…the situation with my boyfriend is what is worrying me right now.

He has been misdiagnosed a few times as bipolar, anxious, socially anxious and some sort of depression but these don’t really fit with what he’s like i don’t think. He is very high functioning he is doing his masters is a top student, has a wide group of friends and loves his mom and him and I have had a beautiful relationship where he has been nothing but great to me for almost two years. but he goes through cycles where he gets suicidal at his lowest (every few months) or really aggressive or suicidal whenever he drinks, he has also been really struggling with existentialism. I guess my question is what can i do to help, I try to be supportive but he closes off at his lowest and when the cycle begins again and he ‘is fine’ he forgets how it was bad and thinks he doesn’t need/ can’t be helped.

He is on medication right now and I am finally convincing him to seek therapy but most of the time he doesn’t think he can be helped.. I am afraid that I will have to worry about his safety and happiness my whole life rather than live a normal one. And that makes me feel like a horrible person. I would really love some advice whatever it may be.

• First off, let’s define bipolar.
• Bipolar is a type of mood disorder that used to be called manic-depressive because it involves phases of mania and phases of depression. There are a few different varieties of bipolar, which we’ll talk about.
  • A manic phase is the defining feature of bipolar. It refers to a period of elevation. Not necessarily happiness, but elevation. The person might have euphoria or happiness, but they can also have extreme irritability, hyperactivity, and agitation. Typically, you will see reduced need for sleep. Not insomnia necessarily but basically feeling that they need no sleep or only a couple hours of sleep due to high energy levels. People with bipolar tend to also have issues with behavioral control, so they might be impulsive or demonstrate poor judgment. It’s common to start new projects or have creative highs during periods of mania.
  • When you see someone in a manic phase, they can seem like they are sped up. Their speech is often pressured and fast to the point that they might seem out of breath or frantic. It’s also common to see an inflated sense of confidence or importance.
  • Manic phases definitely look different person to person, but according to the DSM criteria, the manic phase needs to last at least a week and must be a significant change from the person’s normal behavior.
  • There are certain celebrities and well-known people that seem to be manic all the time. This would not qualify as bipolar, since that is just how their personality is.
  • Bipolar II is very similar, except they have what are called hypomanic episodes. Basically it’s mania that isn’t quite as all encompassing. I don’t want to call it less severe, because it can still be very difficult to cope with and cause problems in someone’s life, but they are less intense.
  • For instance, someone still be sleeping and hasn’t done anything that is going to get them into huge trouble, but they go through phases of being extremely motivated and goal-directed to the point that they have tunnel vision and can’t think of anything else. They might be pressured in their speech and seem like their attention is all over the place.
  • Rather than one week, hypomanic episodes only need to last 4 days.
  • The other side of both of these is that people also have episodes of major depression, which we probably don’t need to dive into here.
  • There are also people who have rapid cycling, mixed episodes, or cyclothymic, which is basically subthreshold depression and hypomanic episodes.

• It’s hard to say whether the variation in mood every few months that you’re talking about would match with a bipolar disorder or not. People with bipolar can certainly be high functioning, especially for people with bipolar II, where their manic phases aren’t completely wrecking their life. In fact, some people are able to harness their hypomania to just get a lot of shit done, albeit in a not-so-healthy way. In Bipolar II, you do tend to have more suicidality, as well. Not really possible for me to diagnose that here, though.
• There is also the possibility that there is some stuff going on under the surface and he’s been really good at covering it up or working through it. Alcohol is often used as a self-medication for anxiety or other sorts uncomfortable emotional experiences, but it also lowers defenses and things that have been under the surface like frustrations or unhappiness come out.
• I think this is a situation that is certainly best handled by professionals. You need to realize that you can’t control him and you are ultimately not responsible for him. You can care and love him and want to help, but you can only do what you can do. You can’t change for him.

• There is a concept called stages of change that describes where someone is on their path to changing something. It starts from pre-contemplation (unaware or uninterested in change) and then goes contemplation, preparation, action, maintenance. The approach that a professional takes should keep in mind what level of readiness for change they have.
• If someone is in pre-contemplation and you jump straight to diagnoses and specific interventions, they may feel threatened or like you are the crazy one.
• He may simply be in a place where he is not able to see that he has an issue, so jumping to therapy feels like a dramatic leap to him.
• If that is the case, it may be more useful to help him recognize what you see and the impact that his behavior has.
• If he feels like his behavior is not as bad as you make it seem, first off you might want to check in with a trusted third party and see what their perspective on it is. We can sometimes be very sensitive about the ones that we love and overinterpret their behavior. However, when you are talking about recurrent suicidality and violent behavior, that does sound like something we want to be concerned about.

• You may also want to highlight the effect that his behaviors are having on you or on other important aspects of his life. You’ll want to stage this in a way that does not feel like an attack on him, but in a concerned manner that recognizes that it may be hard for him to see out of the eye of the storm. If you do not feel safe in having a conversation like this or you worry about him being violent toward you, then you don’t need to. You need to take care of yourself and focus on your safety first.
• You said that he loves his mom. Perhaps you could enlist her help if you feel like you really need to try to get through to him.
• In terms of therapy, its important for him to realize that there are many different types of therapy and many different individual therapists out there. If he hasn’t tried therapy before, it could definitely be worth a shot. If he has tried therapy before and didn’t get anything out of it, maybe he needs a different type of approach or a therapist with a different type of personality. Having him seek out the therapist and find someone that seems capable and interesting to him can be very helpful so that he has some ownership of the process and isn’t just doing it to placate you.
• Like I said, there might be some underlying stuff that he needs to become aware of and work through. At the very least, therapy could give him some tools to work with when those short periods come around, so that he doesn’t end up screwing everything up.
• Aside from therapy, all you can do is be clear and firm with have, establish your own boundaries, and point him toward any resources that you think would be helpful. For instance, I have podcasts that may be helpful such as the episode covering tips for explosive anger. There are books, youtube videos, whatever you think might hit home for him.
• Again, in the end, I just want you to recognize that this is not your responsibility and that you can try your best, but in the end the changing comes down to him.
• You will make your own decisions about what to do in the relationship. Whether you stay, go, make an ultimatum etc is completely up to you. I do hope that you will enlist some other perspectives to help you in seeing things clearly. While his feelings matter, it’s important that they don’t dictate your choices and freedom either. That’s not a healthy foundation for a relationship if that is a factor.