Bipolar disorder can cause people to withdraw from relationships with significant others, family, and friends — but there are ways to ensure loved ones don’t get pushed away.
All relationships ebb and flow. It comes with the territory because, well, we’re human.
But when Bipolar disorder is part of the equation, the dynamics of relationships – with intimate partners, family members, and friends – are more complicated.
Julie K. had not yet been diagnosed with bipolar 2 disorder when she said her wedding vows. But she felt broken and admits that her irritability, unpredictability, and self-loathing put her husband, Chris, “through the wringer with a lot of hurt and heartache.”
She would act defensive when Chris urged her to get help, and she forbade him from reaching out for support, worried about anyone finding out about her darkest moments.
“I always say that our worst behaviors are often reserved for the people who love us the most,” says Julie, of Vancouver. “Behind closed doors was the only place I felt I could be me, that I didn’t have to hide behind a mask. So I would unleash and unload all my pent-up frustrations on my husband, and I assumed he would be my punching bag.”
When she walked into his home office one day and saw his computer opened to an online support group for spouses of people with bipolar, Julie felt betrayed. He gave her an ultimatum — either she see a professional or he was taking himself and their three children to one.
In 2010, at age 36, Julie got a diagnosis, along with help.
“Too many times partners and kids have to tiptoe on eggshells around people with bipolar,” she says. “I actually wish in hindsight that I’d been given an ultimatum sooner.”
How Bipolar Disorder Takes a Toll on Relationships
Extreme mood fluctuations, poor judgment, frenetic behavior, and other symptoms can make intimate partners, friends, and relatives feel overwhelmed, distrustful, and ultimately disconnected. For those without bipolar, it can be difficult to have patience and resilience and to not take things personally — to understand that the behavior is a result of the illness and not genuine feelings.
Even when someone isn’t in the throes of mania or depression, the specter of another episode may loom, causing doubt and anxiety that can affect day-to-day interactions and can result in relationship burnout.
Knowing how to manage and nurture important bonds, despite the challenges, can make all the difference. Being able to cultivate greater self-awareness and to set healthy boundaries is key — and can lead to a new level of understanding in your relationships.“The more self-aware and insightful someone is into what’s happening, the better,” says Helen M. Farrell, MD, a psychiatrist in Boston. “It can be a little painful to recognize, but on the positive side, it can be an impetus for change.”
Bipolar and Withdrawal From Relationships
Two studies offering insight into the link between bipolar and emotional bonds shed light on why supportive, meaningful relationships — while unequivocally possible — can take a lot of work to sustain.
According to a review paper published in Translational Psychiatry in 2022, bipolar affects the brain fronto-limbic network, which is responsible for emotional regulation. Meanwhile, multiple studies have shown that people with bipolar are more likely to experience difficulty interpreting other people’s facial expressions during social interactions.
“People with [bipolar] feel things very intensely, and that can be amplified in a relationship,” says Dr. Farrell. “They’re very attuned to how others are responding or not responding to them, and that can carry an air of sensitivity that other people don’t have to deal with.”
Depending on the interaction, and whether symptoms are present, a typical response might be to feel easily overwhelmed, guarded, or even paranoid. A next step may be to withdraw, which often gets interpreted as cold and distant behavior, a combination that can push people away.
Despite writing a mental health blog in which she speaks openly about her bipolar 2, Hannah B. admits she “struggles to discuss it in my personal life, which causes me to isolate and reject every form of my friends and family reaching out.”
In particular, adds Hannah, who lives in North Carolina, “I’ve lost the depth of connection that I used to have with a lot of friends.”
One of them had been more like a sister for over a decade, since the women were juniors in high school. Despite living five miles apart, they stopped hanging out when Hannah went through periods of rapid cycling, which happened“constantly” over a yearlong period.
“I would get simple texts such as ‘I miss you’ and ‘Hope you’re well’ and ‘I’ve been thinking of you,’ and while those are great, [Hannah] never followed through with anything,” Hannah’s friend Courtney J. recalls. “I would always think that if she missed us hanging out so much, wouldn’t she make more of an effort to actually see me?”
Taking Steps to Reconnect With Friends and Family
Feeling that it was a constant battle to get together, and that Hannah’s surface-level interactions were unfair to their friendship, Courtney pulled back and decided to let Hannah reach out when she was ready. Three months later, in early 2018, she did. They met up and Courtney got the chance to talk in detail about how Hannah’s self-isolation makes her feel.
“We are very honest and open with one another, which is key in a friendship like this,” Courtney says.
Hannah says she needs to become more self-aware when it comes to how her behavior has affected those around her.
Julie can relate. She has been working hard to make amends on another relationship front: parenthood.
In the past, she said, her bipolar left her “little time to be a mom” to her three daughters. Her insecurities about socializing with other parents meant she tried to avoid playdates, birthday parties, and sports. And she routinely justified hyper-focusing on projects during hypomania by convincing herself that what she was working on was “a positive, life-changing, world-revolutionizing project … What I failed to realize was that the consequences of all my actions could be devastating and have long-term negative effects on my children.”
Be Open and Focus on the Positive
Despite Julie’s fears, she says her daughters have been “so forgiving and resilient” since her diagnosis — and now the family talks openly about bipolar. They remind Julie when she’s obsessing over a certain project, for example, or when a trip to the grocery store is long overdue.
Her youngest wrote a post on Instagram that applauded her mom’s strength and creativity, and encouraged parents to talk to their children about their symptoms. “If children have feelings they want to get out, they’ll know they aren’t alone,” she wrote.
“I’m still playing catch-up and trying to turn around something that has been so painful for my family,” says Julie, who is on medication and attends a bi-weekly mental health support group. “This isn’t only my story, it’s their story.”
Chris K. focuses on what he loves about his wife — her wit, her infectious joy and energy when she’s happy, and her natural talent for writing and drawing.To other spouses, he advises: “Never keep score. You need to understand that you’ll be in a place where you’ll be giving more than you’ll be receiving potentially for your entire marriage. It is better to face that early and develop a system to weather the storms. Traditional 50/50 mentality towards a relationship will guarantee failure.”
The Importance of Empathy
Empathy is critical in any relationship, and perhaps more so when a loved one has bipolar. That said, empathy fatigue is a very real thing.
“Even though a parent, sibling or significant other recognizes it’s a biological illness that’s significantly out of an individual’s control, they don’t feel as much empathy over time,” says Eric Morse, MD, a psychiatrist in North Carolina. “The feeling can be, ‘Well, you should’ve seen a psychiatrist more often,’ or ‘You should’ve seen the next episode coming,’ or ‘You should’ve had more medication adjustments.’ They feel like they’ve been there, done that, and they don’t want to listen as much anymore.”
Empathy fatigue can go both ways. The most common complaint Dr. Morse hears from clients is that loved ones often take any minor irritability or short-tempered statement as a sign of another manic episode — or reason for an increase in medication dosage.
“That can make an individual who’s suffering more upset, more angry, and not want to maintain a loving relationship,” Morse explains. “They don’t want every comment to be evaluated through the lens of, ‘This is your illness talking and not you as a person.’”
Preparing for an Episode Before Symptoms Emerge
Ghadeer Okayli, MD, a psychiatrist from Texas, tells clients to work with loved ones on ways to ease stress during an episode before the symptoms present themselves. Prep and freeze a few meals, perhaps, or designate a trustworthy and willing family member or friend to help out at a moment’s notice.
Steven D., also from Texas, says his wife of over 40 years has come to terms with the fact that she wakes up each day not knowing how he’s going to behave. His bipolar brings with it a lot of angst and anger.
He says that she used to take “great offense” and thought that Steven didn’t love her anymore.
While their interactions still often bring tension, particularly when Steven’s racing thoughts require him to ask his wife to repeat herself multiple times, they continue to find their way.
“I tell her, ‘I’m not doing this to irritate you, I’m doing this because I can’t focus on what you’ve said,” he says. “I can’t necessarily keep up with her. The last thing I want is to be a burden on anyone, especially her.”
Almost daily, he records in a journal what happened the previous day. Was it a good day for him? Was it what he envisions as tolerable for his wife?
“On my bad days she gives me a lot of space,” Steven says.
Further complicating matters, bipolar can take a long time to diagnose. A study published in BMC Psychiatry in 2020 found that the delay between onset and diagnosis was an average of 6.46 years among participants.
A lot of damage can be done to a relationship before proper help is found. That’s why Julie says she is thrilled there is increasing awareness about the disorder, and that people who are diagnosed in their teens and early twenties are able to enter into relationships much more educated about themselves and their behaviors than she was.
“Thank goodness they can save themselves so much pain and heartache,” she says.
Keys to Keeping Bonds Strong Amid the Push-Pull of Bipolar
Set boundaries early. “Have a conversation about boundaries during a calm period,” suggests Sharon Barrett, MSW, a clinical social worker and therapist from Toronto, Ontario. Communicate clearly which values and behaviors are non-negotiable, such as verbal abuse or overspending, and spell out the consequences. “Without this, follow through, or boundary setting will be ineffective,” Barrett says.
Know your limits. Once Julie stopped accepting most invitations that came her way, even small ones, life became so much easier. “My schedule looks empty to anyone else,” she says, “but I’m self-aware enough to know that one coffee date a week is my max.”
Rebuild connection. Finding an activity to do together, like going to the gym or taking a language class, can help two people rediscover each other without pressure, notes Farrell.
Encourage partners to seek support. “They can’t do everything on their own,” says Dr. Okayli. Enlist help from others. If needed during an episode, try to arrange for a relative or friend to drive the kids to school. Hire an occasional house cleaner. Help loved ones take breaks to decompress with friends or on their own.
UPDATED: Originally printed as “The Ties That Bind,” Summer 2018
Editorial Sources and Fact-Checking
Bi B, Che D, Bai Y. Neural Network of Bipolar Disorder: Toward Integration of Neuroimaging and Neurocircuit-Based Treatment Strategies. Translational Psychiatry. April 2022.
Insights Into Recognition of Facial Expression in Bipolar Disorder. Progress in Mind. April 11, 2022.
Lublóy Á, Keresztúri JL, Németh A, Mihalicza P. Exploring Factors of Diagnostic Delay for Patients With Bipolar Disorder: A Population-Based Cohort Study. BMC Psychiatry. February 2020.
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