to frustration, stress, or a strain in the relationship–so offering support with sensitivity and respect is key.
One simple way you can show your loved one that you are there for them without being intrusive or overly involved is sending them a message letting them know that you are thinking of them. This provides your loved one with comfort and reassurance without bombarding them with worried messages.