By: Julian Jooste

What is Bipolar Mood Disorder (BMD)

As the name suggests, people with BMD experience extreme, polar opposite states of mood. These can be exceptionally high (manic), or very low (depressed).

Manic episode: Typified by elevated mood, increased energy and irritability. There is often a sense of importance, rapid thinking, talkativeness, a flurry of activity, and a decreased need for sleep. Impaired thinking and psychotic symptoms (hallucinations and delusions) may also be present.  There is substantial disruption to daily life and obligations and hospitalization is sometimes required.

Hypomanic episode: Milder form of mania. These do not cause severe disability or hospitalisation and are not associated with psychosis.

Depressive episode: Characterised by sadness or low mood, diminished energy/interest/pleasure, changed appetite for food, excessive or poor quality sleep, feelings of worthlessness, guilt, or despair.

Mood swing: The episodes of mania and depression shift from one pole to the other. If the shifts occur more than 4 times a year, it is called rapid cycling.

Mixed episode: Mania and depression fluctuate so quickly that they seem to co-occur, or when symptoms that meet the criteria for manic and depressive episodes actually do occur at the same time.

Communication Strategies

An important step in helping a loved one experiencing BMD is to encourage them to seek treatment (a mixture of medication and formal psychotherapy is effective). The following communication strategies also help:

  • Listen and reflect back. Reflecting in your own words shows that you are paying attention and trying to understand. It also allows your partner to clarify their point.
  • Share feelings and understandings.
  • Talk to solve problems, not to win arguments. Try to bring the conversation back to the “here and now”, and remember that you are aiming at a better relationship, not to win an individual victory.
  • Offer sympathy. If your partner is irritable they are likely to be feeling sensitive to every nuance. As bipolar is often quite variable, this helps your partner to feel more supported at the time.
  • Use positive reinforcement. Notice and reinforce even the small things (taking medication regularly, helping with housework, earning a living).
  • Voice your high expectations. When people are made aware of these, they want to retain the positive image we have of them. Saying things like “…I’ve always known you to be respectful…” rather than expressing your disappointment in your partner (this will make them feel worse and share even less).
  • Talk in terms of ‘positives’. For example, instead of saying “…You never touch me anymore...” rather say, “…I miss those amazing back rubs…”

Caring for yourself

  1. Keep your sense of humour and encourage your partner to do the same. It is not about ignoring your problems and needs as well as those of your partner’s.  It is about paying attention to what is ironic, absurd or just plain funny in your situation.
  2. Don’t take things too personally. Learning to detach from your partner’s behaviour is useful. Realising their symptoms are about the BMD and not about you is an important distinction.
  3. Expand your world. Look to your support team, positive family relationships, volunteer activities, creative pursuits, and any other supplemental activities. If you make your spouse your only friend, and your home life your only interest – you’ll find yourself limited, frustrated, and without means to relieve your frustrations.
  4. Do an activity analysis (when will you/did you last make time for your physical, intellectual, emotional, and social needs).
  5. Get adequate rest, exercise, and nutrition. These make it easier to cope.
  6. Set clear boundaries. Discussion and clarity on this helps as not all behaviours are acceptable.
  7. Cultivate patience. Start by trying to be patient with yourself. The process may take time, but gets easier.

Useful Reading Material

  • Fast, Julie & Preston, John. 2004. Loving someone with bipolar disorder. New Harbinger Publications.
  • Lowe, Chelsea & Cohen, Bruce. 2010. Living with someone who’s living with bipolar disorder. Jossey-Bass.
  • Mondimore, Francis. 1999. Bipolar disorder: A guide for patients and families. John Hopkins University Press.