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Bipolar disorder causes extreme mood swings in which a person can go from extreme highs, known as a manic episode, to extreme lows, referred to as a depressive episode. Behaviours exhibited during these episodes can be volatile, hostile, reckless and uncontrollable, and this can cause friction between people with bipolar disorder and those around them.
Often, when their mood is stable, people with bipolar disorder live in a state of anxiousness, not knowing when the next episode might occur or what they might say or do during it. This can impact their social lives and result in them pulling back or experiencing severe anxiety and/or depression symptoms that are disruptive to their everyday lives.
The social impact of bipolar disorder is sometimes overlooked and not always spoken openly about. In this blog, we’re going to look at some of the ways bipolar disorder can impact you on a social level, and how you and the people around you can try to overcome some of the obstacles.
There are a number of symptoms of bipolar that can make it hard for you to socialise or manage and maintain social relationships.
If you’re having a manic episode, you might find that you feel extremely happy and joyous, but to the people around you, it might seem like you’re out of control and behaving recklessly. For example, you might spend lots of money and cause yourself financial damage, or you might engage in an activity which is out of character and dangerous. This can be distressing for loved ones to watch, and not everyone will know how to appropriately deal with these symptoms. You might also say or do hurtful things when people around you try to help during a manic episode, and this can cause tension and fractures in your relationships.
When you have a depressive episode, you might feel hopeless, lacking in energy, irritable, guilty, have suicidal thoughts or even experience psychotic symptoms like hallucinations and delusions. Experiencing such severe symptoms undoubtedly impacts the people around you; they may grow increasingly concerned and encourage you to seek professional support which you may not feel ready for at that moment.). When feeling very low, it is common to withdraw socially. Talking to others, whether socially or professionally, can feel too demanding; however, withdrawing for long periods of time can have a lasting impact on your social life and can maintain your symptoms for longer.
As mentioned, even if you don’t have a social anxiety disorder, you may still find that your bipolar diagnosis impacts other aspects of your life socially. Here are a few of the ways you might find bipolar impacts you on a social level.
Bipolar impacts not just you, but everyone around you. Episodes can be difficult to control, and they can cause you to act in a way that hurts the feelings of those closest to you. Your friends and family are with you through the highs and lows and will often try to offer their support where possible, but this isn’t always easy. If you say or do something during an episode that hurts someone, they may want to withdraw, especially if you find it hard to remember what happened.
In addition, not everyone will feel prepared enough to support someone with bipolar disorder, making it difficult for relationships to be formed or sustained. This goes for romantic, platonic, and familial relationships, leading to difficulties in forming a reliable social support system. Research shows that if you have bipolar and have a good level of social support, you will tend to recover from manic or depressive episodes faster, and you are less likely to exhibit suicidal tendencies and behaviours. In addition, if you have a better social support network, you’re likely to experience fewer episodes overall. Many people with bipolar disorder don’t have high levels of social support because depressive episodes can lead to them to shut themselves away and manic episodes can lead them to push people away, making it difficult to get a good support system in place.
Bipolar isn’t the only aspect of your life that can be affected by a lack of strong relationships; you may find that you don’t go out much or live a high quality of life if you have few people to share it with, leading to issues such as loneliness which can contribute to depression and affect your physical health, too.
For a lot of people, work is where they find themselves spending most of their time and doing the majority of their socialising. If you have bipolar, you might find that one day, you feel productive and focused, but the next day, you feel disengaged and unmotivated. This can make it difficult for you to maintain a consistent performance and output at work, and this can cause friction in the workplace if other co-workers feel like you’re not contributing to the team.
According to Bipolar UK, 90% of people with bipolar disorder tell their employers that they have a diagnosis, but 24% say they regret doing that. Bipolar can cause psychotic symptoms which are still stigmatised and not widely understood, and moods can be unpredictable and challenging to deal with. If a workplace doesn’t offer the right level of support and isn’t educated on bipolar, it can lead to people with bipolar at work being left out and penalised when they’re not in a stable mood.
The fluctuations in mood can also cause varying levels of occupational functioning, so this can make it difficult for people with bipolar to maintain full time employment or progress to more senior roles. If you feel like you’re stuck at the same level whilst other people are progressing in their careers, this can lead to social issues, too.
Social anxiety disorder is often a long-term condition that results in a person feeling overwhelmed and sometimes fearful of social situations. It can manifest itself in many ways, including avoiding social events, not engaging in eye contact, and having low self esteem. These symptoms are common in those with bipolar, leading people to ask whether the two are linked.
If you have bipolar disorder, it doesn’t necessarily mean that you’re going to go on and develop a social anxiety disorder or have problems socially, but the chances are higher and social anxiety has been linked to bipolar disorder. According to research from the National Comorbidity Survey, the majority of people with bipolar also have an anxiety disorder, be it generalised anxiety disorder, separation disorder, panic disorder, or another type of anxiety disorder.
It’s thought that around 21% of people who have bipolar disorder suffer from panic attacks (Epidemiologic Catchment Area study).
There is no definitive proof that certifies why people with bipolar are at a greater risk of social anxiety, but suggested theories include:
If you have bipolar but don’t have an anxiety disorder, you may still notice that you are affected socially by your bipolar disorder due to stigmas and assumptions people make, or due to fears you have about having a manic or depressive episode in front of others. This can cause problems of its own and see you remove yourself from situations you might not feel comfortable or confident being in.
If you have an anxiety disorder that coexists alongside bipolar disorder, you may find that your bipolar is more difficult to treat and begins to interfere with more of your everyday life than if you were to just have one disorder or the other. You may begin to isolate yourself or feel overwhelmed by anxiety to a point where you are restricted and struggle to perform day to day tasks, like going to the shop or meeting up with friends.
Studies have also shown that if a person’s risk of suicidal behaviours is increased if they have an anxiety disorder alongside bipolar compared to bipolar disorder on its own. As mentioned, some people with bipolar disorder try to mitigate their symptoms with alcohol or drugs, and people with anxiety disorders sometimes do the same. Substance abuse can make the symptoms of anxiety and bipolar worse, and this can cause issues of its own that can affect social situations.
Another way social anxiety affects bipolar disorder is that it makes it harder to treat. One of the first ports of call for an anxiety disorder is to go on antidepressants, but research has shown that these medications can increase the risk of manic and/or depressive episodes in people with bipolar. This means treating anxiety can lead to bipolar symptoms being amplified, meaning treatment for anxiety needs to be carefully factored into bipolar treatment.
Knowing how to improve your social life and skills whilst living with bipolar can seem difficult, but there are things you can do to better your social functioning, increase your perceived social support and build healthy relationships.
Everyone’s social lives are different; some people like to have lots of friends and people around them to socialise with, and others thrive more with a smaller social group and some valuable alone-time. With this in mind, determine what your social preferences are. Do you like having lots of people to choose from to socialise with, or do you like to keep a small circle?
Then, consider the types of friends you like to have and what you like to do. Sometimes it’s easier to have friends who have been through similar life events to you because they have a better insight and understanding of what you might be feeling, but other times, it’s a good idea to have more casual friends who you can rely on for less intense socialisation, like going to the cinema or going for coffee.
Assessing our social networks is something we all have to do from time to time. It’s natural to outgrow people or realise that perhaps the relationship you have isn’t working or isn’t healthy. For example, you might have people in your social network who you’ve known for years but who don’t necessarily provide the social support you need, or who aren’t accepting of your bipolar disorder. These people can bring negativity to your life and this can make things worse for you. You might even have people who engage in behaviours that are harmful to you, such as substance use which can amplify mood symptoms, specifically depression symptoms.
Alternatively, you might have people who are able to cope with your bipolar disorder episodes and who don’t judge you or stigmatise you for it. These types of social relationships are good to have in your social network because they can provide the support you need in managing symptoms.
With this in mind, determine who is good for you and who isn’t and potentially restructure your network accordingly. Knowing that you have people around you who won’t judge you or penalise you for your bipolar disorder can make all the difference to how you view social situations and interact with people.
Socialising isn’t just one sided, and it’s important to remember this. Whilst you need people who understand your bipolar and who are sensitive to it, you also need to be able to support them and be there for them when they need it.
One sided relationships are not healthy and are draining for whoever is providing support, and can lead to feelings of neglect. When assessing your social circle, ask yourself if you can be emotionally available to your friends and family when they need it. If you feel unable to provide mutual support, or if you feel like you bring more to the table than they’re able to give you, this might not be a healthy relationship to pursue.
Socialising can be difficult, and it can be hard for people in your life to know how to deal with bipolar. They won’t necessarily get it right the first time, or every time, so therapy can be useful. Family focused therapy is a good option as it allows you to communicate with each other and learn what you can do to better support each other.
Another option is social skills training (SST) or cognitive behavioural therapy (CBT). These are good options if you struggle in social situations because they address both clinical and cognitive factors of bipolar, and can highlight any negative thinking patterns you have, be them about yourself or other people. They can also help you with coming to terms with rejection. This is something that many people with bipolar disorder say they experience, but SST and CBT can help you deal with rejection in a more healthy way.
Bipolar disorder is a far reaching condition that can affect your life in lots of ways. If left untreated, it can dominate your day to day life and make even the simplest of things seem difficult or impossible, including socialising. At Psymplicity Healthcare, we offer expert support and guidance for people with bipolar disorder and their loved ones, as well as leading treatment options to help you manage your condition. To find out more, please contact us.
Mavish is a BABCP Accredited CBT and EMDR Therapist and CBT Clinical Lead at Psymplicity. Since beginning undergraduate studies 13 years ago, Mavish has worked in various mental health settings within the charity, NHS and private sector. Mavish’s passion for learning and professional growth has led to a vastness of experience and accelerated growth in her career while delivering one-to-one therapy, group workshops, training and supervision for professionals and senior team management. Mavish is a keen writer and writes many of the articles on our website, as well of our self-help resources.
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