Licensed Marriage and Family Therapist, Robin Mohilner, LMFT, shared her experience of bipolar mania in a post on her website in 2011.  She described one manic episode like this:

“I was excited by EVERYTHING in life during my hypomania.  The slightest idea felt brilliant to me and could lead me to several minutes of pure joy until the next brilliant idea. People described me as bouncing off the walls.  I felt truly important and special.  I believed that I existed for a specific purpose chosen by God and that I am a prophet.   I stayed up all night studying and decoding the bible and other religious texts throughout the world, as well as studying quantum physics.  My sex drive was through the roof and I had difficulty containing it.”

This is only one person’s experience with mania, but it does capture a number of the symptoms that professionals look for when diagnosing bipolar disorder.  It is a complex disorder that includes highs and lows that can disrupt life and destroy relationships, without the right support and treatment.

Understanding Bipolar Disorder

Bipolar Disorder is a mood disorder characterized by mood instability that includes both depressed mood and manic or hypomanic mood.  It affects men and women, children and adults, and the cause of the disorder is not yet fully understood.   The symptoms of depression experienced by a person with Bipolar Disorder are much like those experienced by person with Major Depression (PubMed Health, 2013), and can include symptoms like:

• Daily low mood or sadness

• Difficulty concentrating, remembering, or making decisions

• Eating problems such as loss of appetite and weight loss, or overeating and weight gain

• Fatigue or lack of energy

• Feeling worthless, hopeless, or guilty

• Loss of pleasure in activities once enjoyed

• Loss of self-esteem

• Thoughts of death or suicide

• Trouble getting to sleep or sleeping too much

• Withdrawing from friends or activities that were once enjoyed

However, a person with Bipolar Disorder must also manage episodes of mild to severe mania, which can sometimes also include psychosis.  Milder mania is sometimes called hypomania. Manic episodes can be very painful and very disruptive to daily life.  Although, some people with bipolar disorder do not experience a manic episode as painful or problematic while they are in the midst of it.  They may even find it enjoyable and exciting.  A manic episode can last days or weeks, and symptoms may include:

• Distractibility
• Little need for sleep/inability to sleep
• Poor judgment and decision-making
• Extreme agitation
• Poor temper control
• Reckless /impulsive behavior and lack of self –control that can lead to behaviors like drinking, drug use, sex with many partners, spending sprees
• Very elevated, expansive or irritable mood, racing thoughts, false beliefs about self or abilities
• Very rapid and pressured speech
• Grandiose ideas
• Delusions or paranoia
• Very involved in activities (PubMed Health , 2013)

The consequences of a manic episode can last for days, months, or even years.  In addition to the symptoms and behaviors above, people with Bipolar Disorder can become suicidal and abuse substances during both manic and depressive episodes.  Robin Mohilner, LMFT, said she was able to recognize her full-blown mania, “by the severity of symptoms and the delusions I experienced.  During full-blown mania, I went from wanting to serve God to being violently angry.  I was completely out of control both emotionally and physically.  I went from being fearless to completely paranoid and delusional. I should have been hospitalized" (Mohilner, 2011).  Manic episodes tend to be less frequent than depressive episodes, but both can interfere with daily functioning and quality of life.  The symptoms and behaviors can impact a person’s ability to maintain employment or have healthy relationships. 

Coping with Bipolar Disorder on the Job

The daily demands of work can be stressful and overwhelming for anyone.  Managing the symptoms of bipolar disorder at work, including mania and mood swings, can impact job performance and relationships with colleagues.  In a survey conducted by the Depression and Bipolar Support Alliance, 9 out of 10 people with Bipolar Disorder said the illness affected their job performance. They believed they had to change jobs more often than others, and were passed up for promotions or assignments with more responsibility (Managing Bipolar Disorder at Work, 2013).

Many people with Bipolar Disorder wonder if they should disclose their diagnosis to their employer.  This is a difficult decision, and there are many things to consider.  Supervisors and co-workers may need to be educated about the disorder and symptoms of depression and mania in order to understand how it may impact the employee and the workplace.  As with any chronic illness, people with Bipolar Disorder will need to miss work to attend medical appointments, and will need to practice good self-care. Working long hours, and becoming over- stressed can increase vulnerability to episodes of depression and mania. A flexible work schedule, or working part-time, can help (Managing, 2013).    There are some additional steps that people with Bipolar Disorder can take to be successful and effective at work. 

• Take medications as prescribed and make time for counseling appointments

• Manage stress at work:   This is essential for people with any type of mental illness, as stress can trigger or aggravate symptoms

• Take regular breaks:  Try relaxation activities at work or go for walks

• Monitor lifestyle:  Besides managing stress, it’s important to exercise daily, get enough sleep, and eat nutritious meals

• Maintain focus and concentration by reducing distractions, using white noise machines, and increasing natural lighting

• Stay organized.  Make daily to-do checklists, use electronic organizers, break large tasks into smaller ones, and get written instructions, when possible

• Develop team skills:  Learn how to work  and communicate as a member of a team, and how to manage conflict at work

• Find Balance:  Balance work time and time with family and friends (Managing, 2013)

Following these steps and guidelines can help a person with Bipolar Disorder manage the demands of work and be successful and healthy.

Bipolar Disorder and Relationships 

Most people want stability and peace in their relationships, and this can disappear in a relationship with a person with untreated Bipolar Disorder.  The symptoms of depression and mania impact everyone around them.   Mood swings and manic behaviors can stress the best of relationships, and test the patience of the most caring person.   For example, how does a man cope when his girlfriend wants to stay up all night remodeling the kitchen when he has to get up for work in the morning?  What can a wife do when her husband empties their banking account during an impulsive gambling spree?  How can parents cope when their teenage son wants to sleep all day, won’t see his friends, and hasn’t taken a shower in a week? Many loved ones are overwhelmed by the moods and behaviors.

Manic behaviors like over-spending, promiscuity, and impulsivity can wreak havoc in a relationships, destroying feelings of trust and safety.  While during a depressive episode, the person may withdraw and become emotionally unavailable.  They may have suicidal thoughts, which can frighten the people around them (Watson, 2008).  Loved ones want to help, but may not know how.  The loved one with Bipolar Disorder can seem like two different people, with very unpredictable moods and behaviors.   Dr. Scott Haltzmann, Assistant Professor in the Brown University Department of Psychiatry and Human Behavior, offers these suggestions to people with bipolar disorder and their loved ones:

• Get an accurate diagnosis and rule out any other causes for the symptoms and behaviors.

• Participate in psychotherapy with a trained psychologist, social worker or counselor to learn about the illness and how to control behaviors that stress relationships.

• Understand medications (e.g. mood stabilizers) and take them as prescribed

• Participate in marriage or couples counseling to work on communication or any underlying issues in the relationship

• Encourage loved ones to attend counseling and be involved in treatment to better understand the illness and why their loved one behaves the way they do.  They can also learn helpful ways to respond and how to take care of themselves (Watson, 2008).

• Attend a support group for people with Bipolar Disorder or depression 

With the right support and treatment, it is possible for people living with Bipolar Disorder to have happy and fulfilling relationships.   

The Benefits and Challenges of Treatment for Bipolar Disorder

Psychotherapy with a trained professional can be tremendously helpful for a person with Bipolar Disorder.  Coping with this complex disorder can be difficult, and counseling can provide skills and support to help limit the negative impacts of the disorder on the person with the disorder and their loved ones.   According to the Depression and Bipolar Support Alliance (DBSA), the benefits of counseling include:

• Increasing understanding of Bipolar Disorder and acceptance of the diagnosis
• Coping with stress
• Identifying and managing triggers for both mania and depression that may worsen symptoms
• Decrease the likelihood and need for psychiatric hospitalization
• Making sense of past traumatic experiences
• Separating true personality from the mood swings caused by the illness – learning that the person is not the illness
• Improving relationships with family and friends
• Establishing a stable, dependable routine
• Learning skills to improve sleep
• Developing a plan for coping with crises
• Learning to recognize and manage medication side effects
• Ending destructive habits such as drinking, using drugs, overspending or unhealthy sex 
• Overcoming thoughts about death or suicide attempts

It may be tempting for people with bipolar disorder to skip medication doses and counseling appointments, or to stop treatment all together. This is especially true when symptoms are mild or absent, or when mania is occurring.  After all, this is when many people feel most productive at work and excited about life and relationships.  One of the challenges in counseling is that people with Bipolar Disorder may not feel like they need help, especially during a manic episode.  They feel good—even great.  Developing the insight to recognize even these “good” feelings as part of the disorder is an important part of counseling.

Bipolar Disorder impacts every aspect of a person’s life, including work and relationships, but it is a treatable illness, and recovery is possible.  The right support and treatment can make all the difference. People with bipolar disorder can have fulfilling careers and healthy and happy relationships with family and friends.   

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Psychotherapy: How it works and how it can help. (2014). Retrieved June 11, 2014, from http://www.dbsalliance.org/site/PageServer?pagename=wellness_brochures_psychotherapy

Managing bipolar disorder at work: Job performance tips. (2014, January 03). Retrieved June 11, 2014, from http://www.webmd.com/bipolar-disorder/guide/managing-bipolar-disorder-at-work-job-performance-tips

Mohilner, R., LMFT. (2011, May 25). An example of “normal” mania. Understand what an episode of mania is for people affected by bipolar disorder. Retrieved June 11, 2014, from http://www.thrivewithbipolardisorder.com/?p=1941

PubMed Health. (2013, January 31). Bipolar disorder. Retrieved June 11, 2014, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

Watson, S. (2008). Bipolar dating and marriage. Retrieved June 11, 2014, from http://www.webmd.com/bipolar-disorder/guide/bipolar-romantic-relationships-dating-and-marriage