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Bipolar Disorder (Children and Adolescents)

Dealing with Bipolar Friends and Family

09/20/2004

Question:

I am unsure about what to do about a friend of mine. We are both college students, and over the past few weeks her behavior has started to worry me. I am unsure about all the details of her case, but she told me a few months ago that she was diagnosed bipolar, although she doesn`t agree with the diagnosis. I have been watching her I do think she is a rapid-cycling bipolar person. She is currently in one of her depression phases, and her behavior has me seriously scared. She told me today that she has been taking cocktails of leftover pills from previous prescriptions, up to 15 pills a night. Last year I saw her take 5-7 non-prescription sleeping pills, and it had the same effect on her as 2 would on me (someone who does not take them), because she had become tolerant to low doses. From what she says - and people that live with her - the cocktails just cause her to pass out, and she has not had to go to the hospital for overdosing. She has kept up this pattern for the last week, and I`m afraid she might start to do more. She was also a cutter last year, but I don`t know if she is currently continuing the habit. She always says that she`s self-destructive and not suicidal, but I don`t think there`s much of a difference. If anyone tries to get her to stop or interfere in her pattern, she gets very mad and pushes them away. I have been thinking about getting her committed, but I am unsure what that will accomplish. I have heard that only the person can decide when they want help and cannot have it forced upon them. Another concern of mine is that if she is committed, she will be expelled from our university (it is an unfortunate policy of ours). If I suggest that she get help, she will push me away, so I feel like my choice is either that I do nothing or I make someone do something to help her. Do I back off and just offer to be there or do I go all out, risking our friendship and her enrollment at school?

Answer:

A very difficult situation indeed. Your friend is extremely lucky that she has a friend like you who cares about her so much. Unless she is actively suicidal or homicidal, she probably would not be admitted (voluntarily or otherwise) to an inpatient hospital. Regarding your college expelling her for this reason, that would be illegal and against the Americans with Disabilities law.

In my experience, I agree with you, unless the person is ready for treatment, they are not going to accept it or use it to their benefit. Many people with mood disorders initially deny they have a problem and often try to self-medicate (with alcohol or prescription/street drugs), which can be extremely dangerous for obvious reasons. So what to do? Before suggesting help, she needs to "let you in" and trust you. I would recommend you talk with her about how much she/your friendship matters to you, give her time to respond, then express your concern about her recent mood ("You've looked really down recently and that worries me.") Give her time to respond; if she doesn't, ask her if she would like to talk about it or if there is anything you can do for her.  If she says "yes" then the door is open for listening to her and making suggestions. If "no," say "I respect that, but I'm still really concerned. What should I do about that?"  If she has said no, then at another time, communicate your concern for her, in a similar manner, regarding the drugs she is taking and her passing out.

Throughout all of this, act as her friend, not her therapist! Don't try to analyze her; leave that to a therapist - it could seriously damage your friendship!

Because she is taking enough prescription medication to make her pass out, I would be really concerned about a future overdose. If she is not open to seeking help and continues this behavior, I suggest you anonymously contact, via phone, the campus counseling center or campus crisis line, if they exist, and discuss the situation with a trained mental health professional. They should be able to guide you on what to do next. If not, I would consider contacting her family and expressing your concerns. This might ruin your friendship, but in the long-run, it might help her survive and recover.

I do hope that helps with your queries about your friend. Take care.

For more information:

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Response by:

Nicholas   Lofthouse, PhD Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University