Erin Walczykowski, Hope for Families Facing the Extremes of Bipolar Disorder
As part of our Overcoming Challenges of Bipolar Disorder educational series, we interviewed Erin Walczykowski, APRN, PMHNP-BC. Ms. Walczykowski is a Bfollowing is Part Two of a two-part interview.
What factors do you take into account when deciding how to treat someone diagnosed with bipolar disorder?
There are multiple factors to take into consideration when treating someone diagnosed with bipolar disorder. This includes acuity of symptoms, current safety concerns (e.g., risk of harm to self or others, including committing a crime), past history of self-harm, age, gender, pregnancy status and plans, available supports, psychosocial stressors, ability/willingness to adhere to medication regimens, nature of current and/or most recent episode, family history of bipolar and associated treatments that were helpful, housing status, socio-economic status, and medical history, including associated medications. All of this helps to guide which treatment options would work best for their particular scenario.
This also ensures that symptoms and behaviors are treated in a manner that ensures patient safety. It is also important to identify a plan regarding childcare in advance, should the patient not be able to safely care for their children or dependents during an episode or while hospitalized.
People living with bipolar disorder often feel alone, isolated, and misunderstood. What actions can their loved ones take to help them with those difficult circumstances?
Family members can empathize and provide an open, non-judgmental ear for their loved one living with bipolar disorder. They can connect the loved one with community resources, including support groups (in person or online) and psychotherapy. Help them to develop healthy relationships. If the loved one living with bipolar disorder feels misunderstood and not heard, family therapy could be useful. The family can encourage the loved one to participate in self-care and stress regulation.
It is also important to not stigmatize the person based on prior damaging behaviors. Family members should engage in their own individual therapy or connect with support groups targeting family members, as a person living with bipolar disorder can cause significant damage to relationships during an active episode. Family members should remember to communicate and make time to talk about problems. But, it is important to learn when to be direct and when to have a softer approach. It is best to not be confrontational if the loved one is in the midst of an episode where they are very angry, as this could incite rage or violence. When necessary, involve the help of mental health clinicians who may be able to communicate with the loved one. React calmly and rationally. Make sure to listen so that they feel understood, then try to work toward a positive outcome.
What do you wish more people understood about bipolar disorder?
Bipolar disorder is more than just daily mood swings and does not make a person “crazy.” People living with bipolar disorder should not be branded with a scarlet letter based on the often damaging behaviors. This disorder involves extreme mood swings that come about due to chemical imbalances in the brain. Those diagnosed with bipolar disorder do not choose this life. They need a lot of support from those around them to help regulate their environment and the stressors they can encounter.
Those living with bipolar disorder are sensitive to emotional changes. They need understanding, mature and compassionate individuals around them as support within friendships, family and romantic relationships. They should neither be shunned nor shamed. Their illness should not be minimized or trivialized. It is vital that those with bipolar disorder surround themselves with people that live healthy lives, helping to encourage good emotional regulation, foster trust, and model good daily habits.
What hope can you offer families whose loved ones are facing extreme situations such as financial ruin, incarceration, commitment to a psychiatric facility, or homelessness?
With the support of a team, including a prescriber, social services, and family members, these situations can be remedied and possibly prevented from recurring. Feelings of mania may feel good at first, but they can spiral into dangerous behavior such as reckless spending, violence or hypersexuality. Anger and violence can also emerge. This can result in families putting distance between themselves and their loved one out of frustration or self-protective measures. It can be difficult to remain an active support when troublesome behaviors cause a strain on the lives of the family. There are steps that can be taken to manage and minimize the most extreme of outcomes.
Commitment helps to ensure the safety of the person living with bipolar disorder, prevent further ruin, and to provide an opportunity for them to get help. While hospitalization carries its own stigma, sometimes this is in the loved one’s best interest. Should these things occur (or even before), the family may have to step in to develop a plan regarding access to accounts and who will take over certain responsibilities upon signs of impending troublesome behaviors.
Partnering with a provider and/or a team of mental health clinicians can help to monitor and prevent these varied outcomes. They can also help to develop a safety plan, which can incorporate what to do, and under what circumstances, to prevent permanent damage. With the right support, there is always the potential to help the loved one get their life back on track. This includes encouraging as much self-sufficiency as possible, as is done by many suffering with bipolar disorder. This is why it may be helpful to connect with support groups, as stories can be shared and advice given from those that have endured such hardships, only to successfully rebuild their life and relationships again.
- Read Part One of our interview with Ms. Walczykowski where she discusses the role of the family caregiver in bipolar disorder treatment.
- Check out our list of resources for overcoming challenges of bipolar disorder.
- Watch our Bipolar Disorder: Beyond the Basics webinar.
