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Anosognosia, or being unaware that you have an illness, is common in people with bipolar disorder.

One of the biggest problems in the treatment of bipolar disorder is that many people aren’t aware they are ill. This lack of awareness, termed anosognosia, can be a major barrier that keeps some people with bipolar disorder from getting the treatment they need. In their minds, they’re not sick, so why take medication?

Anosognosia in Bipolar Disorder

It is estimated that around 40 percent of people who have bipolar disorder also have anosognosia. In fact, anosognosia is the primary reason why those with this disease do not take their bipolar medications. Anosognosia is even more common in people who have delusions or hallucinations associated with their bipolar disorder. When people with anosognosia have a hallucination or delusion, they believe that what they are seeing or thinking is real, and are not convinced that an illness is causing these symptoms.

Many people with bipolar disorder have anosognosia that comes and goes, and anosognosia is often not a problem during periods of bipolar remission. But when a bipolar episode hits, they cannot grasp that they have an illness.

Anosognosia is different from denial, which is a common psychological tool people use to suppress the painful emotions associated with an illness or another stressful event. Instead, anosognosia is thought to be caused by damage to the brain, particularly the frontal and parietal lobes of the brain’s right hemisphere. The right hemisphere of the brain controls thinking skills, and damage can result in a number of problems, including difficulty with reasoning and problem solving.

Anosognosia is not unique to bipolar disorder. It is also seen in schizophrenia, stroke, brain tumor, Alzheimer’s disease, and Huntington’s disease.

Bipolar Disorder and Anosognosia: Coping Tips for Caregivers

As the caregiver for someone with bipolar disorder, you play a major role in your loved one’s life.

The patient “really need[s] to have a reliable care partner,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says it is critical for someone with bipolar disorder to have somebody who can help the patient follow the treatment plan, especially when he is ill and cannot do it on his own.

Here are some ways to encourage your loved one to stick with prescribed bipolar treatment:

• When his mood is stable, tell him that studies show that people with bipolar disorder can improve with medication. Without medication, the odds of him getting sicker increase, which in turn increases the risk of hospitalization, incarceration, suicide, violent behavior, and becoming a victim of violence.
• Developing a partnership with the patient is vital. And that means listening to your loved one’s fears, whether those fears revolve around the diagnosis or being hospitalized against his will.
• Empathize; don’t dismiss his opinions or emotions. Get the patient to talk about what is going on, person to person.
• Pay more attention to what she thinks is important, not what you think. As the caregiver, you might think that the hallucinations are a huge deal, but your loved one might think lack of sleep is the biggest problem. Discuss her problem; it will help develop trust.
• Together, plan how to deal with an acute bipolar episode, especially when anosognosia is an issue.
• Don’t get discouraged if you cannot convince her that she has an illness. Focus on helping her stick to her prescribed treatment. The patient might take the medications if you help her remember some of the negative experiences that occurred when she skipped medications before.

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You don’t have to be a caregiver to offer love and support to a friend battling bipolar disorder

If you’ve just found out that a friend has been diagnosed with bipolar disorder, you probably don’t know quite what to do or what to say. But no matter how your friend acts, and even if she brushes it off as no big deal, she will need your help. So instead of saying “please let me know if there’s anything I can do,” take some initiative and figure out what you can do to best help your friend with bipolar disorder.

Bipolar Disorder: How Your Friendship May Change

Coming to grips with a diagnosis of bipolar disorder and undergoing treatment — usually a combination of therapy and medication — will be difficult for your friend. But what you should understand is that bipolar disorder affects you too. It can be tough for you to watch your friend deal with this illness, and it can put a big strain on your relationship.

“When you’re caring for someone with [bipolar disorder], it’s really a collaborative approach,” says Adele C. Viguera, MD, a psychiatrist and associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio. She stresses that doctors and patients can’t do it alone, and that friends and family members play a huge role in treatment, support, and preventing future bipolar disorder episodes.

The stress on your friend can cause changes in her behavior toward you, which can be tough to swallow when all you’re trying to do is help. What’s important is to keep in mind that bipolar disorder not only affects mood, but energy and activity levels, as well as the ability to do daily tasks.

“Remember that it’s the illness speaking; it’s not her,” says Dr. Viguera. “It can be damaging over time — there’s a lot of resentment that builds up.”

Understand that your friend, you, and your relationship have a long road ahead, but that there are many things that you can do to make it easier on everyone.

Bipolar Disorder: How You Can Help

The caregiver isn’t the only one who can help your friend through this time — you can be a huge help when it comes to your friend’s treatment, because you can offer a great outside perspective to her doctor. Viguera says friends and family play a big part in encouraging healthy behaviors that help with treatment and spotting signs of the early stages of another bipolar episode.

Here are some ways that you can help your friend in her battle with bipolar disorder:

• Learn about bipolar disorder. The more you know about the illness, the better equipped you are to understand what she’s going through, and how to help. Read everything you can find.
• Know the early warning signs of an episode. Everyone’s warning signs are different, according to Viguera. If you know that your friend is about to slip into a manic or depressive episode when she stops eating or sleeping for a couple of days, or shopping excessively, you can warn her — and her doctor.
• Encourage healthy habits. If your friend suggests heading out to a bar for the night, redirect her to a healthier choice. You can suggest a movie, a fun night in, cooking dinner, or hitting a restaurant. Encouraging exercise, plenty of sleep, and healthy eating is always a big help — and these things are much easier to do when you’ve got a buddy helping you stay on track.
• Be involved with treatment. Offer to go to doctor’s appointments with your friend, and tell the doctor that you’re available if he needs to contact you. Viguera says that you can be a powerful influence, both on your friend and for the information you can provide to the doctor. “You really need somebody on the outside observing, whom they trust, saying ‘you really haven’t been doing that well in the last few months,'” says Viguera.

There are many times in life when we don’t quite know how to help a friend. But when a friend has bipolar disorder, there are many things that you can do to not just support, but truly help. Be there, stay involved, and know that this illness can be an ongoing struggle.

Anosognosia, or being unaware that you have an illness, is common in people with bipolar disorder.

One of the biggest problems in the treatment of bipolar disorder is that many people aren’t aware they are ill. This lack of awareness, termed anosognosia, can be a major barrier that keeps some people with bipolar disorder from getting the treatment they need. In their minds, they’re not sick, so why take medication?

Anosognosia in Bipolar Disorder

It is estimated that around 40 percent of people who have bipolar disorder also have anosognosia. In fact, anosognosia is the primary reason why those with this disease do not take their bipolar medications. Anosognosia is even more common in people who have delusions or hallucinations associated with their bipolar disorder. When people with anosognosia have a hallucination or delusion, they believe that what they are seeing or thinking is real, and are not convinced that an illness is causing these symptoms.

Many people with bipolar disorder have anosognosia that comes and goes, and anosognosia is often not a problem during periods of bipolar remission. But when a bipolar episode hits, they cannot grasp that they have an illness.

Anosognosia is different from denial, which is a common psychological tool people use to suppress the painful emotions associated with an illness or another stressful event. Instead, anosognosia is thought to be caused by damage to the brain, particularly the frontal and parietal lobes of the brain’s right hemisphere. The right hemisphere of the brain controls thinking skills, and damage can result in a number of problems, including difficulty with reasoning and problem solving.

Anosognosia is not unique to bipolar disorder. It is also seen in schizophrenia, stroke, brain tumor, Alzheimer’s disease, and Huntington’s disease.

Bipolar Disorder and Anosognosia: Coping Tips for Caregivers

As the caregiver for someone with bipolar disorder, you play a major role in your loved one’s life.

The patient “really need[s] to have a reliable care partner,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says it is critical for someone with bipolar disorder to have somebody who can help the patient follow the treatment plan, especially when he is ill and cannot do it on his own.

Here are some ways to encourage your loved one to stick with prescribed bipolar treatment:

• When his mood is stable, tell him that studies show that people with bipolar disorder can improve with medication. Without medication, the odds of him getting sicker increase, which in turn increases the risk of hospitalization, incarceration, suicide, violent behavior, and becoming a victim of violence.
• Developing a partnership with the patient is vital. And that means listening to your loved one’s fears, whether those fears revolve around the diagnosis or being hospitalized against his will.
• Empathize; don’t dismiss his opinions or emotions. Get the patient to talk about what is going on, person to person.
• Pay more attention to what she thinks is important, not what you think. As the caregiver, you might think that the hallucinations are a huge deal, but your loved one might think lack of sleep is the biggest problem. Discuss her problem; it will help develop trust.
• Together, plan how to deal with an acute bipolar episode, especially when anosognosia is an issue.
• Don’t get discouraged if you cannot convince her that she has an illness. Focus on helping her stick to her prescribed treatment. The patient might take the medications if you help her remember some of the negative experiences that occurred when she skipped medications before.