The Collateral Damage of Bipolar Disorder

The Collateral Damage of Bipolar Disorder

What Do Children Want to Know When a Parent Has Bipolar Disorder, and even more important, How Do We Help Protect Them from Adverse Developmental Trauma? Jennifer Safian posed these questions, minus my paraphrasing, in response to my previous blog on Family-Focused Psychotherapy for Patients with Bipolar Disorder, and subsequently shared personally with me, painful details of her growing up with a father with Bipolar Disorder. Bipolar disorder can devastate families if left untreated, and the impact on children is life long. The extent of the disruption to the family can easily meet or exceed the individual’s symptomatic suffering and impaired functioning.

Two-thirds of bipolar patients do not achieve full social and occupational recovery. Their families also experience ongoing functional distress and dysregulation. Repetitive emotional trauma is an ever present part of their life. When the family organizes itself around the ill person, many other aspects of the family’s growth and development will be impaired. The losses of trust, safety and security forever change the relationships.

In researching Jennifer’s query, much to my dismay (though in retrospect it should not have been surprising), I discovered that most of what is written, and all but a very few research investigations, concern how the family can be helpful to the individual with Bipolar Disorder and not how to help the family, especially young children and adolescents. Most studies, as one might expect in this over medicalized world, investigate and evaluate the risk of “mental illness” in “Children of parents with bipolar disorder”.

But how do we help protect children from the ravages of uncontrolled mania and suicidal depression? How do we help children address their own unmet emotional needs? Unfortunately, in these situations of Unbalanced Systems, the family is often not up to the task of working to successfully adapt to the physical, psychological, emotional, and spiritual challenges of severe and chronic psychiatric illness. Despair, helplessness, hopelessness, confusion, subjective incompetence and a sense of isolation cause both the patient and the family to withdraw from and avoid the challenges of illness management and adaptation.

Ronald B. Cohen, MD discusses how children are affected when a parent struggles with bipolar disorder.Children are unable to influence the power dynamics of their family of origin. Psychoeducation and support groups such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) can be helpful. Regulated early child care services reduce risk. Engaging at least one stable adult in the extended family system to help the children integrate the trauma and make sense of the loss can enhance resilience, defined as the ability to withstand and rebound from stressful disruptive crises that interrupt developmental tasks.

For adolescents, adult children, and younger children as they subsequently enter the life cycle stage of emerging adulthood, self-differentiation and family of origin work help make meaning out of adversity. The safety of secure attachments helps foster the ability to acknowledge suffering, restore dignity and reinvest in a meaningful way. Helpful skills include the ability to focus on your own life, seek support, set boundaries, manage stress, and ask for help. When all else fails, consulting with a well-trained family systems therapist can help keep the process moving forward in a positive direction.

What have I missed? Please share your thoughts and experiences concerning living with a parent with a severe and persistent psychiatric illness in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here. If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks. I look forward to hearing what’s on your mind.

Ronald B Cohen, MD, PC Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
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  1. Karen Denvir on August 15, 2013 at 8:11 am said:

    As the child of a parent with severe bipolar disorder, “collateral damage” is probably the best term I’ve heard describe the effects of seeing the person who is supposed to be in control and most stable in your life spiral into a psychotic episode of mania and debilitating depression. The chaos that ensues is unbearable – when that person is the breadwinner and unable to hold a job, financial difficulties amass. When that person’s emotions flare up at a moment’s notice, sometimes leading to violence, every moment feels like walking on eggshells to avoid those instances in the future and utter confusion about what brought it on. When living in a small town, where everyone is in on your business because your friend’s mom is the first selectman or the town social services worker, or a neighbor sees the cops or ambulances at your door – can lead to difficulties for the child with their peers at school, without “appropriate” models of how to handle these difficulties or even how to ask for help. When you are the person in your home with the most control and the least power, it’s incredibly frustrating.

    This was my experience and how I came to be a family therapist myself. Having never had a “normal” model of family processes, I am fascinated by seeing how families work. In the face of severe mental illness where children are involved, everything you said about helping them engage in age-typical developmental processes, acknowledge the trauma and work to restore dignity, set healthy boundaries and build self-differentiation and validation to regulate stress and manage their lives is what my experience of having to reconstruct my own life for myself has been like.

    Thank you.

    • Ronald B Cohen, MD on August 16, 2013 at 8:57 am said:

      Hi Karen,

      Kudos on your strength and resilience, and thank you for your willingness to share some of the painful intimate details of your story. Best wishes on your commitment to use your experience to help others avoid similar pain and distress.



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