Helping a Person with Bipolar Disorder

Helping a bipolar family member or friend

Dealing with the ups and downs of bipolar disorder can be difficult—and not just for the person with the illness. The moods and behaviors of a person with bipolar disorder affect everyone around—especially family members and close friends. During a manic episode, they must cope with reckless antics, outrageous demands, explosive outbursts, and irresponsible decisions. And once the whirlwind of mania has passed, it often falls on them to deal with the consequences. During episodes of depression, they may have to pick up the slack for a loved one who doesn’t have the energy to meet responsibilities at home or work.

The good news is that most people with bipolar disorder can stabilize their moods with proper treatment, medication, and support — so if your friend or family member has bipolar disorder, take hope. Furthermore, you can play a significant role in his or her recovery.

Here are some ways you can help a person with bipolar disorder:

• Learn about bipolar disorder. Educate yourself about bipolar disorder. Learn everything you can about the symptoms and treatment options. The more you know about bipolar disorder, the better equipped you'll be to help your loved one and keep things in perspective.
• Encourage the person to get help. The sooner bipolar disorder is treated, the better the prognosis, so urge your friend or family member to seek professional help right away. Don't wait to see if the person will get better without treatment.
• Be understanding. Let your friend or family member know that you're there if he or she needs a sympathetic ear, encouragement, or assistance with treatment. Remind the person that you care and that you'll do whatever you can to help.
• Be patient. Getting better takes time, even when a person is committed to treatment. Don't expect a quick recovery or a permanent cure. Be patient with the pace of recovery and prepare for setbacks and challenges. Managing bipolar disorder is a lifelong process.

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.

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 bipolar disorder treatment

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.

Convincing a person with bipolar disorder to see a doctor

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).

If your friend or family member admits to a problem but is still reluctant to see a doctor, the following points may help convince him or her to get treatment:

• Bipolar disorder is a medical condition, like diabetes or asthma.
• You're not to blame for bipolar disorder. You didn't cause it.
• Your symptoms are caused by chemical imbalances in the brain.
• There are effective treatments for bipolar disorder.
• When bipolar disorder isn't treated, it usually gets worse.

Being a partner in 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 your loved one wants or needs.

Things you can do to support bipolar disorder treatment:

Finding qualified doctors and therapists Setting up appointments and going along Offering your insight to the doctor Monitoring your loved one's moods

Learning about the person’s medications Tracking treatment progress Watching for signs of relapse Alerting the doctor to problems

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. Encourage the person to speak to the doctor about any bothersome side effects. A change in medication or dosage may solve the problem. Remind the person that abruptly stopping medication is dangerous.

Early warning signs and symptoms of bipolar relapse

Even if a person with bipolar disorder is committed to treatment, there may be times when symptoms get worse. Friends and family members can help by watching for early warning signs and taking immediate steps to stabilize the symptoms and prevent relapse.

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.

Bipolar Disorder Warning Signs & Symptoms
Mania symptoms	Depression symptoms
Sleeping less Elevated mood Restlessness Speaking rapidly Increase in activity level Irritability or aggression	Fatigue and lethargy Sleeping more Trouble concentrating Loss of interest in activities Withdrawing from others Change in appetite

Coping with bipolar symptoms: 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 with 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.

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 the National Alliance on Mental Illness at 1-800-950-NAMI.

Related links for helping a person with bipolar disorder

Helping a bipolar friend or family member

Bipolar Disorder: A Guide for Patients and Families - Patient and family guide to the symptoms, warnings signs, treatment, and support of bipolar disorder. (Expert Consensus Guidelines)

Manic-Depressive Illness - Information book for people with bipolar disorder and their loved ones. Includes information on symptoms, treatment, and effects on the family. (Internet Mental Health)

Helping a Friend or Family Member with Depression or Bipolar Disorder - Advice for friends and family members on how to help and support a person with bipolar disorder. (Depression and Bipolar Support Alliance)

What Can Family and Friends Do to Help? - Tips for helping and supporting a loved one through bipolar disorder treatment and recovery. (Mood Disorders Society of Canada)

Coping with bipolar disorder symptoms

The Role of Family and Friends in a Bipolar Person's Life - Article on how to support a person with bipolar disorder and cope with challenging symptoms. (HealthyPlace.com)

Dealing with Family Tensions Caused by Bipolar Disorder - Advice on coping with bipolar disorder symptoms and handling the relationship problems it can cause. (Patient Health International)

Beating the Marriage Odds - Learn how marriages involving bipolar person can stay strong by sharing responsibility, planning ahead, and setting boundaries. (National Alliance on Mental Illness)

Supporting treatment for bipolar disorder

Tips for How to Help Someone Manage Bipolar Treatment - List of ways you can help a friend or family member with their treatment for bipolar disorder. (Families for Depression Awareness)

Tools for Everyone - Download a sample mood chart and a bipolar disorder treatment contract, and find information on how to use them to help your friend or family member. (Massachusetts General Hospital Bipolar Clinic & Research Program)

How to Help Someone in a Crisis - Guide to handling a bipolar disorder crisis, including what to say and do and how to get a loved one to check in to a hospital voluntarily. (Depression and Bipolar Support Alliance)

Melinda Smith, M.A., contributed to this article. Last modified on 3/23/08.