4 of the Biggest Barriers in Bipolar Disorder

By Margarita Tartakovsky, M.S. 

People with bipolar disorder can face many challenges — from the illness’s fluctuating feelings to its destructive effects on relationships. Below, two experts reveal some of the biggest obstacles and offer strategies to overcome them.

Challenge: Uncontrollability

“Bipolar disorder can feel uncontrollable,” according to Sheri L. Johnson, Ph.D., professor of psychology at the University of California-Berkeley and director of the Cal Mania (CALM) Program. Symptoms, such as mood changes, can seem to appear suddenly and without provocation. And they can diminish daily functioning and ruin relationships, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder.

Strategies: While bipolar disorder can seem unpredictable, there are often patterns and triggers you can watch out for. And even if you can’t prevent symptoms, you can minimize and manage them.

One way to monitor changes is to keep a mood chart, Van Dijk said. Depending on which chart you use, you can record everything from your mood to the number of hours you slept, your anxiety level, medication compliance and menstrual cycle, she said. (This is a good chart, she said.) For instance, you can anticipate a potential depressive episode if you see that your mood has been progressively sinking in the last few days, Van Dijk said.

Practicing healthy habits is an effective way to lessen the hold emotions have on you. Make it a priority to get enough sleep, going to bed at the same time and waking up at the same time, Van Dijk said. Create a calm bedtime routine, avoid substances such as alcohol – which disrupts sleep – and don’t exercise in the evenings, said Johnson, also co-author of Bipolar Disorder: A Guide for the Newly Diagnosed.

Sleep deprivation can trigger mania, and “it makes you more susceptible to being controlled by your emotions, such as irritability,” Van Dijk said. On the other hand, sleeping too much can cause lethargy and also reduce your ability to manage emotions, she said.

Exercise helps to reduce depressive symptoms. Eliminating caffeine can reduce irritability and anxiety and improve sleep, Van Dijk said. She suggested cutting out caffeine for two weeks and paying attention to any changes. Some people also find that certain foods exacerbate their mood swings. You can check by cutting out specific foods from your diet, and watching the results, she said.

You also can use a variety of strategies to stave off the negative consequences from your symptoms. For instance, if impulsive spending is a problem, gain control by having a low limit on your credit cards, Johnson said. When you’re experiencing early signs of mania, have someone else hold onto your checks and cards, Johnson said. If you do overspend, return your purchases, she said. You can even ask a friend to go with you, she added.

Challenge: Medication

“There is no ‘one size fits all’ medication that helps everyone with bipolar disorder,” Johnson said. Lithium is typically the first line of treatment. But for some people the side effects are especially troublesome, she said. Finding the right medication (or combination of medications) can seem like a daunting process.

Strategies: Learn as much as you can about mood-stabilizing medications, Johnson said, including their potential side effects. “Find a doctor who will work with you to make adjustments based on your experiences with the different medications,” she said. Expect that it might take several tries to figure out the best medications for you.

Many of the side effects dissipate after the first two weeks, Johnson said. Changing the dose schedule helps to minimize side effects. For instance, if you feel groggy, your doctor might suggest taking your medication in the evening, she said.

Support groups are another valuable tool, Johnson said. (She suggested looking at the Depression and Bipolar Support Alliance website for a group.) For instance, individuals in these groups are usually familiar with compassionate doctors in the area, she said.

Challenge: Relationships

Bipolar disorder is hard on relationships. The very symptoms – swinging moods, risky behaviors – often leave loved ones feeling confused, exhausted and like they’re walking on eggshells, Van Dijk said.

She also sees loved ones have difficulty distinguishing between the illness and the person. They might invalidate the person’s feelings and either blame everything on the illness or believe the person is making conscious choices when it is the illness.

Strategies: Bipolar disorder is difficult to understand, Van Dijk said. “Different affective episodes, [such as] depression versus hypomania, result in different symptoms, and one episode of depression or hypomania can be different from the next within the same person,” she said.

So it’s incredibly important for loved ones to get educated about the illness and how it functions. Individual therapy, family therapy and support groups can help. Refer loved ones to self-help resources and biographies or memoirs of people with bipolar disorder, Johnson said.

Getting a handle on your emotions also improves relationships, she said. Working on assertiveness is key, too, she said. Individuals with bipolar disorder tend to have a tough time being assertive. Therapy is a good place to learn assertiveness skills. But if you’d like to practice on your own, Van Dijk suggested using “I statements”: “ I feel _____ when you ______.” She gave the following example: “I feel scared and hurt when you threaten to leave me.”

Challenge: Anxiety

According to Johnson, about two-thirds of people with bipolar disorder also have a diagnosable anxiety disorder.

Strategies: Johnson stressed the importance of using relaxation techniques and not using avoidance behaviors. As Van Dijk explained, “the more you avoid things because of your anxiety, the more your anxiety will actually increase, because you never allow your brain to learn that there’s nothing to be anxious about.”

Psychotherapy is tremendously helpful for managing bipolar disorder and the above challenges. If you’ve been prescribed medication, never stop taking it abruptly – this boosts the risk for relapse – and communicate regularly with your doctor.

http://psychcentral.com/lib/4-of-the-biggest-barriers-in-bipolar-disorder/00013185

The big payoff of well-chosen words

You may think that talk is cheap. But, when words are used thoughtlessly, carelessly, or hurtfully, they can take a heavy toll. Like an arrow, “wrong” words can be sharp, piercing a person’s spirit, ripping away at self-esteem, and making a person feel belittled or even betrayed. Ill-chosen words can strain friendships and create stress. And especially vulnerable are people who have bipolar disorder.

Now, let’s be honest. Dealing with bipolar disorder is not only tough for the people who have the illness, but it’s also a challenge for those who live with them. Taking time to consider the impact of what you say before you “fire away” makes it easier. Choosing your words carefully can strengthen relationships, fuel recovery, and make for a better quality of life for everyone.

“Never tell anyone that he looks tired or depressed,” says H. Jackson Brown Jr., in his book Life’s Little Instruction Book (Rutledge Hill Press, 1991). That’s good advice! Now, let’s look at 10 more comments to avoid making to someone who has bipolar disorder. These observations come from more than two decades of dealing with the illness and from years of leading support groups and consulting with families. The goal is to help family and friends to more peacefully coexist with those of us who have bipolar.


What not to say

You sound a little down today.
That’s what a friend said to me within the first 30 seconds when she phoned the other day. No kidding! Since I live with bipolar disorder, of course I don’t always feel 100 percent up to par. I just don’t need my symptoms constantly gauged or continually evaluated. It’s like having a never-ending physical. Most people with a mental illness know how they feel. Being told you are not sounding well is not constructive, nor is it a substitute for true compassion.

I thought you were taking your medication.
Dealing successfully with bipolar disorder cannot be reduced to whether or not someone has taken a pill. There are no quick fixes. Confronting a chronic, serious illness is an ongoing process, and there are bound to be ups and downs. The more you take the time to learn about bipolar disorder, the more you will understand how difficult managing such a condition can be. There are countless resources—books, videos, support groups, etc.—that address and reduce the mystery and misunderstanding surrounding bipolar disorder.

You’re too smart to have bipolar disorder.
When I first heard that remark, I felt so horrible, as if I could have prevented what had happened. Even worse, I felt that someone, such as a homeless person, was somehow more “deserving” of such an illness than I. The brain, like any organ in the body, is subject to having problems. It is cruel to say something that suggests that bipolar disorder doesn’t exist, isn’t legitimate, or isn’t as significant as any other medical condition.

You know he’s ‘bipolar,’ don’t you?
Reducing someone to the illness he faces is destructive. In fact, it is cruel to see a person only through the lens of a diagnosis. Unfortunately, it happens all too often. A person who has bipolar disorder should not be defined by that with which he might struggle. Guard your tongue. Focus on the person you know and love, and dwell on all that makes that individual special. Your friend or family member still has a life.

Stop acting like a fool!
Granted, some conduct associated with bipolar disorder can be very difficult to contend with. When you realize, however, that a particular behavior is actually symptomatic and born of the illness, it makes accepting and dealing with it much easier. I see families who think that their situation is unmanageable, until they meet other families facing the same circumstances. With education and patience, these families come to realize that there is an explanation for what they’ve been witnessing.

It doesn’t take much to set you off!
Those of us who have bipolar disorder are often more vulnerable and responsive to what happens around us. When you make careless statements, your tongue becomes a trigger that can rouse a reaction and escalate symptoms. You unnecessarily incite a mood change in the person you really want to help.

You’re lazy and don’t have a life anymore.
Are you pushing someone who has bipolar disorder to get on with life? Doing so might create stress, counteract recovery techniques, and worsen overall health. If you have a family, a job, social engagements, etc., consider yourself not only lucky, but also far apart from the typical individual who deals with bipolar disorder. Such a person has often dealt with a radical departure from any sense of a normal routine. Recovery takes time and work, and the role you play is critical. Help by using constructive dialogue that acknowledges progress. Don’t push too hard and don’t expect everything to happen overnight.

We used to have high hopes for you.
I sat at a support group and heard a mother say: “My son was going to be a doctor and have a wonderful family, but now he has bipolar disorder.” As I listened, I watched the young man’s face just drop. He was crushed by his mother’s words. Such a statement is not healthy, because it does not convey unconditional love. What you say does matter. Remember that we are all human beings, not human “doings;” the more you acknowledge our being, the more we can end up doing. There is no need to squash hope or diminish dreams.

Don’t take everything so personally.
With bipolar disorder, there are obvious physical symptoms, such as changes in appetite or sleep; the mind, as well as the brain, are impacted. The patient’s self-esteem also takes a tremendous hit. That’s why a promised phone call that never comes may be taken much harder than you might imagine. Likewise, saying things that ignore or make light of someone’s sense of self-esteem should be avoided.

You seem a little overly enthusiastic.
Remember that someone who has bipolar disorder is still entitled to a personality. Before I had bipolar disorder, I was outgoing, happy-go-lucky and quick-witted. Now even though I have this illness, those same personality traits still exist. At a support group recently, a young man was very energetic and expressive. Someone accused him of being manic. Fortunately, a psychiatrist was present. He said that the young man was displaying no manic symptoms whatsoever and that it was cruel to strip a person of his personality merely because he has a diagnosis. The doctor added that anyone is entitled to a full, normal range of emotions.


What you can say

Sticks and stones can break bones, but words hurt, too. Talking carelessly can shatter self-esteem and stifle a person’s motivation to have a life again. Instead, use statements that are more likely to strengthen relationships and support recovery.

Here are some simple phrases to get started:

“I love you, and I care.”
“You’re not alone in this.”
“I’m sorry you’re in so much pain.”
“I’m always willing to listen.”
“I’ll be your friend no matter what.”
“This will pass, and we can ride it out together.”
“You are important to me.”
“When all this is over, I’ll still be here.”


Speaking of differences

Last year, at the Fernbank Museum of Natural History in Atlanta, Georgia, an amazing, special exhibit revealed that every imaginable genetic differentiation—body size, health, anything—is attributable to less than one percent of all genes (Human Genome Project). We are more than 99 percent identical. So, if you know someone who has bipolar disorder, why not concentrate on speaking to the 99 percent of that person’s humanity that really matters?

Talk is not cheap. It pays to use words that encourage, enlighten, and empower. You can make a positive difference in your loved-one’s recovery and in your peace of mind.


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Stephen Propst has bipolar disorder and uses many of the concepts he writes about to maintain his recovery. He serves as vice chair of the Depression and Bipolar Support Alliance (DBSA) board of directors; is a conference speaker and a coach/consultant about conditions such as bipolar disorder. He can be reached at talktosteve@joimail.com

 

Author:Stephen Propst

http://www.bphope.com/Item.aspx/128/the-big-payoff-of-well-chosen-words-

Worst Things to Say to a Person With Bipolar Disorder

When your friend or loved one has bipolar disorder, here are the worst things you can tell them.

Supporting Someone with Bipolar - For Family and Friends

Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is the one thing they needed to hear. While some of these thoughts have been helpful to some people (for example, some people find that praying is very helpful), the context in which they are often said mitigates any intended benefit to the hearer. Platitudes don't cure depression.

• "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"
• "No one ever said life was fair"
• "Pull yourself up by your bootstraps"
• "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"
• "Shit or get off the pot"
• "What you need is some real tragedy in your life to give you 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"

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http://www.healthyplace.com/bipolar-disorder/bipolar-support/worst-things-to-say-to-a-person-with-bipolar-disorder/

Seriously? In sickness and in health....What a person does can be grounds for divorce but not the sickness alone. Can you imagine someone having grounds for divorce because their spouse had cancer epilepsy or Alzheimer's?

Understanding And Dealing With Bipolar Disorder

Bipolar disorder is not the result of a "weakness" in one's personality or character. People with bipolar disorder have limited or no control over their moods, intellectual processes and energy. Bipolar disorder can become disabling, but it is also a treatable or manageable mental illness in most cases. 

A combination of medications and psychotherapy helps a vast majority of people with this illness return to happy fulfilling lives. The challenge is to provide treatment as soon as possible. Unrecognized and untreated symptoms of Bipolar disorder can have a profound and lasting impact on personality and one's character.

In many cases, the symptoms of bipolar disorder will occur with other problems such as substance abuse, poor school performance, family conflict or trouble a work. 

People with bipolar disorder are very prone to medicate they symptoms with alcohol, stimulants and sedatives. Some will turn to stimulants to help them cope with their depression. Treatment of more that one problem may be necessary.

Most people with bipolar disorder are usually treated with medications such as Lithium which tends to manage mania. Tegretol (Carbamazepine), Valproate (Depakote), Lamotragine (Lamictal) are three additional medications that were originally used to control seizures. These drugs have been found to act as a mood-stabilizers and to manage bipolar symptoms. Benzodiazepines such as Lorazapam and Ativan are sometimes prescribed for insomnia. A number of medications are used to manage mania especially when it cannot be controlled. Combinations of medications have been used with some success. Some of these include antidepressants and antipsychotic medications. A relatively new medication, Zeprexia, has been used to quickly manage and control manic symptoms in bipolar disorder. However this drug is often associated with severe side effect including massive weight gain and increased risk for diabetes. Treatment of bipolar disorder is not always easy, especially in the early stages, and requires a great deal of trial and error. 

If a person is in the midst of a manic episode, he or she may not recognize or appreciate the impact of their behavior. Children may not feel at risk or that they are impulsive, reckless or taking any risks. In fact, many people conclude that a manic episode is just normal adolescent behavior. While it may appear that way at first glance, the cycles in a child's behavior will tell the difference. A person in the midst of a manic episode may experience an elevated sense of well being or over confidence that he and her or she may refuse to get help. They can be very difficult to deal with. People in mixed phases can be very irritable, even volatile, aggressive and difficult to interact with. Parents may notice a change but not know what is causing it. In some cases, a person who is very manic, severely depressed, or mixed, may need to be hospitalized for his or her own protection in order to receive treatment. Education, guidance and support from a psychotherapist is often very helpful when a manic or depressive episode resolves. A therapist can help the person to deal with personal relationships, maintain a healthy self-image and ensure that the person complies with his or her treatment. Family counseling and support can be very helpful where the family is willing and able to participate productively. Psychotherapy can also assist the person in coping with the side-effects of the medications. 

Serious and Critical Symptoms

• Suicidal behavior, thoughts, feelings
• Dangerous, threatening or self-harming behavior
• Extreme neglect and lack of self-care

Information And Steps You Can Take

• Seek immediate help if a child has any serious and critical symptoms.
• Consultation with a qualified mental health professional or crisis intervention specialist is recommended if a child is in the midst of a manic or depressive episode.
• Anyone with symptoms of bipolar disorder should have a comprehensive medical, social and psychological evaluation.
• Ongoing encouragement and support from friends and family are also very important. It may be helpful to join a self-help or support group to help those coping with this illness.
• Ask about, evaluate, and address any suicidal, self harming or dangerous behavior.

Dated: December 30, 2007

http://www.incrisis.org/Library/Bipolar.htm