World Bipolar Day: A guide to navigating social relationships for individuals with bipolar disorder

"Bipolar disorder is a mental health disorder characterised by significant shifts in mood and activity levels. These fluctuations in mood can range from periods of extreme elation, irritability or high energy (mania) to periods of intense sadness and hopelessness (depressive episodes). The severity of these shifts in mood can vary from person to person," explains Riea Enok, therapist at The Mood Space. She tells us that bipolar disorder is a lifelong condition, and can affect the way individuals' function in different areas of their lives, including interpersonal relationships. The stigma associated with mental health disorders may also prevent people from forming, and maintaining fulfilling relationships. On World Bipolar Day, the mental health expert answers pertinent questions, and lays down a path for navigating social relationships for individuals with bipolar disorder, and their loved ones.

How does stigma fuel feelings of isolation?
Enok: Due to lack of knowledge and awareness about mental health conditions like bipolar disorder, persons may have suffered harassment and judgement from even their closest friends and family over the years. There may be a hesitation to disclose the diagnosis or share experiences with others. They may even avoid interacting with people or push them away which can leave them feeling misunderstood and alone," says Riea Enok, therapist at The Mood Space.
Individuals with bipolar disorder may have internalised the judgement and negative messages they heard about their mental health condition. This can affect self-esteem where they may foster a fear of abandonment in relationships. Additionally, when an individual living with bipolar disorder sees others going through life without the same difficulties they have, it can further fuel feelings of loneliness and alienation.

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How does bipolar disorder impact social relationships?
Enok: Bipolar disorder can make it harder for individuals to fulfil their roles and responsibilities in different areas of their life, such as work, family, household, parenting (among others). It can affect family dynamics and introduce a lot of stress and frustration in the home environment. When a parent lives with bipolar disorder, it may impact relationships with their children who may find it difficult to make sense of the sudden changes in mood and behaviour in their parents. Similarly, at work, symptoms hamper relationships with coworkers as well as supervisors. Additionally, some relationships involve a lot more closeness and intimacy than others (e.g. romantic relationships) and the impact of bipolar symptoms may increase in this context.

What can happen when individuals with bipolar disorder go through extreme mood swings?
Enok: During manic and hypomanic episodes, individuals can become highly talkative, agitated and irritable in their interactions with people. This can make it difficult to effectively communicate their needs and feelings leading to misunderstanding and conflict in relationships. Additionally, individuals may engage in impulsive or high-risk behaviours such as overspending, substance abuse or risky sexual behaviours which can further disrupt the stability in their relationships. On the other hand, during depressive episodes, individuals experience profound sadness and hopelessness and may withdraw or isolate themselves. Loved ones may feel anxious and helpless to respond to these sudden shifts in behaviour which can further strain the relationship.

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What can be some common obstacles in maintaining healthy relationships?
Enok: A key to navigating relationships, is tuning into our own as well as other's emotions. Bipolar disorder is associated with difficulties with emotional recognition and regulation. This makes it difficult for individuals to accurately recognise their own as well as other's emotions and respond appropriately. They also have trouble soothing and managing their own emotional reactions which can make it difficult to function in relationships. Additionally, behaviours such as aggression and self-harm or suicidal behaviours are common inindividuals with bipolar disorder, which can become a source of stress for those who care for them.

Stress is a part and parcel of any relationship. Individuals with bipolar disorder are also highly sensitive to stress whether it is positive or negative it can trigger their symptoms. So common relationship experiences like breakups, arguments or even beginning a new relationship can become a trigger for symptoms.
In a relationship where one or the other person has a mental health condition, there may be a tendency for focus to shift to the person with the illness with less attention being paid to the needs and experiences of the other partner. The day-to-day requirements a partner may have to fulfil such as monitoring medication, routine and sudden shifts in behaviour and mood can leave little room to care for themselves leading to stress and ‘caregiver burnout'.

How can individuals with bipolar disorder, and their loved ones navigate social relationships?
Enok: A fundamental factor in building healthy relationships when one or the other person has a mental disorder, is recognising that they are not their illness. When an individual has a mental health disorder there is a tendency to define them in terms of their diagnosis, whilst forgetting everything else that makes the person who they are. When individuals with bipolar disorder and their loved ones learn to look beyond the challenges the illness brings to a relationship and focus on its positive qualities it can foster healthier and deeper connections. Following are some practices individuals with bipolar disorder and their loved ones can put in place to create stable and meaningful relationships.

Open communication
One of the primary tasks is to create a space in the relationship for open communication. The patterns and behaviours associated with bipolar disorder may be confusing for those who are not aware of the illness. Having open discussions about this can help them understand where these symptoms come from which can allow them to be of greater support.

Educate yourself
Additionally, educating oneself and others about the disorder can go a long way in fostering empathy and understanding in a relationship. It can also be helpful to discuss what can become potential triggers for the individual with bipolar disorder so support plans and coping strategies can be put in place.

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Accept, and share responsibility
A key to establishing a relationship with someone who has a mental illness is learning to accept the individual with bipolar disorder as they are with judgement. Helping someone manage an illness is not the same as pushing them to be ‘healthy' or shaming them for their symptoms. In turn, individuals with bipolar disorder need to learn to take responsibility for their behaviours and its consequences and be open to feedback from their family and friends. This approach of shared responsibility and collaboration is key to strengthening a relationship. judgment

Cultivating self-care for stability
Practising self-care is important in any relationship, but it is all the more important when one has a mental illness like bipolar disorder. For both the person with the illness and those they share a relationship with taking care of one's own needs is a must. The maintenance of a healthy routine (sleep, diet, exercise, medication, avoidance of substances) is an important part of the treatment process for bipolar disorder and individuals can work in collaboration with their loved ones to put this in place. Remember, regularising your day-to-day life can translate to stability in relationships as well. Working with mental health professionals such as psychiatrists and therapists is also an important part of treatment. Therapy can help the individual work on various coping and communication skills to better navigate their relationships.