Navigating Relationship Challenges Related To Bipolar Disorder
If you or a partner has bipolar disorder (BD), you may have experienced challenges in your romantic relationship due to the symptoms that typically accompany this mental health condition. Maintaining any type of healthy relationship can be difficult and requires effort from all parties, and this can be especially true when one or more partners is living with a mental illness. Read on for an overview of bipolar disorder and strategies for building a healthy relationship when you or a partner has a mental health diagnosis like this.
An overview of bipolar disorder
There are three different types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Each one is characterized by significant mood swings, referred to as episodes, which may vary in severity depending on the type.
Someone with bipolar I disorder will experience manic episodes and may sometimes experience depressive episodes as well. Symptoms of bipolar I disorder are typically the most severe of all three types of bipolar disorder and may sometimes necessitate hospitalization for the individual's safety. Someone with bipolar II disorder will typically experience less severe but still serious and potentially disruptive symptoms of hypomanic and depressive episodes. Someone with cyclothymic disorder may experience hypomanic and depressive episodes that are milder in severity than those seen in bipolar I and II disorders.
Symptoms of manic, hypomanic, and depressive episodes
A short description of these types of episodes and their common symptoms are below.
Manic episodes
During a manic or hypomanic episode, the individual may be in an abnormally good or intense mood and have increased levels of energy. They may also express grandiose thoughts and make poor decisions that involve risky and impulsive behaviors.
For example, during a manic episode, an individual might try to convince their partner to begin a massive home project that will require money that the couple doesn’t have. They might provide assurances that they’ll be able to do all the work themselves, even though they don’t have the skills the project requires.
Major depressive episodes
When a person is experiencing depressive symptoms, they slow down and lose interest in activities they previously enjoyed. They may sleep too much or too little and have little to no energy. It may be challenging for them to concentrate or make decisions. During depressive episodes, someone may withdraw and isolate themselves from their partner, resulting in feelings of disconnection and loneliness.
Mixed episodes
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) refers to these symptoms as “mixed features.” Around 40% of bipolar patients experience mixed episodes, which involve a combination of both manic and depressive symptoms at once. For example, the person may have a depressed mood but racing thoughts, or be in a euphoric mood but experience suicidal ideation. With symptoms swinging from one extreme to another, it can be difficult for a partner of the individual to understand what’s going on or how they can best support their loved one.
If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.
Bipolar disorder treatment
Typically, treatment for bipolar disorder involves psychotherapy, medication, or a combination of both. Therapy can help an individual with bipolar disorder find emotional support, develop healthy coping strategies, and address potential comorbid mental health challenges.
Medications commonly prescribed for bipolar disorder include mood stabilizers, antipsychotics, and antidepressants. However, certain medications—such as SSRIs and other antidepressants—have been shown to cause or precipitate manic symptoms. Always consult with a healthcare provider prior to starting or stopping any medication.
Additionally, certain lifestyle changes can improve the symptoms of manic and depressive episodes. Maintaining a healthy diet, exercising regularly, and getting plenty of sleep can help with mood regulation and other challenges associated with bipolar disorder.
Common relationship challenges related to bipolar disorder
Research suggests that certain challenges, as listed below, may be common in romantic relationships involving one or more individuals who are living with bipolar disorder. Note, however, that the type and severity of these challenges can vary widely depending on the couple, their situation, the type of bipolar disorder an individual has, and whether they’re receiving regular treatment for it. Those with more severe forms of this illness, such as bipolar I, and those who are living with undiagnosed or unmanaged bipolar disorder may be more likely to face these challenges in their relationships, and finding professional support for bipolar disorder may help couples address them.
Partner burnout and trouble relating to symptoms
Partners may have to make sacrifices in order to care for their loved one with bipolar disorder. For example, they may have to take on more household responsibilities or sacrifice leisure time in order to meet their partner’s needs, which could potentially lead to burnout or resentment.
In one study, nearly half of the participants with bipolar disorder were unable to work and received a disability pension. People with this condition who do have a job often experience higher rates of absenteeism and may have more job instability. As a result, the majority of a couple’s financial responsibilities may be placed on the partner without BD, which can cause stress.
It can also feel overwhelming for the partner to help manage bipolar symptoms in order to prevent a negative impact on the couple's life. For example, if a couple has children, the partner without BD may have to take on additional parenting duties during a depressive episode. During a manic episode, they may have to monitor joint credit card statements to ensure the person with bipolar disorder isn’t excessively spending money they can’t afford to lose.
A partner who does not have bipolar disorder may have trouble understanding what their loved one with bipolar disorder is experiencing, and they may not know the best way to respond to various symptoms. The person with bipolar disorder may then feel misunderstood or stigmatized. Psychoeducation can be an effective way to address this and other challenges.
Hypersexuality
Hypersexuality is a common symptom of bipolar disorder that may present during a manic episode, which could result in pressure on the individual’s partner to engage in sexual behavior. It can also sometimes result in other sexual behaviors that can be damaging to a relationship, such as infidelity.
Health problems and emotional exhaustion
The physical and emotional strain of having a partner with bipolar disorder—particularly if symptoms are not appropriately managed—may result in health problems. Some of the most common challenges include tension, insomnia, muscle pain, and tiredness.
Trouble navigating other types of relationships
Other people may not demonstrate the same levels of flexibility and understanding that a partner or close loved one may have. As a result, people with bipolar disorder may struggle to maintain relationships with extended family, friends, colleagues, neighbors, and other people outside of their immediate circle. This may lead to feelings of isolation whether the individual is single or in a romantic relationship. It may also cause the partner without BD to feel like they’re the only or one of the few sources of emotional support for their partner, which can be an overwhelming responsibility.
Navigating relationship challenges related to bipolar disorder
Learn about the challenges of living with bipolar disorder
It can be helpful for both partners to learn as much as they can about bipolar disorder, including key symptoms and support options. Having a sense of curiosity and aiming to better understand the condition can help the partner(s) without bipolar disorder empathize with what their loved one is experiencing and recognize when they may need extra support. A few places to start include:
- National Institute of Mental Health
- National Health Service (NHS)
- American Psychiatric Association
- MedlinePlus from the National Library of Medicine
You might also look into books, podcasts, YouTube videos, and other content formats to hear from other people who have bipolar disorder or who are in a relationship with someone who does.
Practice self-care
Keeping up with self-care is essential for overall well-being, whether you have bipolar disorder or love someone with the condition. For example, it can help to take time for activities that promote well-being and bring you joy, engage in regular exercise, get enough sleep, and seek support from family and friends. By looking after yourself in these ways, you may be better equipped to address the challenges that can come with maintaining a healthy relationship of any kind.
Create a supportive environment
Designing a supportive environment that promotes the mental well-being of all partners can be important. This can involve:
- Establishing healthy routines
- Encouraging healthy lifestyle habits
- Offering emotional support during difficult times
Encourage open communication about mental health concerns
Open communication is necessary for any healthy relationship, but it can be especially important when someone in the relationship is navigating mental health challenges. Both partners should generally be willing to share their feelings and experiences and listen to the other without judgment. Communication may help the couple navigate mood swings, identify situations that may trigger a mood episode, and work together to find solutions.
Set healthy boundaries
Setting boundaries, or clearly communicating personal needs and limits, can be crucial to help protect your own well-being and maintain a healthy relationship where both partners feel like their needs are being met.
For example, a person with bipolar disorder may need regular personal space in order to manage their emotions and help them avoid experiencing the symptoms associated with a manic, hypomanic, or depressive episode. Similarly, their partner may need to have set personal time each week to pursue their own hobbies and interests and avoid burnout.
Treatment can ease relationship challenges related to bipolar disorder
Treatment for bipolar disorder often involves a combination of psychotherapy and medication, and healthy lifestyle habits and support groups may also be helpful. Therapy may be a particularly important component, as research suggests that individuals with bipolar disorder who participate in cognitive behavioral therapy (CBT) may decrease their chances of relapsing by 60%.
For the partner of a person with bipolar disorder, therapy may help them learn coping strategies for when they feel overwhelmed or stressed. It can also help prevent feelings of resentment or loneliness that might cause friction in a relationship. Some may also choose to participate in couples counseling, where they can work together to resolve conflict and develop strategies to address future challenges that may arise.
Benefits of mental health treatment through online therapy
Some research suggests that up to 75% of bipolar symptoms are depressive symptoms, which may include effects like a lack of energy and difficulty concentrating. These may make it difficult for a person to consistently participate in in-person therapy, so online therapy may be a convenient alternative in such cases. With online therapy through a platform like BetterHelp for individuals or ReGain for couples, you can attend sessions from home or anywhere you have an internet connection.
Efficacy of online therapy for people living with bipolar disorder
A growing body of research suggests that online therapy can be an effective tool for addressing a wide range of mental health challenges. In one study, researchers examined the impact of online CBT in treating those with bipolar disorder who were also taking lithium. Participants saw a reduction in their depression symptoms and reported being likely to recommend the treatment to others.
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