How to Deal with a Family Member Who Has Bipolar Disorder

Supporting Your Family Member

Understand that some of your family member’s behaviors are linked to the disorder. For example, a person who is chattering on about themselves selfishly or bragging is normally recognized as arrogant or self-centered. This behavior in a person with bipolar disorder is a sign of mania, as are other risky behaviors that may be equally unappealing to you. Recognizing that this is a symptom of the illness, and not an intentional behavior by your family member is helpful in understanding their condition. However, be cautious not to associate every mood your family member has with their illness; people with bipolar disorder can be mad or sad in healthy ways, too. One way you can understand your family member's illness better and show support is to simply ask about their experience of it. Make sure, however, that you use discretion and identify if they feel comfortable talking with you about it before you attempt to engage them. If this is too threatening, you could simply ask how they are doing and gain more information about what they are currently going through.

Support your family member in their mental health treatment. Since bipolar disorder is best treated with medication and therapy, it is crucial to be supportive of your family member engaging in treatment. One way to become involved is to participate in your loved one’s psychotherapy. Family therapy can be a helpful resource in supporting an individual with bipolar disorder. Communicate with your family member’s mental health care provider. If your loved one has signed a release for you to speak with their therapist or doctor, you can notify that person about possible concerns or problems as they arise. You can also gain more information on how to assist your family member. If your family member is not currently receiving mental health treatment, you can encourage or help them to seek treatment. PsychologyToday.com. and the American Psychological Association (APA) are both helpful resources. You can search for therapists or psychiatrists in your area who specialize in bipolar disorder. However, be careful not to push treatment on your family member if they are reluctant (unless they are potentially harmful to herself or others); this can scare them off and disrupt your relationship.

Help monitor medication compliance. It is common for individuals with bipolar disorder to avoid taking their medication since the “high” of mania can feel good to them. If you notice that your family member has gone off their medication, the first step would be to notify their psychiatrist or general practitioner as soon as possible. Most likely the doctor will want to speak with your loved one and will inform you of how to proceed. If you are not able to speak with a doctor, you can encourage your loved one to take their medications, or provide incentives (such as special treats or doing something with them that they enjoy) if they agree to be med-compliant.

Adhere to a medication regime. Do keep in mind that adherence to a medication regiment is not necessarily just a simple, straightforward matter of choosing whether or not to take a pill. Medications commonly used to treat bipolar disorder frequently cause substantial adverse effects such as forgetfulness, sleepiness, gastrointestinal symptoms, excessive sweating, substantial weight gain, hair loss, skin rashes, sexual problems and other unpleasant and distressing symptoms. If someone you care about has stopped their medication or expresses the desire to discontinue medication, it may be helpful to inquire as to what their reasons are. They may well have compelling reasons, beyond merely “I’m feeling better and I don’t need it”. Others may claim that they enjoy the high of hypomania and don’t want to take medication that will end their feeling of euphoria. Adverse effects are most commonly experienced when starting a new medication or increasing the dose, however they may occur at any time in treatment and may be a cause of substantial distress or discomfort to the individual. If your loved one is not adhering to their medication regimen because of adverse effects, do encourage them to talk with their doctor to determine whether a change in strength or timing of dose, or an alternative medication might alleviate or minimize the problem to a tolerable level.

Assist during a manic or hypomanic episode. If you notice signs that your family member may be experiencing an episode, it is crucial to engage them in harm reduction. Negotiate to reduce harm during risky behaviors (gambling, excessive spending, drug abuse, reckless driving) Keep children, disabled people, and other vulnerable people away so that the antics do not disturb them Speaking with your loved one's medical health clinician, or calling an ambulance or suicide hotline if they are at risk of harming themselves or others

Plan for a crisis. It is important to have an action plan for dealing with an emergency to effectively de-escalate a crisis. Have contact info of important relatives who can help, as well as doctor’s numbers and hospital addresses. Do not just store this information in your phone in case it loses battery; you should have these numbers written down and on you at all times (such as in a wallet or purse). Give a copy to your family member. You could even develop this plan together when your family member is emotionally stable.

Help your family member avoid triggers. A trigger is a behavior or situation that may increase the likelihood of a negative outcome, in this case, a manic, hypomanic, or depressive episode. Possible triggers include substances such as caffeine, alcohol, and other drugs. Triggers can also include negative emotions such as stress, an imbalanced diet, sleep irregularities (sleeping too much or too little), and interpersonal conflicts. Your loved one will have their own specific triggers. You can help by discouraging your family member from engaging in these behaviors, or by helping them prioritize their responsibilities to reduce stress levels. Criticism and critical people are common bipolar triggers. If you live with your family member you could remove substances such as alcohol from the home. You could also attempt to foster a relaxing environment by controlling lighting, music, and energy levels.

Exercise compassion. The more educated you become about bipolar disorder, the more understanding and accepting you can be. While it may still be a challenge to cope with this disorder in the family, your concern and thoughtfulness can go a long way in supporting your family member. One way to show that you care is by simply letting your family member know that you are there for them, and you want to be supportive of their recovery. You can also offer to listen to them if they want to talk about their illness.

Taking Care of Yourself

Practice empathy. Putting yourself in your family member’s shoes is a helpful way to increase your understanding of their behavior as well as to reduce your negative emotions about or reactions to their mental health. Allow yourself to imagine what it would be like to wake up unaware if that day you would be plummeted into depression or elevated into a frenzied state of energy.

Focus on your own mental health. Caring for a loved one with bipolar disorder can sometimes lead to stress and depressive symptoms. Remember that you can only begin to help someone else if you first maintain your own physical and mental health. Be aware of your own behaviors and your underlying feelings about your family member. Give up control. It is important to understand and remind yourself (either aloud or in your mind) that you cannot control your family member's behaviors. They have a condition that you cannot fix. Shift your attention to focusing on your own needs. For example, you could make a list of your own personal goals and begin working toward them. Use coping resources. Coping resources are specific ways to cope with a particular issue, and they are vital to self-care. Coping strategies can include activities you enjoy such as reading, writing, art, music, outdoor activities, exercise or sports. Therapeutic activities can also assist self-care including relaxation techniques (such as progressive muscle relaxation), meditation, keeping a journal, mindfulness, and art therapy. Another way to cope is to create distance or remove yourself from stressful situations when they arise.

Consider professional help. If you find that you are having a difficult time coping with your family member’s symptoms of bipolar disorder, it may be beneficial to receive your own therapy. Evidence suggests that gaining family therapy, not just education, can help individuals (especially caregivers/parents) deal with having a family member with bipolar disorder.

Understanding Bipolar Disorder

Recognize that bipolar disorder is a biologically based condition. This means it has a strong genetic component and tends to run in families. Therefore, it is not the fault of your family member any more than it would be if they had a medical condition. Bipolar Disorder is not something your family member can control through will-power alone.

Understand the different symptoms of bipolar disorder. There are two main types of bipolar disorder, Bipolar I Disorder and Bipolar II Disorder. It is important to identify which type your family member has to understand their particular symptoms and behaviors. Bipolar I is evidenced by a person experiencing manic episodes that typically last a week or longer. Some symptoms of a manic episode include: heightened/irritable mood, exaggerated self-esteem, decreased need for sleep, increased talkativeness, distractibility, increase in goal-directed activity, and engaging in risky behaviors (such as gambling or having unprotected sex with multiple partners). Bipolar II is evidenced by at least one major depressive episode as well as a least one hypomanic episode (similar to a manic episode, but less severe and can last as little as four days).

Understand how bipolar disorder is treated. Bipolar disorder is typically treated with a combination of medication and therapy. Psychiatrists or general practitioners often prescribe mood stabilizers such as Lithium to reduce the symptoms of bipolar disorder. Psychologists, Marriage and Family Therapists (MFTs) and other clinicians typically assist the individual with bipolar disorder in managing and coping with their symptoms. Typical types of therapies include Cognitive Behavioral Therapy (CBT), Family Therapy, and Interpersonal Therapy.

Gain education on the typical effects of bipolar disorder on the family. Family members of individuals with bipolar disorder may experience burden and lack of energy. Additionally, spouses of individuals with bipolar disorder may experience a lack of support, and many do not seek help. If a family member believes that the person with bipolar has control over their illness this can lead to feelings of burden and dissatisfaction with the relationship.