Communicating with a Loved One with Bipolar Disorder

Interpersonal communication can be a challenge for people with bipolar disorder, a neurobiological genetic disorder. They may have real trouble focusing on a conversation because the prefrontal cortex of the brain is a “bit off-line,” according to William Shryer, DCSW, LCSW, Clinical Director of Diablo Behavioral Healthcare in Danville, California.

If conversations get heated, anger “turns on,” or stimulates this important part of the brain, he says, resulting in communication problems. That’s why someone with bipolar disorder may sometimes be irritable.

These techniques can help to improve communication and reduce conflict between someone with bipolar disorder or depression (the other end of the bipolar spectrum) and a partner or family member.

Check-in. Before beginning an important conversation, get a mood rating from one to ten to find out if they’re in a good place to be receptive. Then permit them to postpone the conversation, if necessary. Pressuring will only create anxiety and make things worse.

Establish in advance a non-verbal cue, such as a gesture, or a verbal cue, a word such as “popcorn,” says Shryer, that will alert your partner to focus on what you’re saying.

Be aware. Although people with bipolar disorder usually test as highly intelligent, they may have a co-occurring auditory processing disorder typical of bipolar disorder, says Shyer.

Realize that sometimes people with bipolar disorder misinterpret verbal and non-verbal cues, such as voice pitch and volume, variations in tone, eye contact, and body language, which can interfere with the information being communicated. Sometimes, he says, e-mail or written communication can be more effective.

Work together as a family or couple with a therapist or counselor who will teach communication skills. If you are the partner, friend, or family member, become educated about his/her disorder.

Be patient. Remember that people with bipolar disorder have “busy brains” and are easily distracted, says Shryer.

Triggers and Early Warning Signs to Watch For

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, which have led to mania or depression in the past. Common triggers include:

• stress
• financial difficulties
• arguments with your loved ones
• problems at school or work
• seasonal changes
• lack of sleep

Common Red Flags for Bipolar Disorder Relapse

Warning signs of depression

• I quit cooking meals.
• I no longer want to be around people.
• I crave chocolate.
• I start having headaches.
• I don’t care about anybody else.
• People bother me.
• I start needing more sleep, including naps during the day.

Warning signs of mania or hypomania

• I find myself reading five books at once.
• I cannot concentrate.
• I find myself talking faster than usual.
• I feel irritable.
• I am hungry all the time.
• Friends tell me that I am crabby.
• I need to move around because I have more energy than usual.

Thing to Say and Not to Say to Someone with Bipolar Disorder

Do not Say:

• “What’s your problem?”
• “Will you stop that constant whining?”
• ‘What makes you think that anyone cares?”
• “Have you gotten tired yet of all this me-me-me stuff?”
• “You just need to give yourself a kick in the rear.”
• “But it’s all in your mind.”
• “I thought you were stronger than that.”
• “Pull yourself up by your bootstraps.”
• “No one ever said life was fair.”
• “Why don’t you just grow up?”

• “Stop feeling sorry for yourself.”
• “There are a lot of people worse off than you.”
• “You have it so good – why aren’t you happy?”
• “What do you have to be depressed about?”
• “You think you’ve got problems…”
• “Well, at least it’s not that bad.”
• “Lighten up.”
• “You should get off all those pills.”
• “You are what you think.”
• “Cheer up.”
• “You’re always feeling sorry for yourself.”
• “Why can’t you just be normal?”
• “You need to get out more.”
• “Get a grip.”
• “Most folks are about as happy as they make up their minds to be.”
• “Get a job.”
• “You don’t look depressed.”
• “You’re just looking for attention.”
• “Everybody has a bad day now and then.”
• “Why don’t you smile more?”
• “A person your age should be having the time of their life.”
• “The only one you’re hurting is yourself.”
• “You can do anything you want if you just set your mind to it.”
• “Depression is a symptom of your sin against God.”
• “You brought this on yourself.”
• “Get off your rear and do something.”
• “Snap out of it.”
• “You’re always worried about your problems.”
• “Just don’t think about it.”
• “Go out and have some fun.”
• “Just try a little harder.”
• “I know how you feel – I was depressed once for several days.”
• “You’d feel better if you went to church.”
• “What you need is some real tragedy in your life to give your perspective.”
• “This too shall pass.”
• “Go out and get some fresh air.”
• “We all have our cross to bear.”
• “You don’t like feeling that way? So, change it.”
• “You’re a real downer to be around.”
• “You are embarrassing me.”
• “You’d feel better if you lost some weight.”
• “You’re too hard on yourself. Quit being such a perfectionist.”
• “Don’t take it out on everyone else around you.”
• “You are going to lose a lot of friends if you don’t snap out of this.”
• “You’re dragging me down with you.”
• “You’re just being immature.”
• “You are your own worst enemy.”
• “That is life – get used to it.”
• “My life isn’t fun either.”
• “You don’t care about the rest of us – you’re so self-absorbed.”

Do Say:

• “I love you.”
• “I care.”
• “You’re not alone in this.”
• “I’m not going to leave/abandon you.”
• “Do you want a hug?”
• “You are important to me.”
• “If you need a friend…”
• “It will pass, we can ride it out together.”
• “When all this is over, I’ll still be here.”
• “You have so many extraordinary gifts – how can you expect to live an ordinary life?”
• “I’m sorry you’re in so much pain. I am not going to leave you. I am going to take care of myself so you don’t need to worry that your pain might hurt me.”
• “I listen to you talk about it, and I can’t imagine what it’s like for you. I just can’t imagine how hard it must be.”
• “I can’t fully understand what you are feeling, but I can offer my compassion”
• “I’m sorry you’re having to go through this. I care about you and care that you are hurting.”
• “I’ll be your friend no matter what.”
• “I cannot understand the pain you’re in, I cannot feel it. But hold onto my hand while you walk through this storm, and I’ll do my best to keep you from slipping away.”
• “I’m never going to say, ‘I know how you feel’ unless I truly do, but if I can do anything to help, I will.”