I think my friend has bipolar disorder

[Vick88]

I have a good friend of whom I believe has Bipolar Disorder. My father was diagnosed when I was in my teens and I am very familiar with how it takes affect.

 

My friend shows the symptoms and can be set off very easily during periods of mania, becoming very irritable, hostile, and dreams up very unrealistic scenarios that cause him to believe he can do the impossible. He will often not listen to reason and gets in spells where he thinks the world is out to get him and that he has a sixth sense.

 

This friend can also exhibit behavior that is greatly kind, positive and loving; I know he cares deeply about me and my husband, which is why we have chosen to look past some of the difficult aspects of his character.

 

He has been going through tough times, on disability for several years due to the fact that he has been deemed mentally unfit to work. He has put a lot of expectations on me, telling me things such as I need to start companies with him, need to hire him to be my nanny and wants a great deal more of my time than I can reasonably give. If I tell him I cannot do this, he becomes resentful toward me. The last time we invited him over as a guest of honor, he went off on my mother and was very rude about the dish I prepared and slightly hostile throughout the evening. Since then, I have decided to take a step back and think about which level of friendship I am able to handle.

 

My question is, I want him to be tested for the disorder as I really care about him and think getting on the right medication could completely change his life and help him out of his situation. It is extremely difficult to have this kind of conversation, especially since I have distanced myself lately. How should I approach this? I know I need to wait until we are able to patch things up a bit.

[casey.lives]

Pretend your going through a mental health education phase of your own. That it's your new interest and that your consumed by it. Talk about it .. without pointing a finger. See if a light bulb moment happens. Either way you've opened up conversation.

[Taramere]

If he's on disability, then that must surely mean that he's been through various medical assessments.

 

I kind of sympathise with what you're saying. Family and friends see aspects to patients that medical practitioners (who only have brief meetings with those patients) don't. However you have to balance that against the reality of medical practitioners having strong clinical experience that better positions them to decide whether a person simply suffers from a tendency to mood swings....or is sufficiently extreme to justify a diagnosis of bi-polar disorder (with the kind of treatment on perhaps pretty heavy duty meds that such a diagnosis might entail).

 

I'm picturing your friend going to his doctor and saying "a friend of mine's father had bipolar disorder - and my friend thinks I have it too" and the doctor rolling their eyes a bit about yet another situation they're encountering where an unqualified person has been diagnosing friends with serious mental health conditions.

 

Even if you have direct experience of dealing with a person who suffers from bipolar disorder and know a lot academically about the condition, unless you're making an objective (ie having no personal relationship with the person) in a clinical setting - with a good deal of clinical experience to back up your assessment, then I think it's wise to tread very carefully in the matter of trying to diagnose other people.

 

You're facing a difficult situation. You might want to think about contacting mental health services yourself and sharing your concerns. Here's a brief guide for people who are concerned about a loved one's mental health.

 

Worried about someone? - Rethink Mental Illness, the mental health charity

 

If you take an approach that's respectful of the skills and experience of people who work in this field (ie by contacting them and asking for some advice on how to deal with this concern you have) I think you've more chance of helping your friend in a responsible and effective way.

[Downtown]

I really care about him and think getting on the right medication could completely change his life and help him out of his situation.

Vick, I applaud you for wanting to help your moody friend. I caution, however, that it can be easy to confuse bipolar with BPD (Borderline Personality Disorder) because they share some symptoms. Moreover, it is common for a bipolar-1 sufferer to also have BPD. A recent study of nearly 35,000 American adults found that 36% of the males having bipolar-1 also suffer from full-blown BPD. See Table 3 at 2008 Study in JCP.

 

This distinction is important because, whereas bipolar usually can be successfully controlled by simply swallowing a pill, BPD is a thought distortion that cannot be touched by medication and is highly resistant to treatment (because BPDers typically refuse to stay in therapy). I therefore suggest you take a look at my list of 12 BPD/Bipolar Differences, which describes the major differences I've seen between the behaviors of bipolar sufferers (e.g., my foster son) and BPDers (e.g., my exW).

 

Significantly, learning to spot these warning signs will NOT enable you to diagnose your friend's issues. As Taramere explained, only a professional can do that. Yet, like learning warning signs for stroke and heart attack, learning those for bipolar and BPD is something you are capable of doing. That's why hundreds of mental health centers try to educate the lay public by describing the symptoms for these disorders on their websites.

 

I want him to be tested for the disorder

There is no "test" that can identify bipolar or BPD. Instead, these disorders are diagnosed based on the behavioral symptoms of the patient. This presents a problem, of course, because it is unlikely such symptoms would be evident in a 50 minute meeting with a psychologist or psychiatrist (unless the patient is hospitalized for strong mania or severe depression).

 

Granted, the bipolar sufferers may be sufficiently self aware to accurately describe their issues when seeking an evaluation -- if they are in a normal state. With BPDers, however, it is rare for high functioning sufferers (and the vast majority are high functioning) to be sufficiently self aware to accurately describe their own dysfunctional behaviors.

 

How should I approach this?

If you are seeing strong warning signs for bipolar, your friend may be receptive to discussing it when he is feeling normal. If not then, you might try discussing it when he is somewhat depressed and unhappy and is looking for some way out of his pain.

 

There is a good chance, however, that he already knows. As Taramere noted, his being on public assistance may have occurred following a diagnosis. On the other hand, you didn't mention his age -- which means the bipolar may be new to him. It typically starts showing symptoms in the 18 to 30 age range, with the mean onset being at 25 years of age.

 

If you are seeing strong warning signs for BPD, I would suggest you NOT say anything to him about that disorder. He almost certainly would project the accusation right back onto you. And, because that projection would occur entirely at the subconscious level, he would consciously believe that YOU are the one having strong BPD traits. Hence, simply observe that he seems very unhappy and suggest he see a therapist for professional guidance. Tell him that he deserves to be feeling much happier. Hopefully, BPD is not a problem for him because it is rare for a BPDer to stay in therapy long enough to make a real difference.

[Vick88]

Downtown, Taramere, thank you so very much for taking the time to write such thorough and thoughtful responses. I researched BPD and must agree that his behavior may even be more fitting of this category. It actually feels much better realizing that as I am completely unqualified to really suggest a diagnosis, it is important to seek professional guidance before even really hinting at the topic. It's hard sometimes to know the level of responsibility you should play when feeling like there may be something you can do to change their life around and save your friendship in the process.

 

I think that people deserved to be loved as they are, not to feel like they have to change to keep a friend, and that is why it has been weighing on me so heavily to have a hard time dealing with the behavior.

 

I am hoping to guide him to the right kind of therapy or treatment, whatever it may be, as our friendship is very strained now and I am unable to handle the hostility that comes with the swings but still care about his wellbeing deeply. I watched my father go from laying in bed 24 hours per day for several months putting a huge strain on our family to getting a job, taking care of himself and stepping up his life within a matter of months after he found the right medication and therapist.

 

I just feel so guilty for it coming to this, that I have distanced myself as I realized that every time I am around my friend, I start losing my self-esteem, questioning myself, feeling hurt and drained, even though I feel I am giving everything I can. I know he really values me as a person, but is unable to see how his behavior is inappropriate and hurtful. I have never experienced anything like this with a friend and I hope we can find a way to work everything through.

Edited September 28, 2015 by Vick88

[Downtown]

I researched BPD and must agree that his behavior may even be more fitting of this category.

If you are interested, Vick, you may want to take a quick look at my list of 18 BPD Warning Signs. If most sound very familiar, I would suggest you also read my more detailed description of them at my several posts in Rebel's Thread. If that description rings many bells, I would be glad to join Taramere and Casey in discussing them with you.

 

I hope we can find a way to work everything through.

Sadly, if he really does have strong BPD traits, his abusive behavior likely will get worse toward you. As long as you were only a casual friend, you likely would get along fine with a BPDer. As soon as you became closer, however, you would have started triggering his two great fears: abandonment and engulfment.

 

Because those two fears lie at the opposite ends of the very same spectrum, it is impossible to move away from triggering one fear without simultaneously drawing closer to triggering the other. Hence, no matter how carefully you walk on eggshells to avoid triggering him, you WILL trigger one fear or the other. Even if you say and do absolutely nothing, your mere presence in the room will serve to trigger a fear. This means that the only person who can heal a BPDer is that person himself. The necessary healing is an inside job.

Edited September 29, 2015 by Downtown

[Taramere]

If you are interested, Vick, you may want to take a quick look at my list of 18 BPD Warning Signs. If most sound very familiar, I would suggest you also read my more detailed description of them at my several posts in Rebel's Thread. If that description rings many bells, I would be glad to join Taramere and Casey in discussing them with you.

 

I have to admit it's not a condition I know much about, Downtown - other than a basic sense that it's what people used to call manic/depressive disorder. I have a couple of clients who are sufferers, so it would probably be helpful for me to get a better understanding. I don't work with people in a therapeutic way, but occasionally as part of my job I'll liaise with other professionals who do, so it would be helpful to get a better sense of what they're talking about. I'll take another look at your warning signs.

[Downtown]

I have to admit it's not a condition I know much about, Downtown - other than a basic sense that it's what people used to call manic/depressive disorder.... I'll take another look at your warning signs.

Taramere, the warning signs I discuss in that post are not for

manic/depressive disorder (now called bipolar disorder). Rather, they are for BPD (Borderline Personality Disorder). If you are interested in the red flags for bipolar, I do discuss them in my list of 12 BPD/Bipolar Differences. It describes the major differences I've seen between the behaviors of bipolar sufferers (e.g., my foster son) and BPDers (e.g., my exW).

[alphamale]

My question is, I want him to be tested for the disorder as I really care about him and think getting on the right medication could completely change his life and help him out of his situation. It is extremely difficult to have this kind of conversation, especially since I have distanced myself lately. How should I approach this? I know I need to wait until we are able to patch things up a bit.

you need to get him to a good psychiatrist. everything will fall into place after that

 

 

btw, yes I am bipolar

[Vick88]

Downtown, you are so resourceful and it’s absolutely wonderful to have someone with so much knowledge on the subject to counsel for help!!! Thank you for your efforts to help a stranger, really, thank you.

 

As you relayed this as a spectrum disorder, I found it interesting to think of that way because anyone can exhibit behaviors that are intense, demanding, controlling, etc at times, but it really makes sense to think that we can all fall on different areas of a continuum with varying intensities.

 

To answer your post, we were close friends, but lived far away from one another as he moved shortly after we met. It has become very strained ever since I moved to the same city he lived in about 6 months ago. Also, I combed through your post about the 18 warning signs and was wondering what your opinion is after going through each area.

 

Here they are:

 

• 1. Black-white thinking, wherein she categorizes everyone as "all good" or "all bad" and will recategorize someone -- in just a few seconds -- from one polar extreme to the other based on a minor comment or infraction;

 

Yes, he has cut several people out of his life for various reasons. There are five cases I know about (I am guessing more), in which two of them he spoke them with glowing adoration, then in one minor instance completely cut them out of his life, taking them the level of a good friend to a complete enemy. I have seen him make up with one of these people.

 

• 2. Frequent use of all-or-nothing expressions like "you always" and "you never;"

 

I will have to pay more attention to see about this one, but it seems like something he would say.

 

• 3. Irrational jealousy and controlling behavior that tries to isolate you away from close friends or family members;

 

Yes, I can see this. I am not sure if it is intentional, but seems to be a test of my loyalty in our friendship.

 

• 4. A strong sense of entitlement that prevents her from appreciating your sacrifices, resulting in a "what have you done for me lately?" attitude (e.g., not appreciating all the 3-hour trips you made to see her for two years) and a double standard ;

 

YES. This so, so much. It’s becoming really hurtful as I can never seem to give enough. Never experienced this with anyone in my life, and I can only seem to keep him happy if he feels I am giving him everything I can.

 

• 5. Flipping, on a dime, between adoring you and devaluing you -- making you feel like you're always walking on eggshells;

 

YES! This, completely!

 

• 6. Frequently creating drama over issues so minor that neither of you can recall what the fight was about two days later;

 

Yep.

 

• 7. Low self esteem;

 

Yes. Seems almost contradictory to the entitlement, but it makes sense.

 

• 8. Verbal abuse and anger that is easily triggered, in seconds, by a minor thing you say or do (real or imagined), resulting in temper tantrums or cold sulking that typically start in seconds and last several hours;

 

Yes. He goes off on people, for example, someone cut him in line to where he would have had to wait an extra 30 seconds or so, he completely lost his temper instead of making a suggestive comment.

 

I have experienced it first hand also, being blamed for bad friendship when I wanted to spend time with someone else. I often feel as though I have to walk on eggshells as not to set him off.

 

• 9. Fear of abandonment or being alone -- evident in her expecting you to “be there” for her on demand, making unrealistic demands for the amount of time spent together, or responding with intense anger to even brief separations or slight changes in plans;

 

Yes. He makes snide remarks about how I don’t see him enough quite often, even if I am seeing him as much as I possibly can.

 

• 10. Always being "The Victim," a false self image she validates by blaming you for every misfortune;

 

Yes. Not every misfortune as we are not partners, but he really seems to only see what he is giving and not what others do for him, and then paints himself as a victim as a result.

 

• 11. Lack of impulse control, wherein she does reckless things without considering the consequences (e.g., binge eating or spending);

 

Not really, I would say he really doesn’t manage his finances well and can be careless and overdo it, but I don't think I would classify him as losing control impulsively.

 

• 12. Complaining that all her previous BFs were abusive and claiming (during your courtship) that you are the only one who has treated her well;

 

We are not together romantically, so it is hard to tell. I wouldn’t say he speaks too ill about his exes though.

 

• 13. Mirroring your personality and preferences so perfectly during the courtship period (e.g., enjoying everything and everyone you like) that you were convinced you had met your "soul mate;"

 

I wouldn’t say he was mirroring me, but we definitely seemed to have immediately a connection that was very strong for some reason.

 

• 14. Relying on you to center and ground her, giving her a sense of direction because her goals otherwise keep changing every few months;

 

Yes. He has done things (as I posted earlier) like ask me to start two different businesses with him, then later to hire him as my nanny, not asking but TELLING me I needed to help him.

 

• 15. Relying on you to sooth her and calm her down, when she is stressed, because she has so little ability to do self soothing;

 

Yes but not always as we do not live together, but when we are together and has any kind of emotional drama, I would say so.

 

• 16. Having many casual friends but not any close long-term friends (unless they live a long distance away);

 

Yes. I was beginning to wonder why all of his close friends live a considerable distance away and his other friends are much more casual. I would say he maybe has one or two that are more than casual that are close by, but he is far closer to the ones who live far away, and our relationship was much better and built while we were living far away from one another.

 

• 17. Taking on the personality of whatever person she is talking to, thereby acting quite differently around different types of people; and

 

No, this is probably the only one I would totally disagree with. He is pretty unapologetic about who he is.

 

• 18. Always convinced that her intense feelings accurately reflect reality -- to the point that she regards her own feelings as self-evident facts, despite her inability to support them with any hard evidence.

 

Yes, yes, and yes.

 

 

Do you have an idea of what to do in regards with trying to reason with him about some of the hurtful things he has done and said? I think the only way going forward is to set boundaries but I do think that I owe him an explanation of why I have distanced myself and want to do so in a way that is honest, effective and also takes his emotional reactions into consideration.

[Downtown]

Do you have an idea of what to do in regards with trying to reason with him about some of the hurtful things he has done and said?

Vick, if he has strong BPD traits, he likely has the emotional development of a four year old. Among other things, this means he has little control over his emotions. The result is that any attempt to discuss a sensitive subject will trigger a release of his intense feelings in only ten seconds. That is, the rational man in front of you likely will become an irrational, angry man in seconds if you start criticizing him for hurting your feelings.

 

Importantly, I'm not saying he gets a free pass to offend whomever he wants because he will throw a temper tantrum when reprimanded. As with young children and adults, BPDers must be held fully accountable for their own actions and bad choices or they will have no incentive to improve. Yet, with BPDers, there is very little chance you will ever see such improvement no matter what you do. Although they have the emotional development of a young child, they nonetheless are adults who have a mind of their own and don't have to listen to you.

 

I researched BPD and must agree that his behavior may even be more fitting of this category.

Given your response to the 18 BPD traits, I agree that the warning signs you describe are much closer to BPD than to bipolar. But, even if he does have strong BPD traits, bipolar can't be ruled out. About 30% of male BPDers also have co-occurring bipolar-1. See Table 3 at 2008 Study in JCP. Hence, if you've not yet had time to do so, you may want to take a look at the list of 12 BPD/bipolar differences I cited in my first post above.

 

Lack of Impulse Control: Not really.... I don't think I would classify him as losing control impulsively.

Granted, you are not seeing any binge spending or excessive drug use. The other traits you are seeing, however, are consistent with a lack of impulse control.

 

Frequent use of all-or-nothing expressions like "you always" and "you never" -- I will have to pay more attention to see about this one.

I don't believe you will have to wait long to see it. In light of the other symptoms you are seeing, I suspect you will see this trait very soon, probably when you meet him next. You are describing a man who relies heavily on black-white thinking. If he has strong BPD traits, he does this because his self image is so fragile that he cannot tolerate being aware of his strong conflicting feelings toward other people.

 

His subconscious protects him from experiencing such complexity by "splitting off" the conflicting feeling, putting it out of reach of his conscious mind. In this way, he consciously does not have to deal with conflicting feelings, ambiguities, uncertainties, and other grey areas of interpersonal relationships. It makes his life much simpler in that respect, while creating all sorts of other problems (e.g., the loss of all his close LTRs).

 

That's why he is capable of flipping between Jekyll and Hyde in less than a minute, will cut someone out of his life on a whim, and doesn't have sufficient impulse control to avoid "going off on someone," as you say, when that person cuts in line in front of him. Moreover, it is his lack of impulse control -- indeed, lack of control over any emotions -- that is evident when he's unable to do self-soothing to calm himself down.

 

His B-W thinking also will be evident in the way he categorizes people as "all good" (white) or "all bad" (black) -- and will recategorize someone from one polar extreme to the other based solely on a minor comment or infraction. Importantly, he also categorizes himself in the same harsh manner (as good or bad). This is one reason a BPDer is so reluctant to admit making a mistake, i.e., to him admitting fault means he is "all bad."

 

I think the only way going forward is to set boundaries but I do think that I owe him an explanation of why I have distanced myself and want to do so in a way that is honest, effective and also takes his emotional reactions into consideration.

Vick, if your friend has only moderate BPD traits, you may be able to somewhat reduce his dysfunctional behavior (when he is around you) by establishing stronger personal boundaries and religiously enforcing them -- and by learning better techniques for validating his feelings. Yet, if his BPD traits are strong, my experience is that all the boundaries and validation in the world won't make a dent in his behavior problems. It is rare for a high functioning BPDer to stay in therapy long enough to make a real difference.

 

Our friendship is very strained now and I am unable to handle the hostility that comes with the swings but still care about his wellbeing deeply.

If your friend has strong BPD traits as you suspect, he is not sufficiently emotionally mature to sustain a close friendship for very long. Moreover, the closer you become to him, the quicker he will push you away and end the friendship. One reason is that he has such a fragile sense of self that, as you become a closer and more intimate friend, he will increasingly feel like you are engulfing him and trying to control him.

 

A second reason is that, as your friendship become more valuable, his fear of abandonment grows to where it becomes painful. Like nearly everyone else, a BPDer craves intimacy in conversations with close friends. When he gets exactly that, however, he will start fearing that you will abandon him as soon as you realize how empty he is on the inside.

 

A third reason is that a BPDer is incapable of trusting you for any extended period. This is a severe limitation because TRUST is the foundation on which all close LTRs and marriages must be built if they are to last. Moreover, it is this inability to trust that explains why he is unable to believe that you truly love and value him -- which would be evident in his frequently administering loyalty tests. After you successfully pass a test, the only thing that changes is that he will raise the bar higher for you to jump over on the next test.

[craw]

I wouldn't do anything.

 

I had this happen with a friend, he moved to China and had some sort an episode. His parents finally flew him back to Canada. He actually called my sis and me separately which helped his mother out locate him.

 

When he came back,

 

He has completely cut me out of his life. Blocked me on all social media. He thinks I'm trying to get him admitted.

 

I've lost a best friend. His parents won't get him treatment and largely ignore the problem.

 

I'm still hurt by him as I type this out, at the same time I hate him. All he does is walk in and out of my life. This time he comes back and telling him to eff off.

 

Best of luck with you, proceed with caution.

[Vick88]

I made an appointment to meet and speak in a few days time. I am really nervous about him going off on me and saying hurtful things, as I imagine the more honesty I relay from my feelings, the more this will happen.

 

I did look into the post about BPD versus Bipolar and must say I do see the differences much more fitting into BPD. I was a bit confused because sometimes he has unrealistic ideas that I would classify as grandiose (starting these businesses with me even though he has no knowledge of how to do it), so it still may be possible, but definitely seems to fit BPD more. I know I am still unqualified to diagnose him, but I am amazed at how many of the symptoms of BPD he fits into... looking through research about how to cope with it has been extremely helpful and relieving regardless.

 

Although all of this realization has been helpful, it still hurts to hear these things from a person that you care about. I know in my heart that I have been a good friend to him and that he has issues beyond my area of helping, but I still hope to accomplish something from the talk, even if it means I will have to possibly let the friendship go. It's still hard with all of this knowledge not to be affected by him believing I am a terrible person in these outbursts and my seemingly innocent actions are a monstrosity.

 

I will post an update of how it goes. Thanks to everyone who has read and contributed to helping me get through this.

[Vick88]

Hello again everyone,

 

I wanted to update about the meeting I had with my friend... I stayed really calm and spoke to him about some of the things that had been needed, such as him going off on my mom. He really didn't get how this was inappropriate behavior, how it was late and time for him to go, and had lashed out at my husband who offered him a ride saying that he was very "rude" for doing so as he was trying to tell him nicely it was time to go. I asked him how he would have preferred we handle the situation and he responded by saying he had every right to stay there, and I could put my son to bed while he stayed and continued debating with my mom. O_O My mom was very uncomfortable and even slightly offended by his remarks, so it really surprised me that he said this.

 

Out of all of this and many things as well, I feel he has almost no social understanding and I realize he has extreme difficulty admitting his faults. I felt as though I was the one apologizing and that I feel no positive quality coming from the friendship anymore, I feel constantly criticized for not doing enough and judged. I have kept my distance for a while and have just been told that I am the one with a problem as I don't "seem to need friendship or benefit from it" (not his, but any) and how he is "so different." I feel that is quite a statement and implying he is a better person somehow. This hurt considering how much I have given and put in over the past couple of years, I was always the one contacting him to see one another (he guilts me about this and how I should do it more when he has actually almost never invited me out or over, he waited for me to do it).

 

I think it is in my best interest to keep a distance and see the friendship as more of an acquaintance level as it has been pretty draining to go through so much drama and questioning myself over the past months. I don't feel he has my best interests at heart and I want to surround myself with people who do.

 

How do you tone down a friendship with a person who exhibits really strong symptoms of BPD? I fear I will be on his list of people he hates and has cut off for similar reasons (ie. being honest with him about his expectant behavior, feeling taken advantage of, etc). As he introduced me to my husband, I have felt indebted to him despite the fact that he has been possessive, snitty and unkind over the past months. We live in a small town and will surely run into each other often.

[Downtown]

How do you tone down a friendship with a person who exhibits really strong symptoms of BPD?

What you do is become very very BORING. Hence, instead of disagreeing with him or reacting to his outrageous allegations, you say something vague like, "Oh, really, I had never thought about it that way before." Or "Hmm, that gives me something to think about later."

 

For more specific tips on dealing with BPDers, I suggest you read BPD on the Behavioral Unit. It offers advice targeted to the nurses on mental health units. They have to deal with BPDers all day long. I also recommend two articles a BPDfamily. One is Surviving a Breakup with Someone Suffering with BPD (Article 9) and the other is Leaving a Partner with BPD (Article 10). By the way, Vick, thanks for returning to give us an update. I was wondering how you are doing with your friend situation.

[carhill]

My quick and dirty is 'walking on eggshells' (read it) and 'agree and redirect' works some of the time, much like it does with psychosis and schizophrenia. I experimented after perfecting the coping mechanism while caring for a psychotic. Of course, everyone is different.

 

While I commend folks who stick it out with BP1/2 friends, and especially BPD spectrum folks, when push comes to shove, save yourself. The world needs mentally healthy people who care and we can't fix everyone, no matter how much we do care.

 

How do you tone down a friendship with a person who exhibits really strong symptoms of BPD?

 

I second Downtown's suggestion of boring and agree and redirect is a move in that direction, along with more silence and distance. Usually what happens is they'll latch on to another target and one will be discarded and, in this situation, that's OK.