I often receive questions about anxiety and bipolar disorder. It’s estimated that 90% of people with depression experience some form of depression. This means that most of us with bipolar disorder will experience anxiety at some point. Anxiety can limit so much that we want to do. Luckily there are many things you can do to manage and ultimately prevent anxiety from taking over your ability to enjoy yourself. The following is an example of the questions I regularly receive from readers:

 Q. I have a great boyfriend, who is used to visiting his friends on a regular basis. Our relationship is still quite new (9 months) and I’m used to isolating. It’s the only issue we have in our relationship. My hesitancy to go out and meet new people. Are there any tools you can think of to make going out and meeting his friends less frightening for me so we can have more balance in our relationship.
 Regards
 E.

A. Hello E,

First of all, if you’re writing this question it means you know you have the problem and want to do something about it. That is really a good sign. It also may help to know that social anxiety is actually a normal part of bipolar disorder for many people. Before you had a relationship, it was easier to just stay home and not deal with it. Now you are being forced to look at the problem or you know you will have more trouble in your relationship. The first solution is to remind yourself that what you’re going through is normal and part of an illness. It’s also probably a part of your personality. Being an introvert is fine in some ways, but when it comes to other more outgoing people, you have to be willing to do things their way once in a while as well. The second step is to write down all of your thoughts and feelings regarding going out and meeting people. You can make a new Health Card called ‘going out’ for example. I use my anxiety card for this.

Once you have done that. Look at your thoughts. They are probably the same every time you go out- and yet you go out to so many different places. This tells you the fear of going out has a pattern- not because of a specific location. Once you deal with your own thoughts and feelings, you can remember that the thoughts are bipolar disorder thoughts and not the real you.

Next, tell yourself that the next time your boyfriend asks you to go out with him, you will definitely say yes. Tell your mind that there is no arguing: you’re going. This is a deal with yourself that you have to keep. This stops the tug of war conversation that often goes on in the brain when you want to go one way and bipolar disorder wants you to go the other way. Then make a goal and stick to it such as talking to one new person.

Then you can get to the real technique of going out. Imagine all that will happen- all of the feelings on your list - all that you will face and decide just to deal this by recognizing the anxiety and going out anyway. Remind yourself, ‘These are normal anxiety feelings. I know what they are and I can deal with them.’ Breathing is a huge help here. You can then have space to do the one thing that you have promised yourself to do at the event. If you think of the situation before you go, it often helps you see that it’s your reaction to what is going on that causes anxiety. This doesn’t mean you won’t be anxious, it just means you go to the event and deal with the anxiety there instead of at home alone. If things get too stressful, then walk outside and take a break. This helps a lot with being over stimulated.

Finally, you have to tell your boyfriend exactly how to help you by using the third column in the Health Cards. You can teach him how to respond when he hears you say certain things and what to do if you are feeling stressed. It probably won’t help if he says, ‘Com on! Just go out with me. It’s not that big of a deal.’ Instead, teach him to say what you need, such as ‘I know this is hard for you. We don’t have to stay long. I’m here if you need a break and want to talk. I respect that it will take time for you to be more comfortable.’ You say the relationship good, so I’m sure he would be more than willing to do this.

It takes small steps to get over social anxiety. I have done it and you can too.
Julie

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Let’s start out with a story about cabbage. (A conversation between my mom and myself)
Mom: Why don’t you put some cabbage on your salad?
Julie: I want to have cabbage on my salad but it is just too hard to do it.
Mom: Julie! It’s too hard to have cabbage? What is your problem?
Julie: It’s not just cabbage, Mom! It’s getting it out of the fridge. Taking off the old leaves, finding a place to cut it, making sure the knife is clean, slicing it, putting it on the salad and then cleaning up the cutting board. It is too much right now.
Mom: It really is just cabbage, Julie. Why does everything have to be so hard for you?
Julie: Mom. It is not a *normal* thing! It is not a cabbage thing. It is a*bipolar* thing. It is an overwhelmed thing. It has nothing to do with cabbage. Things are hard for me because I have a book deadline and I have bipolar disorder.
Mom: Ok. I understand it a bit better when you put it that way. Would you like me to do the cabbage for you?
Julie: I would like that a lot! I have so much going on right now I can not think about cooking.
 
A few days later I asked her, “Mom, of all the mood swings you know I have now and you have seen in the Health Cards, what is the hardest one for you to understand?” She answered, “The anxiety and how you tell me you get overwhelmed so easily.” I understand why she feels this way. She has depression herself, so she understands that. I have talked to her about mania and psychosis and though she has no idea what they feel like- she can see they are symptoms of bipolar disorder- but my anxiety and overwhelmed feelings seem so arbitrary to her. I am unable to do things on some days and on others I am fine. Some days she can ask me to do something and the next time she asks the same thing it makes me sick. She never knows what she is going to get from me! (Poor Mom!)
 
The moral of this story is that you, as a friend or family member need to understand that bipolar disorder is complicated. You really don’t have to understand all of the terminology or even empathize with us, but you do have to have tools to help you deal with us. My mother has the Health Cards and she uses them all of the time because I am just simply baffling to her. I can see it when she looks at me. I can see it when she has to once again change her behavior so that I don’t get sick. I can see it is hard on her, but the only thing I can do is constantly work on myself to stay well and give her as much information as she needs to help our relationship stay stable when we are together. You as friends and family members have such a hard job. When people with bipolar disorder are sick, it is the friends and family who have to somehow read our moods and behaviors and know what to do to help us get well. We may not say this enough- but THANK YOU!
 
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Ten things friends and family members NEED to know about those of us with bipolar disorder.
 
10. If you blame us or put us down or get impatient or angry with us for bipolar disorder behavior it simply makes us SICKER! Impatience never got us out of bed or made us less depressed. Anger never made us stop spending when we are manic. Kind and realistic rules and limits do help. Telling us that you will not and cannot live with us if we don’t treat bipolar disorder first does help. But helping us help ourselves is the best gift you can give us. The Health Cards can help you figure out what part of our behavior is bipolar disorder and what part is just us. If you know what behavior is a symptom of the illness, you can then treat the illness to help the behavior instead of getting so upset with us all of the time. (We are upset enough with ourselves, believe me!)
 
9. Understand that we cannot always help you do things when we are sick. You may need help around the house, with the kids, the bills, the laundry, etc. Deep down we know that, but sometimes we are just too sick to do anything. Help us get well and then we can help you around the house more. Help us get well and we will be a good friend, partner, daughter, son, grandson, granddaughter and parent. If you expect us to be able to do normal things when we are sick, then you will only get more upset with us. If you expect us to treat bipolar disorder first- that is reasonable and something we can work on together! Then we can do the laundry and the dishes with pleasure. We can have fun in life.
 
8. Depression is very motivated. I don’t know if there is a more successful illness in the world. It is a champ, a winner! It sets goals and follows through with its goals. “I want Julie to be really sick and down on herself today. I want her to stay in bed, eat junk and cry buckets of tears.” And it sure does do a good job! Depression is serious and motivated and strong. Without the right tools it is impossible for us to fight it. WE ARE NOT LAZY! WE ARE NOT SLACKERS! WE ARE NOT DUMB, WEAK OR FAILURES! We are sick. Learn our individual signs of depression by using the Health Cards and help us fight it. If depression is motivated and successful, then we all have to get motivated and successful. If you see us sitting on the couch doing nothing day after day- don’t get on our case for being on the couch. Get some tools to help us get off the darn couch! Get motivated, serious and strong, just like depression. Then teach us how to do this. Help us find the right mix of medications, alternative treatments and lifestyle changes that make depression the failure instead of making us look like failures. We need your help to fight this illness. We need your love to beat depression.
 
7. What you do in YOUR life makes a huge difference in how we experience our bipolar disorder symptoms in OUR lives. This is not fair on you, but it is a reality. It should be that you can do what you want and we can lead our own lives and let you be you – but people with bipolar disorder cannot simply separate themselves from the things you do. If you are stressed and unhappy and unhealthy, you have to know that it affects us greatly.

6. Bipolar disorder is a disability. It is not really recognized in that way right now, but it will be more so in the future- many of us are dis-abled from leading the life we want and you want us to lead. We simply can’t function like other people can function. We can’t snap out of it, therapy our way out of it or just get on with it- whatever the “it” is you want us to do. WE HAVE TO LEARN WHAT WE CAN DO AND WE NEED YOUR HELP! Please know that stress makes us sick- good stress, bad stress, stress that is none of our business- all stress makes us sick. Can you look at us differently? Can you see us as people who have an illness that often makes us unable to be “normal”? Can you hug us, love us and help us even when we make you scared, angry and embarrassed? Please help us turn a disability into an opportunity.
 
5. This illness is not about you. We are not trying to punish you or ruin your life. We do not want to treat you badly. It is a side effect of bipolar disorder when we change our moods. This does not make it ok- and it does not mean that it will not cause huge problems for you, but it is not about YOU at all.

4. If we are manic, spending money seems like a good idea. It is part of the illness. It is a proven symptom of mania. We need your help in creating checks and balances so that we can prevent manic spending sprees. If you are blind to what we are spending when we are well and then suddenly notice the $5000 we spend during a manic episode and then get angry, it is not fair. Please be consistent and help us monitor our money at all times so no one is caught unawares again. You can use the Health Cards to help us prevent manic spending sprees. We can’t do it alone.
 
3. Medication side effects really, really suck. They often make us fat, tired, sick, scared, suicidal, seemingly stupid and angry. We need help in adjusting our meds and telling the doctors what we need. It is not ok to have these side effects and when we are in the middle of them and a doctor is telling us just to “wait and see how things go,” we feel helpless and want to give up. Help us find different medications and comprehensive treatments that do not have so many side effects. Advocate for us if we are intimidated by our doctors.
 
2. Some of us with bipolar disorder cannot work like “normal” people. We cannot go to the office or keep a 9-5 job. It simply makes us too sick to function. Many of us have had a different job every year because we want so badly to fit in and be like everyone else. The reality is that we may need to find alternative ways to support ourselves and we truly need your help. Please understand that we WANT to be productive- we just have to find a different way of being productive. Going to an office really is not everything. If we need disability, help us get disability and understand that it is so very humiliating for intelligent people like us to have to get help from the government because we can’t work. Never, ever make us feel guilty because we can’t work! Help us find work that is non stressful, fun and helps us be independent. And if you are supporting us because we can’t work- thank you so very, very much.
 
1. People with bipolar disorder are intelligent, funny, creative, free thinkers, different, loving and kind - WHEN THEY ARE WELL. People with bipolar disorder are demanding, sad, annoying, scary, self centered, all over the place, uncaring, dangerous, and crazy - WHEN THEY ARE SICK. In order to help us be all of the good things, bipolar disorder must be treated first. Use the Health Cards and any other books you may have to help us treat the illness first – for the rest of our lives. This is the ONLY way for us to have a good relationship. Because bipolar disorder does not want any of us to be happy. Friends and family are so important in the lives of people with bipolar disorder. We do not need you to take care of us- not at all- we need you to help us take care of ourselves: Take care of yourself first, get the right tools and then show us that you are willing to join us in our goal for a stable life. Always take care of yourself, but NEVER GIVE UP ON US!

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If you’re a family member or friend of someone with bipolar disorder, you may read this and think, “ I can’t do all of this. I can’t be their caretaker. I can’t be so understanding all of the time.” It’s pretty normal to feel this way. I lived with someone for 10 years who has bipolar disorder and now have many friends with the illness. Sometimes they are hard to be around. I have friends who get very negative when they’re depressed. I have others who become zombies when they have to take a lot of medications. I have family members who will not get help when it’s obvious they’re having a mood swings. And though it’s hard, I have learned to be more understanding and helpful. Of course it helps that I have the illness myself, but I still feel the frustration that everyone who loves someone with this illness feels.

I guess the most important thing to remember is that none of this is fair. When you read the above list, there may be only a few things you’re willing to do. If you’ve supported someone with bipolar disorder for many years and feel they’re not helping themselves, then you certainly have a right to say something and stop supporting them if it’s what you need to do. If you have a family member who is causing chaos in your life, it may be that ‘understanding’ is no longer an option. I know that my family has worked for years to understand how to help me. In fact the conversation at the beginning of this newsletter was from a few years ago. It’s amazing for me to read that conversation now, because it simply wouldn’t happen that way these days. My mother has truly learned how to support me and help me with this illness. We started using the Health Cards in my family over five years ago. I can honestly say that we now work as a team. When I get sick, they are there for me. I try to make up for my illness in every way possible by doing what it takes on my own to stay healthy. I’ve taught myself how to manage this illness so they don’t have to do as much as they used to. Now they are part of my team instead of having to take care of me all of the time. Since we have all figured out what I need, I can tell they are not as confused as they used to be. And I know they don’t always wonder why I’m like the way I am. They know it’s bipolar disorder. They know what to expect and they know how to help. This has saved our relationship.

If someone you love has just been diagnosed with bipolar disorder, it’s going to take time to learn how to help them. It’s not innate. If you have bipolar disorder, you’ll have to teach your family and friends what helps you. That’s why part three of the Health Cards is so important. We have to work with each other if we want to keep our relationships strong and healthy. If all of this is new for you, give it time. Things definitely get better.

Julie

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 ABOUT THE AUTHOR: Julie A. Fast best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie’s work specializes in helping real people manage all aspects of their daily lives and despite the complications that bipolar disorder creates. Learn how to how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit: http://www.bipolarhappens.com 

Dear Julie,
Today’s OPRAH’s topic is bi-polar disorder.  I have bi-polar and used to work on “General Hospital.”  The show will feature Maurice Benard, an actor on “GH” who has bi-polar and whose character, “Sonny Corinthos” does as well.  He appeared on “Oprah” in 2004.  Last year there was a lengthy storyline about bi-polar, and they try to fit it in during the general storyline as well (such as the character going off his meds, drinking when he gets stressed, etc.)  At least they are trying to de-stigmatize it somewhat… it isn’t easy.  Oh, and if you wonder why he taped his segment in L.A. instead of Chicago, he gets panic attacks if he tries to get on an airplane.

I don’t know whether you can get the word out for folks to tape “Oprah” today, but I know they re-run it around 1:00 AM (great for manic episodes at night.
Thanks for all you do to help those with bi-polar disorder.

The term rapid cycling can be very confusing. I recently asked my co-author Dr. John Preston for a clear explanation:

Rapid cycling is at least four discrete episodes during a 12 month period (these can be mania, hypomania, or depression). The term ultra-rapid cycling is not precisely defined but many refer to this as having possibly monthly cycles (e.g. 12 per year)….untradian cycling is where there are not really discrete manic or depressive episodes, but the person is extremely emotionally labile, with chaotic and intense mood changes that occur every day or several times during a day. One way to describe it is that they experience intense emotional instability….some mood shifts are in response to stressful events (e.g. an argument with a friend), but some are unprovoked (seem to come out of the blue and not associated with a specific trigger)

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Do you have rapid cycling? If you’re not sure, talk to your doctor. This is important information as it can affect the drugs you take and how you deal with triggers. My book Take Charge of Bipolar Disorder talks about the different types of bipolar disorder diagnoses and how they relate to rapid cycling. I have ultradian rapid cycling, which is why I have to be so very careful with triggers. I do have very distinct depression and mania episodes. This shows you how the terms can describe part of your diagnosis, but not see the whole picture. Ultradian is a new term that isn’t used much. The term ultra-rapid cycling is more common. It’s very important that you know if you have bipolar one or bipolar two and if rapid cycling is part of your diagnosis.

Julie
www.bipolarhappens.com

I recently found out that I won the Eli Lilly Reintegration Achievement Award. That’s quite a mouthful! The award is for a person with either bipolar disorder or schizophrenia who takes their personal treatments skills and uses them to help other people manage the illness as successfully as possible.