Bipolar Answers

Hi Maddy,  As you wrote, mental health struggles affect not only the person who is experiencing them but also family and friends that care about them. The fact that you are reaching out with your question illustrates just how much you care for the wellbeing of your relative and the desire to help.  Try to create a safe non-judgmental space in which they can talk openly and honestly about what they are experiencing. Ask them how they are feeling and be open about your own experiences with mental health. Experiencing a manic or depressive episode can be quite scary to the person who is going through it especially, when as you said, they have not sought out help as of yet. Although you may not be able to understand their experience just the fact that you are trying to understand speaks volumes. Educate yourself as much as you can about things like Bipolar disorder, depression, and mania. There are books that have been written from the perspective of someone with Bipolar that can help provide insight into what the experience can be like. There are lots of resources online, but be sure that you are looking at well established sites such as official mental health agencies and governmental departments. If you can learn what some of their triggers are, this can help a lot as well. If for example, there are certain behaviors you notice before a manic or depressive episode that you are aware of, you could gently let them know in a way that reflects care and concern. Although there are many things that may be a trigger some common triggers include sleep disturbances, physical illness, stressors related to work, relationships or money, the death of a loved one or the end of something (such as graduation). Of course, these examples are not all encompassing. Triggers are as individual as each person is. Finding a balance between support and control can also be a bit of a tricky one. Often times, people with various mental health diagnoses experience overly controlling or critical behavior from friends and family. Ongoing communication and acceptance of one another's feelings is crucial for this. For example, talk with your loved one about how you feel in an open honest way at a time that is conducive for the conversation. If they are experiencing a low, that would not be a good time to talk about how you feel when they are depressed. A good conversation to have with them when you are both in a good head space would be to ask them what they need when they are experiencing a low (or a high). They may say that they need company or conversely they may let you know that they wish to be left alone. Remember that ultimately, each person is an expert on their own experience and knows best what they need. As long as the person is safe, if they request to have time alone, for example, one way that you can show them that you are supportive is by honoring their need.  Remain calm and provide support whether you are faced with a manic episode or a depressive episode. For example, sometimes during a manic episode people may see or hear things that are not there. This is often a time where we ask the question of "is it better for me to disagree with them and potentially cause further upset or should I just agree and potentially further fuel the belief further?" Stay calm and reassure the person that you are aware that what they are experiencing feels real to them. It's often helpful to focus on what they are feeling rather than confirming or challenging their sense of reality, which in those moments feels incredibly real for them. By supporting the person you are helping them to feel seen and heard.  A good place to start as far as getting a diagnosis is with a Primary Care Physician or General Practitioner. If possible try and go with your relative, with their permission of course, to the appointment in which the subject will be discussed. It can sometimes be helpful to have examples of some of the concerning behaviors that you have seen, especially if the person doesn't believe that they are ill. The best combination of treatment typically involves medication, therapy, and self-management. It goes without saying that while you are helping them and actively working on supporting them so that you can have a positive relationship, it is just as important to make sure you continue to focus on self care. Make sure that you are taking care of your own needs: physical, emotional, and spiritual, as this will benefit both you and them. You cannot help from an empty well and remember that the tool that you are looking to keep "sharp" is you.  Patience is another huge thing to remember when supporting your relative. Getting better takes time, even once the person is committed to treatment. Don't expect a quick recovery or a permanent cure. Be patient with the pace and be prepared for setbacks and challenges. Managing Bipolar is a lifelong process. Accept both your loved one's and your limits. Remember that they cannot control their moods or snap out of a depression. Neither depression nor mania can be overcome through willpower, self control, or reasoning. Remember that each and every day they are doing their absolute best. Some days their best may look like them not getting out of bed, while other days they will seem like they are completely fine.   Know what you need to be able to lend support and that sometimes you may need to simply step away. That is ok as well. Remember that ultimately, recovery is in the hands of the person, not yours. You can be there to support them and cheer them on but you cannot force recovery (or even being seen by a professional) on them. These decisions are ones only they can make

Bipolar Disorder is a diagnosis whose symptoms create an erratic and sometimes create gret chaos in the person's life who has the diagnosis but also in the lives of those who regularly come into contact with them.  What seemed fine two or three sentences ago can just as suddenly turn dangerous and lead to a hospitaliztion as you notice.  It can also just as quickly destroy the peaceful setting of a wedding and create forever negative memories of something that should be beautiful and wonderful.  It is, however, as you probably already realize something that is difficult to manage.  Setting boundaries is healthy but it can be difficult to navigate the emotions of another person who is hearing or receiving the boundary setting.  The timing of setting boundaries needs to be chosen with the greatest of care.  It seems that you have been managing this dilemma for a while and would like some guidance. It would be important for you to share how the person diagnosed with Bipolar Disorder has been affecting your life.   You say that this happened 3 years ago so I would ask that you prepare a time line of how she affected your life prior to the diagnosis and since the diagnosis.  No piece of information is too miniscule.  They are all very important to resoling your dilemma and determining how to begin setting boundaries.  Please be as specific as you can concerning any past interactions and attempts to work with her mental health symptoms.  What was successful and what was not successful?  Are you aware of the National Alliance for the Mentally Ill a/k/a NAMI?  There are many groups throughout the United States and they provide resources at their websites and meetings that are educational and supportive.  You can reach then at www.nami.org.  You may find that their availability is limited to or heavily internet or virtually focused today.  That would be a good resource whether virtual or in person.  Bipolar Disorder is best managed through a combination of counseling and medication.  Medication is going to be generally a lifelong situation as it is a chronic disease much the same as diabetes or heart disease.  She will decompensate from time to time so finding successful responses to her symptoms that you can use on a regular and steady basis.  This is likely to reduce the chaos and change for you.  Read a good book on Bipolar Disorder. The best writer I know is Kay Jamison who wrote An Unquiet Mind and who is a medical professional diagnosed with Bipolar Disorder.  You will find that a search of "Bipolar Disorder" on Amazon will produce family books for those who love a family member diagnosed with Bipolar Disorder.

Hi there. I'm sorry that you are struggling with the symptoms that you are experiencing. I can imagine that it is overwhelming and distressing for you. What I would like to do for your question is to give you a better sense of what BPD is in contrast with Bipolar Disorder. From what you described, it is highly likely that you have just BPD. BPD often mimics or appears like Bipolar Disorder. The difference between the two is with respect to the length of time and severity of the symptoms. For Bipolar Disorder, people often experience grandiose ideas, impulsivity secondary to those ideas, high levels of energy, and a decreased need for sleep. These symptoms occur together and are for a specific period of time therefore considered a "mood episode." With BPD, the symptoms are more pervasive and difficult to control in your day-to-day. The symptoms do include: difficulty with maintaining relationships because you go back and forth between "idealizing" to "hating" them; fears of abandonment; self-harming behaviors to help with alleviating emotional pain; frequent and intense experiences of suicidal ideation and/or gestures; impulsive behaviors (the goal being to alleviate emotional pain or to "fill the emptiness"); difficulty with managing your temper/anger outbursts; frequent and intense moodiness/mood lability; fleeting paranoia when you are under a lot of stress; lack of an identity/poor self-esteem (you often build your relationships with others by being a chamelion/blending in so that you are not rejected and feel like you belong but don't have a strong sense of self); and, chronic feelings of emptiness (which fuels impulsivity, self-harming and clinging to relationships even if they are unhealthy). Self-harming is one of the more "classic" or telling symptoms of BPD. When a person is experiencing bipolar disorder, they may become impulsive and also, during that episode, struggling with insight whereas when you are experiencing symptoms of BPD, you are aware of what is occurring but you have difficulty managing how you feel because it is so overwhelming. Can people have both? Absolutely, but there is generally a period of time when if Bipolar symptoms are under control that you are better able to see if BPD symptoms are still occurring or if they have stopped. I hope that this is helpful.

You have to remember with anything, that you can’t diagnose borderline personality disorder by yourself. My recommendation would be for you to find a psychiatrist or psychologist to obtain an evaluation as it would be important especially if you are considering medication as part of your treatment. BPD is often confused or overlaps with other conditions, so you need a mental health professional to evaluate you and make an accurate diagnosis. Try to find someone with experience diagnosing and treating BPD. As BPD is rarely diagnosed on its own because it often co-occurs with other disorders such as depression or bipolar disorder; substance abuse; eating disorders; and anxiety disorders. When BPD is successfully treated, the other disorders often get improve, too. But the reverse isn’t always true. For example, you may successfully treat symptoms of depression and still struggle with BPD. For the assessment, it is good to find out if you have any family members with any mental health issues to ensure that you are provided with an accurate diagnosis especially since BPD is caused by a combination of inherited or internal biological factors and external environmental factors, such as traumatic experiences in childhood. Although many people with BPD take medication, the fact is that there is very little research showing that it is helpful. What’s more, FDA has not approved any medications for the treatment of BPD. This doesn’t mean that medication is never helpful but if you suffer from co-occurring problems such as depression or anxiety, medication will address those problems. There is not a cure for BPD itself. In addition to a psychiatrist or psychologist, you need to find a therapist who is qualified in BPD treatment and recovery. Therapy may serve as a safe space where you can start working through your relationship and trust issues and “try on” new coping techniques. Dialectical Behavior Therapy (DBT) and/or Schema-Focused Therapy are helpful treatment modalities when addressing BPD. DBT treatment is a type of psychotherapy (talk therapy) that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment. Schema Therapy is an integrative approach to treatment that combines the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model. Schema-Focused Therapy has shown remarkable results in helping people to change negative ("maladaptive") patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.