I Hate You, I Love You: Couple Relationship Functioning with a Bipolar Partner

Written by Janet Giron-Legarda

Bipolar Disorder (BD) and related disorders, which include Bipolar Disorder I, Bipolar Disorder II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and related disorder, Bipolar and related disorder due to another medical condition, other Specified Bipolar and related disorder, and Unspecified Bipolar and related disorder, involve individuals experiencing mild to extreme episodes of manic and depressive moods (American Psychiatric Association, 2013). Each of the disorders has its own set of criteria for diagnosis. The criteria include how many episodes an individual experiences in a set amount of time, how severe the episode is, how long the episode lasts, and which type of mood episode the individual experiences. These changes in mood may cause difficulties in many areas of an individual’s life. By informing oneself of the warning signs of an impending episode, you can prepare for the coming mood cycles and get your partner the help they may need. Relationships involving at least one partner with BD are more likely to “experience relationship distress and dissolution” (Rowe & Morris, 2012, p. 328). We will be focusing primarily on the general effects that Bipolar Disorder I and Bipolar Disorder II have on relationships. Information about diagnostic criteria and other facts about BD can be found at this link. 

Defining Characteristics of Bipolar Disorder

​Recognizing symptoms of BD will help to understand the impact of the disorder on a romantic partnership. Mood swings are either hypomanic or manic, mild to moderate or severe depressive, or mixed episodes. Hypomanic or manic episodes consist of “hyperactivity, euphoria, talkativeness, grandiose ideas, irritability, reckless behavior, marked distractibility, loss of normal inhibitions and decreased need for sleep” (Tranvåg & Kristoffersen, 2008, p. 6). Hypomania is more commonly associated with Bipolar Disorder II. These episodes include “distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days…(with) a noticeable change from usual behavior” (APA, 2013, p. 132). Bipolar Disorder I is more commonly associated with manic episodes. In order to meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) for a manic episode, an individual will be “abnormally, persistently elevated, expansive, or irritable…and (have) persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 week, accompanied by at least 3 additional symptoms” (APA, 2013, p. 127). During manic episodes, the individual may be unable to engage in ordinary communication, which can affect relationships with others (Tranvåg & Kristoffersen, 2008).

​Major depressive episodes must have 5 or more of the symptoms identified in the DSM-5 for a 2-week period and “represent a change from previous functioning,” including either “depressed mood or loss of interest or pleasure” (APA, 2013, p. 125). Depressive episodes can range from mild to severe and are “characterized by lowering of mood, reduced activity and energy, tiredness, sleep disturbances, reduced self-esteem, ideas of guilt or worthlessness, reduced capacity of interest and enjoyment, psychosomatic symptoms, suicidal thoughts and acts” (Tranvåg & Kristoffersen, 2008, p. 6). During depressive episodes, individuals who suffer from BD may experience starvation, dehydration, and, in extreme cases, suicide (Tranvåg & Kristoffersen, 2008). In situations involving both manic and depressive episodes, an individual diagnosed with BD may experience symptoms of psychosis, including delusion and hallucinations. Mixed episodes are when an individual experiences symptoms of hypomania, mania, or depression at the same time. According to the DSM-5 (APA, 2013), the “mixed features specifier can apply to the current manic, hypomanic, or depressive episode in Bipolar I or Bipolar II Disorder” (p. 149).

Bipolar Disorder and Relationships

​The behavior of an individual diagnosed with BD can affect his/her partner’s behavior; a BD-related episode can cause significant strain on the relationship and the individual’s partner. Individuals diagnosed with BD have difficulty maintaining healthy relationships with family, friends, and intimate partners. Problems arise in many important areas of life when coping with BD such as financial problems, difficulties in sexual relations, poor communication, and loss of stability and security (Rusner, Carlsson, Nyström, & Brunt, 2012; Sheets & Miller, 2010; Tranvåg & Kristoffersen 2008). The mood swings and symptoms associated with a diagnosis of BD can have aversive effects on close relationships. For instance, stress can lead to a number of physical problems, such as body aches and depression. Additionally, partners of individuals diagnosed with BD may grow to resent their partners for the disorder (Rusner et al., 2012). 

​The quality of the relationship changes as an individual goes through mood episodes and as his/her partner adjusts to life with a partner diagnosed with BD. Relationship distress is common with either manic or depressive episodes; however, according Sheets and Miller’s (2010) article, “patient depressive symptoms were significantly associated with patient perception of family and couple functioning” (p. 375). The effects of manic symptoms experienced by individuals diagnosed with BD are highly correlated with poor intimate relationship functioning for their partners (Sheets & Miller, 2010). 

Bipolar Relationships and Managing Life

​According to Rowe and Morris (2012), mood changes experienced by both partners are linked to overall relationship quality; therefore, partners must pay attention to not only the individual diagnosed with BD, but their own mental health and wellness, too. Understanding both partners’ mental health has the potential to increase quality of the relationship, assists in coping with BD, and provide a better understanding of the onset of an episode. 

In conclusion, learning the signs of an oncoming episode can help to prevent extreme symptoms and allow adequate time to get help. Educating oneself about BD and communicating with your partner can be beneficial to the relationship. Being knowledgeable about what your partner experiences with BD and ways you can help him/her during times of need can help reaffirm your commitment to your relationship and partner. Also, partners should not treat individuals diagnosed with BD if they are incapable of living a normal life. Individuals diagnosed with BD are more than the disorder itself and should be treated with respect.
 
More information about BD can be found at this link.

​References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Rowe, L., & Morris, A. (2012). Patient and partner correlates of couple relationship functioning in bipolar disorder. Journal of Family Psychology, 26, 328-336.

Rusner, M., Carlsson, G., Nyström, M., & Brunt, D. (2012). The paradox of being both needed and rejected: The existential meaning of being closely related to a person with bipolar disorder. Issues in Mental Health Nursing, 33, 200-204.

Sheets, E., & Miller, I. (2010). Predictors of relationship functioning for patients with bipolar disorder and their partners. Journal of Family Psychology, 24, 372-375.
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Tranvåg, O., & Kristoffersen, K. (2008). Experience of being the spouse/cohabitant of a person with bipolar affective disorder: a cumulative process over time. Scandinavian Journal of Caring Sciences, 22(1), 6-10.