Recent Engagement Causing Relapse?

By Kristina Randle, Ph.D., LCSW

Hello, my name is Steven. I’m kind of afraid to really describe my situation, cause of my distrust that someone I know may be reading this and judge me. I am a sophomore at a private college. I’m also 19. I recently got engaged, and it’s causing me to relapse. My former doctor diagnosed with Bipolar II w/ psychotic features. My mood swings have been coming back since the engagement. I’ve been in a mixed episode for about 6 months. Everything is kind of going downhill. My depression is killing me. New fears that I’ve never had are just showing up. For example, I get anxious when I’m near fire, or in the dark. When it’s dark, I have a feeling that someone is out to get me, and they are in my room watching me. Near fire, I feel like someone is going to throw me into the fire. I am afraid of what will happen in the future, cause of my past. I used to be a cutter. I am afraid to be alone as well. I don’t even trust my friends anymore. The worst thing is I snap at people. I snap at my fiancee, parents, brother, everybody. I am afraid they will ship me off to some mental hospital. The worst thing is no health insurance, so I can’t even see a doctor. I can’t think clearly either. I mix up words in sentences, and sometimes I’ll forget what I am talking about mid sentence. Writing is easier, cause I can see what I wrote if I forget. I don’t even feel like talking to anybody anymore. Every time I talk to somebody, I feel a sinking feeling in my stomach. I get irritable if I don’t have at least sometime to myself each day. That decreases my ability to control anger. It’s getting hard for me to function. Could this one event really cause this many problems?

A. Hello Steven. I understand that it was difficult to write your letter but I’m glad you did. You wanted to know whether getting engaged may have triggered a relapse. The answer is yes, it is possible. Bipolar disorders, especially those with associated psychotic symptoms, as well as other psychotic disorders including schizophrenia, can be and often are triggered by stressful events or a change in life circumstances. It is a relatively common occurrence among those with psychotic disorders.

In some cases, psychosis develops gradually. Clinically, this is referred to as the prodromal phase. This phase can last for approximately four to six weeks but that timeframe can vary. During this time, an individual will become increasingly sick and less able to function. This may be what you are experiencing. Individuals who have experienced psychosis report it to be very frightening. Because a psychotic episode can be so confusing, disturbing and frightening, it is imperative that you alert a mental health professional. If caught early enough, it is possible that a psychotic episode can be averted.

What’s most important in this situation is seeking immediate treatment. I understand that you do not have health insurance but there are still ways to access a mental health professional. Community mental health centers (CMHC) often provide low-cost or free treatment to individuals who cannot afford health insurance. They may also be able to help you access health insurance. Generally, most CMHC’s have individuals on staff who can help with this specific task. I would strongly advise you or one of your relatives to call a local CMHC to inquire about what services are available to you. It would be best if you could see a psychiatrist. He or she can provide a full and thorough psychiatric evaluation and prescribe medications that may effectively stop or prevent the psychotic episode from occurring.

If you feel that you might harm yourself or someone else, or that you are unable to take care of your basic needs including showering or eating, you should go to the hospital immediately. At the hospital, they will evaluate your situation and determine whether you need to stay for a short time to stabilize. If not admitted to the hospital, they will provide you with some level of treatment, including possibly medication and a referral to a program or clinic for followup care.

I recognize that you are frightened of the hospital but please understand that in certain situations, being admitted may be necessary. Typically, mental health hospital stays are relatively short. The primary goal of hospitalization is to stabilize your symptoms, begin treatment and to help facilitate outpatient resources upon a patient’s discharge.

It is important to keep in mind that with psychosis, it is vitally important to seek treatment as soon as possible. Psychosis generally does not improve on its own; it usually requires treatment in the form of medication. Please call your local CMHC or click on the find help tab at the top of this page. You can also try calling your local health department and asking for referrals.

The prospect of getting married may be too overwhelming for you at this time. The development of psychotic symptoms seems to indicate this.

I hope you are able to access help. Please take care. I wish you well.

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Last reviewed: By John M. Grohol, Psy.D. on 6 Aug 2010

APA Reference
Randle, K. (2010). Recent Engagement Causing Relapse?. Psych Central. Retrieved on September 3, 2014, from http://psychcentral.com/ask-the-therapist/2010/08/06/recent-engagement-causing-relapse/