Supporting Someone With Bipolar Disorder

Nov 7, 2023 | Bipolar Disorder

In understanding bipolar disorder, it can be helpful to start with the name itself.

The word bipolar refers to “two poles” or, in other words, two ends of the mood spectrum.

There is the “low” end of the spectrum (sadness/depression) and there is the “high” end of the spectrum (elation/ mania).

When someone is depressed, we typically notice changes in the following areas:

  • Thoughts: negative self-talk/self-image, cynicism or pessimism, difficulty problem-solving, difficulty focusing and concentrating, beliefs that no one cares or that nothing really makes a difference, etc.
  • Feelings: sadness, despair, apathy, numbness, irritability, frustration, shame, guilt, restlessness, anxiety, unmotivated, etc.
  • Actions: isolating from others, absent more often or entirely from work, school or caregiving responsibilities, decline in quality of work, school, or caregiving, profound difficulties completing everyday tasks like cooking, showering, running errands, not engaging in hobbies or interests, etc.
  • Physical symptoms or signs: changes in appetite, changes in sleep pattern, weight gain or loss, less energy, aches and pains, headaches, brain fog, etc.

Although many of us are familiar with what depression can look like, fewer of us are familiar of what mania can look like:

  • Thoughts: overconfidence, inability to see consequences, racing thoughts, lots of new ideas and plans, easily distracted, rapid decision making, paranoia, strange beliefs, hearing voices, seeing things that are not seen by others, etc.
  • Feelings:excitement, elation, irritability, agitation, etc.
  • Actions: impulsive, risky actions (i.e. spending excessively, infidelity, substance use, etc.) that the person would never normally do, starting or taking on big, new projects, talking very quickly, interrupting people often, saying things that are out of character and potentially harmful, etc.
  • Physical symptoms or signs: not needing to sleep as much as normal or at all for days on end, feeling full of energy, hyperactivity, etc.

Importantly, when someone is manic they are often not able to see consequences or act in accordance with their values. This can lead to decisions with disastrous consequences like accruing substantial debt in a short period of time or cheating on their spouse. These actions are not representative of who the individual is as a person as they are not in a state of mind to make rational, balanced decisions. Often, when people are no longer manic, they deeply regret the actions they took while manic which can contribute to the depressive episodes that typically follow mania.

Not everyone who has bipolar disorder experiences mania. Some people experience hypomania or mixed episodes.

Hypomania is a less intense or “toned down” version of mania. Instead of not sleeping for days, people who are hypomanic usually still sleep just much less than usual. The impulsivity and risk taking with hypomania are also less pronounced: people are less likely to be reckless with spending money, sex, drugs, etc. Hypomania also usually does not include paranoia, strange beliefs (a.k.a. delusions) or hallucinations. A “mixed” episode is where people experience symptoms of both mania or hypomania and depression. You can read more about that here.

 

Here are some “dos and don’ts” for supporting someone with bipolar disorder:

  • DO NOT: make assumptions about what it means when someone says they have bipolar disorder. You can have bipolar disorder and never experience a full-blown manic episode. You also only need one manic, hypomanic, or mixed episode to meet the criteria for bipolar disorder. Someone might have one of these kinds of episodes and then only experience depressive episodes going forward.
  • DO: thank people for sharing their diagnosis with you and let them know you are happy to listen to whatever they might want to share about their condition.
  • DO NOT: assume that anytime someone with bipolar disorder is excited, happy, sad, irritated, upset, etc. that this is because of their mental health condition or ask, “have you been taking your medication?”
  • DO: make a plan in advance for what to do when someone experiences depression, hypomania, mania, or a mixed episode. This plan is best made when someone is not in an episode of some sort. This plan can include notifying close family members, their family doctor, psychiatrist, counsellor, etc. along with whatever support the person identifies as helpful.
  • DO NOT: tell the person what to do to get better or try to fix them. You can collaboratively problem solve with the person if they are stuck, but often people simply need a listening ear. Bipolar is also a complex, chronic condition that cannot be easily solved, and we are not the mental health professional(s) treating the person.
  • DO: when the person is unwell, offer practical supports and acknowledgements of their difficulty like sending flowers, writing a “get well soon” card, dropping off baking or a meal, visiting them, shovelling the sidewalk, childcare support, etc. For a full list of ideas check out this amazing list!