In-Depth: Living with Bipolar Disorder

It’s common for individuals who’ve been recently diagnosed with bipolar disorder to reject the diagnosis, feeling overwhelmed at the thought of having an illness. Some even wait it out, struggling with several episodes before they pursue treatment.

However, an “accurate diagnosis is a positive first step,” said Noreen Reilly-Harrington, Ph.D, clinical psychologist at the Harvard Bipolar Research Program at Massachusetts General Hospital and co-author of Managing Bipolar Disorder: A Cognitive-Behavioral Approach Workbook.

Bipolar disorder changes the course of your life, but it doesn’t mean you can’t do great things, said Holly Swartz, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic in Pittsburgh.

With a combination of medication, psychotherapy and self-management strategies, individuals with bipolar disorder can lead productive, successful lives. Here’s how.

Common Misconceptions about Bipolar Disorder

In addition to the unwarranted stigma that surrounds bipolar disorder, there are many misconceptions about its symptoms, diagnosis and treatment. These are several prevailing myths:

  • Individuals cause their disorder. Bipolar disorder is caused by a complex interplay of genetic, biological and environmental factors.
  • You can will yourself out of mood swings. Left untreated, bipolar disorder can wreak havoc on a person’s life. It requires both medical treatment and psychotherapy.
  • You’ll never be normal. “Many patients in the beginning feel like they won’t be able to accomplish their goals, that bipolar will prevent them from getting married or getting the job of their dreams,” Reilly-Harrington said. She adds that though your life might require certain changes, you can pursue your dreams. For instance, her student patients might take fewer classes every semester and take longer to graduate, but they still achieve a college degree.
  • Bipolar is easy to diagnose. “It’s often very difficult to diagnose bipolar disorder based on an initial visit, even a prolonged one,” said Elizabeth Brondolo, Ph.D, a clinical psychologist specializing in bipolar disorder and professor at St. John’s University in New York. This typically occurs because our self-awareness changes with mood.

    “It can be hard to translate the experiences and moods you have into the symptoms identified in the DSM or other scales,” said Brondolo, who also co-authored Break the Bipolar Cycle: A Day-to-Day Guide to Living with Bipolar Disorder. For instance, what might appear to you as confidence and clever ideas for a new business venture might be a pattern of grandiose thinking and manic behavior. While you’re focused on your business experience, others notice your mood and behavior, Brondolo said. Same with irritability, a symptom that often goes unrecognized: You’re more focused on feeling frustrated than looking inward. Because you might not be a reliable reporter, talk to your loved ones to get objective impressions, Brondolo said.

  • Medical treatment is worse than the disorder. Many people perceive medication as worse than the illness. Although some people can experience a bad reaction to certain medication, you don’t get hooked on medication like you would a street drug, said Monica Ramirez Basco, Ph.D, clinical psychologist at the University of Texas at Arlington and author of The Bipolar Workbook: Tools for Controlling Your Mood Swings. In fact, “medication is key for treating bipolar disorder,” said Brondolo.

Related: Building a Routine When You Have Bipolar Disorder

Telling Others about Your Diagnosis

Having a support system is critical in successfully managing bipolar disorder. But you might be uncertain about who to tell. According to Reilly-Harrington, be very selective. She emphasizes that it shouldn’t feel like a secret, but you should realize that people’s reactions vary widely. Because many people don’t understand the disorder, patients can feel disappointed after disclosing that they have it.

Many patients, though, do have positive experiences. For one of Brondolo’s patients, who worked in a very supportive environment, telling her boss allowed the patient to be herself and do her job more effectively. (Learn about potential accommodations for bipolar patients here.)

However, every workplace and family member is different. Brondolo suggests first consulting your therapist or doctor. Also, examine your concerns, Brondolo said. Ask yourself, “What am I worried about?” “How can I potentially be harmed?” Consider turning to support groups to learn about other patients’ experiences, suggests Reilly-Harrington.

If you’re ready to disclose your diagnosis, be straightforward, said Brondolo. It’s helpful to give information about the disorder since myths abound.

Treatment of Bipolar Disorder

To effectively treat bipolar disorder, a treatment team—typically, a therapist and a psychiatrist or other medical doctor—is important. This way, professionals from different perspectives are sharing the best information possible and providing “feedback about the nature and intensity of the symptoms in response to medications and side effects,” said Brondolo. She adds that this brings tremendous relief to the practitioners, patient and loved ones, because “you feel like decisions are being made collaboratively.”

Psychotherapy for Bipolar Disorder

Research has shown that cognitive-behavioral therapy (CBT) and interpersonal and social rhythm therapy (IPSRT) are effective in treating bipolar disorder.

CBT features five key components, according to Basco, the UTA psychologist. It:

  • Educates patients and loved ones about symptoms and managing the disorder.
  • Helps to create an early warning system to detect symptoms before they escalate.
  • Teaches strategies for controlling negative emotions and thinking and destructive behavior patterns.
  • Helps individuals stick with treatment and take medication consistently.
  • Focuses on managing stress and solving life problems.

As part of the CBT approach, Reilly-Harrington helps her patients create a treatment contract, which consists of three parts:

  1. Selecting the support system. Patients select several people they believe will be supportive and helpful throughout treatment. These individuals are then taught about bipolar disorder.
  2. Preventing depression. Patients along with their supportive others learn how to recognize the warning signs of depression, anticipate an episode and manage it. Reilly-Harrington talks with her patients about how their sleep, mood and behavior change when an episode is about to occur. Then, her patients list specific ways their support team can help when symptoms surface. Because suicidal thinking is common during depressive episodes, Reilly-Harrington asks her patients how they can be honest with their support system and get help.
  3. Preventing mania. Mania tends to sneak up on patients, going from sociable and chatty to a full-blown euphoric episode. Similar to above, patients and their support system learn to anticipate and manage episodes. Reilly-Harrington also has her patients use a “two-person feedback” system, where they verify ideas with two people.

IPSRT is a manualized treatment with three components:

  1. Interpersonal psychotherapy, originally developed to treat unipolar depression, focuses “on the links among mood symptoms and interpersonal relationships and life events, helping to understand reciprocal relationships among these factors,” said Dr. Swartz. “Unstable mood can disturb relationships and life endeavors, while relationship problems can lead to mood instability,” she said.
  2. Social rhythm focuses on developing and maintaining regular routines. Research has shown that “disturbances in circadian biology are associated with bipolar disorder,” but “there are social cues that can help entrain one’s underlying biological rhythms,” Dr. Swartz said. Such social cues include keeping a consistent schedule of sleeping, eating and other daily activities. “The social rhythm component of IPSRT helps individuals learn to develop more regular routines in order to, presumably, regulate the underlying biologic systems,” Dr. Swartz said.
  3. Education concentrates on helping patients become experts on bipolar disorder.

Related: The 4 Keys to Managing Bipolar Disorder