Tiffany Romito, 37, and her husband Mike, 41, were looking forward to hosting a party on Christmas Day for their friends and family this past year. But as their four kids were unwrapping their last gifts on Christmas morning, Tiffany — who has bipolar disorder — started to get anxious about the mess the wrapping paper was making, and everything she still needed to do to get ready for the party.
As her stress level rose, her patience evaporated, and she began to snap at her husband and kids.
After years of marriage, Tiffany and Mike had a system for handling the situation. Mike suggested that Tiffany spend a bit of time in a space she’s created for herself in their basement bedroom while he cleaned up the wrapping and toys with the kids and began party prep. Tiffany headed downstairs to the couple’s bedroom for some time on her own to relax.
Tiffany has made their bedroom a sanctuary to use when she needs to. She keeps it uncluttered, and stocks it with comfortable blankets, essential oils, and candles to help her relax. She uses the space to pray, meditate, practice yoga, and reflect in order to de-stress, and sometimes will also take a shower as part of her routine.
Tiffany was diagnosed with bipolar disorder about the time she and Mike met. In the eight years they’ve been married, they’ve worked together to troubleshoot how to anticipate conflict and strained moments, such as their Christmas morning experience, that can trigger Tiffany’s symptoms, and try to avert them.
Bipolar disorder can pose some extra challenges in marriage. Indeed, this mental health condition is associated with lower odds of ever marrying, as well as marriages that end in divorce more quickly, according to a review of studies on marriage and mental health conditions published in the July–December 2017 issue of the Industrial Psychiatry Journal.
But “for a marriage, bipolar disorder doesn’t have to be a limiting factor,” says Gregory Nawalanic, PsyD, a clinical assistant professor of psychiatry and behavioral sciences at the University of Kansas Medical Center in Kansas City, and the clinical director of psychology services at the University of Kansas Health System's Strawberry Hill Campus. Dr. Nawalanic treats patients with bipolar disorder.
And even though there will be challenges, “that’s true of every marriage,” Nawalanic adds.
Tiffany and Mike say they’re constantly refining their strategies. But here are some tips that have worked for them.
1. Communicate — Even When Things Are Going Well
Talking to one another about ways to problem-solve when issues come up, especially during periods of stability, is critical, say Tiffany and Mike.
Nawalanic agrees. “That lays the groundwork and expectations for what is mutually agreed upon as acceptable and helpful in moments when things escalate,” he says.
A good example, Nawalanic says: If one spouse decides they need some brief alone time when a partner is having symptoms, as Tiffany did Christmas morning, a prior conversation about that choice can help the other spouse know it’s a coping strategy rather than an unexplained withdrawal.
Safety does come first, though, says Nawalanic. For instance, if one partner is concerned that the other could harm themselves during a manic or depressive episode, “that should take precedence over the agreed-upon retreat,” says Nawalanic.
2. Know Your Partner’s Signs and Triggers
Nawalanic says knowing what the start of a mood episode looks like may help prevent it or allow you to get help early.
A depressive episode may have symptoms including depressed mood, feelings of sadness and hopelessness, loss of interest and pleasure in normal activities, insomnia or oversleeping, changes in appetite, and suicidal thoughts or actions, according to the Mayo Clinic.
For a manic or hypomanic episode, symptoms may include feeling abnormally upbeat, jumpy, or wired, increased energy or agitation, exaggerated sense of self-confidence, decreased need for sleep, increased talkativeness, racing thoughts, and impulsive or risky decision-making, say Mayo Clinic experts.
The most important thing, says Mike, is to know what your partner’s triggers are and to try to put yourself in their headspace so you can understand the situation and help them. “If you see a trigger that could lead to an episode, then it’s important to think of something that makes you uncomfortable — say, flying or being in an elevator — try to understand what your partner is going through at that moment. Doing that lets you better help them in the situation,” says Mike.
Nawalanic says couples might even consider a word to use — say, “mistletoe” — to indicate they think their partner might be headed for an episode and to show their love and support, even though they may have to take some actions to protect their spouse.
3. Give Each Other Space
“It can be hard to put the other person first, or be the best version of ourselves,” says Nawalanic. “Sometimes each person in a couple, both with and without bipolar disorder, needs space where we can refill our personal emotional tank.”
Tiffany meditates and does yoga when she’s feeling stressed by a manic episode, and Mike knows to let her have some time alone and looks after the kids at these times.
And he also has a hobby and a space he can retreat to. He plays video games, especially when feeling stressed, which he finds relaxing. They try to end their “on their own time” with some conversation about why they needed time alone.
For example, on Christmas day after Tiffany spent time on her own, Mike went down to talk with her after a little while. Tiffany says that “having Mike come down in a peaceful, nonconfrontational way allowed us to have a meaningful conversation.”
4. Remember That It’s the Bipolar Disorder, Not the Person
Remember that bipolar disorder is not a choice for your loved one, Nawalanic says. If your spouse is having a mood episode, it’s important to work against the symptoms rather than the person.
When episodes occur, says Mike, “I remind myself that it’s not my wife, whom I love, who is acting this way, it’s the disorder that is taking over in the moment. Being patient and being conscious of what is happening and why helps us both then.”
That patience also requires realizing that hurtful words can also be part of the disorder. Mike says Tiffany can say things that are hurtful during a manic episode “but the worst thing I can do is to reciprocate, to say hurtful things as well, or start yelling back.”
5. Take Time for the Two of You
Mike and Tiffany plan a date night at least once a month as a couple, sans kids. “Every couple has issues they deal with and deserves the joyous times of marriage as well,” Nawalanic says.
6. Learn as Much About Bipolar Disorder as You Can
Tiffany and Mike say they did their research, finding resources online about bipolar disorder so they would understand what was happening, treatment options, and how to handle situations. Nawalanic agrees, saying that seeking out information together as a couple can be a powerful way to get everyone on the same page.
7. Plan in Advance How You’ll Talk About Medication
If a spouse with bipolar disorder suddenly has symptoms, their partner might understandably want to ask if they took their medication. But that might sound accusatory to the partner having the symptoms. “It’s a hard question to hear,” says Tiffany, which is why how it’s asked is so important. “You don’t want to be made to feel irresponsible.”
“I’ve learned to ask in a tone that says I’m concerned and not frustrated, such as ‘Was there something that kept you from taking your medicine today?” says Mike.
This is another example of an important conversation to have when moods are stable, says Nawalanic. He adds that even using a predecided code word or phrase — like, “Did Sally come over today?” — can help establish that you are concerned, rather than judgmental.
8. Have a Plan for Emergencies
Nawalanic says it’s critical to discuss what you’ll do during a serious episode, whether it's simply being there for support, calling a physician, or even initiating a hospitalization. After the episode the couple should have a conversation about what happened and why.
Mike and Tiffany’s own plan for emergencies: If the situation escalates to a concern for Tiffany or anyone else in their family, Mike steps in to handle it, says Tiffany. “From calling the doctor to heading to the hospital if he thought that was necessary, we’ve developed that level of trust,” Tiffany says.
Tiffany and Mike make it a point to “reconnect” after an episode and talk about what happened, how each of them felt, and what else they might add to the plan, if needed.