Supporting someone living with bipolar disorder

Bipolar disorder is a type of mood disorder which affects about one in 50 adults in Ireland. What can families do when a loved one is going through it?

Sean Lonergan of the Bipolar Education Programme here in St Patrick's Mental Health Services discusses supporting and promoting the recovery of a loved one living with bipolar disorder. You can read more and watch Sean talk on the topic below.

What is bipolar disorder?

People living with bipolar disorder go through mood disturbances. This means that they experience more than the ordinary changes or healthy mood shifts that most people have in response to everyday life.

Sometimes a person with bipolar disorder has no symptoms; sometimes they have a few symptoms; and, at other times, they go through an intense change of mood called an “episode”. During an episode, the person’s thinking, feeling and behaviour changes significantly and affects how they function day-to-day, with this lasting for a considerable amount of time.

Types of episodes

The different types of episodes a person with bipolar disorder may experience can be called:

• Mania | Symptoms include euphoria (an excessively high mood); increased energy and activity; restlessness; racing thoughts; irritability; challenging or aggressive behaviour; and poor judgement
• Hypomania | Symptoms are similar to mania, but usually milder and lasting for just a few days
• Depression | Symptoms include low energy; tearfulness; anxiety; social withdrawal; loss of interest; feelings of guilt or worthlessness; obsessive thoughts; and changes in sleep or appetite

Although mania and hypomania are defining traits of bipolar disorder, over the course of the illness, symptoms of depression are actually more common.

Psychosis

Some people with bipolar disorder may have psychosis or psychotic symptoms. Symptoms of psychosis include:

• Hallucinations: hearing, seeing or sensing the presence of things that are not actually there
• Delusions: false, strongly-held beliefs that are not based in evidence or logical reasoning.

Bipolar spectrum

There is increasing recognition of a spectrum of bipolar disorders, which range from severe mood disturbances, which are very marked and different to a person’s typical personality, to milder mood variations which can be harder to distinguish from a healthy, balanced state of mood.

What causes bipolar disorder?

While there is no known single or certain cause for bipolar disorder, there is a lot of understanding about different factors which contribute to it.

Both nature and nurture play a part in bipolar disorder. This means that there are genetic, physical, environmental and social factors involved.

Some people are more likely to experience bipolar disorder than others. For example, people who experience trauma, stress or adversity – particularly in their early lives – or people who have a first-degree relative, such as a parent or sibling, living with the condition have greater chances of developing bipolar disorder themselves.

It is when a complex mix of these different factors come together that a person is more likely to develop bipolar disorder and that bipolar episodes are triggered.

Can bipolar disorder be treated?

There are a number of different ways that bipolar disorder can be treated. The best first step for someone experiencing bipolar disorder is to talk to their GP who can take them through their options and refer them to the supports they may need.

Psychological therapy

Psychological therapies such as Cognitive Behavioural Therapy (CBT), family-focused treatment (FFT) and interpersonal and social rhythm therapy (IPSRT) can be effective in manging symptoms of bipolar disorder. They can help the person to develop behaviours and daily routines which can protect them from experiencing severe or prolonged symptoms.

Medication

Some people may take medication to help manage the symptoms of bipolar disorder and treat episodes of mania, hypomania and depression. Medication generally works best when used in combination with other treatments, like therapy. Finding the right choice and dosage for the person can take time: there is a process needed of exploring different options and seeing what works for the person.

Collaborative care

For a person going through bipolar disorder, their GP is most likely going to be their primary point of care and treatment on an ongoing basis. Depending on the stage of their illness and the treatment they are receiving, however, the person may also be supported by a psychologist, psychiatrist, pharmacist, social worker, occupational therapist, housing support worker and others.

Collaborative care is a way for the person to work together with their treating team and their family and friends to get the best results from treatment. This promotes treatment concordance, which means the extent to which the person, their clinician, and their supporters are in agreement about the person’s care plan and about how much they can do together to progress it.

Elements of collaborative care include:

• Becoming knowledgeable about bipolar disorder and its treatment
• Developing a system of supportive individuals who can be involved in the care plan
• Learning how to communicate efficiently with everyone involved in the care plan.

How can I support someone going through bipolar disorder?

Peer and family support is very important for people going through bipolar disorder. Family, friends and carers with positive, supportive and encouraging attitudes can help the person to identify when they need support, to engage with treatment, and to stay focused on their recovery.

There are three parts to recovery: education, treatment and support. When these come together, there is a much improved chance of recovery and resilience. Family and friends can be a vital part of that.

Here are some tips which can help you to support someone going through bipolar disorder.

Learn about bipolar disorder

Informed care and support can make all the difference. Take some time for both you and the person to learn about bipolar disorder – such as its symptoms, models of care and treatment, side effects of medication and so on – and about how to support recovery. If the person is in your family, make it a family matter: acknowledge that one family member’s bipolar disorder affects the whole family, so everyone could benefit from learning about it and being supportive of the person and each other. 

Support collaborative care

Encourage and support collaboration and treatment concordance. Understand how you can support the person’s care plan and work with the person and their treating teams to contribute to it. Where allowed and appropriate, meet with the person’s clinicians or treating team.

Recognise when support is needed

Bipolar disorder can manifest in many different ways. It is important to be able to distinguish healthy, natural mood shifts from more significant mood changes or episodes. Knowing the person’s typical personality and behaviour can help you to identify when the person is ill rather than having a “good” or “bad” day within a healthy range of mood shifts. It is best to assess this over time rather than in the moment of a mood change or episode. Keep a record of significant events – such as responses to new medication or triggers of an episode – so that you can have useful information to help with this.

Have open communication

Discuss with the person how they want you to approach it with them when they are unwell, and how best you can support them when they are unwell. Clarify how you might deal together with potential conflict, and, if tension or conflict arises, calmly express your feelings about it to the other person. Practice active listening and try to problem-solve or reach compromises together, rather than telling the person what the solution to a problem should be. Manage boundaries with the person, but try too to share enjoyable experiences with them that aren’t related to bipolar disorder.

Be patient

Support and caregiving experiences can differ between people: finding what works for you to deal with your situation can be a process of trial and error. Acknowledge what you and your loved one are doing and give yourself credit for how you are helping to manage the person’s symptoms and support their recovery.

Look after yourself

When the person is first diagnosed with bipolar disorder, it can be a turbulent time for both them and you. Maintaining your own wellbeing at this time and throughout their recovery is important. Allow yourself time to come to terms with your loved one’s diagnosis and to have your natural, emotional responses, such as anger, sadness or confusion. Keep calm and be tolerant. Do things that you enjoy to nourish yourself.

Have hope

Remember, in most cases, bipolar disorder can be treated and managed. Very many people with bipolar disorder live contented, fulfilling and healthy lives: looking after them and yourself through it all leads to a hopeful future.