By

Julia Métraux

Medically Reviewed

by

Allison Young, MD

Published on September 26, 2023

While some people may not struggle to tell friends, family members, or an employer about their bipolar disorder, for others it can feel very nerve-racking. These 7 tips can help.

At age 31, Julie A. Fast — now a bipolar disorder expert and researcher — was diagnosed with the condition. Later on, she was diagnosed with schizoaffective disorder, bipolar type (a psychotic disorder involving symptoms of both schizophrenia and bipolar disorder).

Bipolar disorder wasn’t entirely new to Fast, now 59, when she was diagnosed. Her partner at the time was diagnosed with the condition in 1994, just one year before.

Still, in her social circles, she found that most people did not know or understand her condition. “I’d go to a party, and maybe two or three people would say, ‘I know of bipolar disorder,’” says Fast, who coauthored the book Take Charge of Bipolar Disorder with John Preston, PsyD. 

Because awareness of bipolar disorder and its symptoms is increasing, many people with the condition, like Fast, feel more comfortable sharing their diagnosis with others. “I can deal with whatever happens when I disclose my illness to others,” Fast says. “It will show who can help me and who can’t.” 

But some people with bipolar disorder may still feel hesitant to share their diagnosis, in part because of stigma and fear about how others will respond, experts say.

Why Sharing a Bipolar Disorder Diagnosis Can Feel Challenging

Factors like shame, embarrassment, or stigma — negative and often untrue beliefs society holds about someone or something — make some people with bipolar disorder feel hesitant to talk about their condition, research shows.

Many people with bipolar disorder experience a form of stigma called “public stigma,” which is related to how other people view and act toward people with bipolar disorder, according to research published in February 2022 in the Australian & New Zealand Journal of Psychiatry. Public stigma is linked to more anxiety symptoms, worsened ability to function, and problems at work, per the same research.

Although public stigma can come from anyone around them, many people with bipolar disorder experience it from people close to them — family, friends, or even their healthcare providers, per the same report.

Fear of how others may respond as a result of stigma is another potential barrier. “They may worry that disclosure could negatively affect their relationships with friends, family, or romantic partners,” says Leanne Quigley, PhD, an assistant professor in clinical psychology at Yeshiva University in New York City.

Public stigma and how others view bipolar disorder can lead many people with the condition to feel negatively about themselves, according to the aforementioned report.

“[They] may also experience internalized stigmas where they report low self-esteem, low quality of life, and limited engagement in their communities,” says Adrian Jacques H. Ambrose, MD, MPH, the medical director of the psychiatry faculty practice organization at Columbia University in New York City, who treats people with bipolar disorder. This is what’s known as “self-stigma,” per the aforementioned report.

RELATED: A Therapist Speaks: What Is Bipolar Disorder Stigma, and How Can We End It?

When to Tell Someone About Your Bipolar Disorder Diagnosis

The decision about when to share your diagnosis with someone else is very personal. It can depend on the type of relationship you have with the other person and whether they seem to have some sort of understanding of conditions like bipolar disorder.

When It Comes to Your Significant Other or Someone You’re Dating …

For romantic relationships, Fast recommends sharing a bipolar diagnosis as soon as possible. “I don’t really support the idea of getting in a relationship with somebody unless you have fully discussed the impact of bipolar on the relationship,” Fast says.

That’s important because the symptoms can affect the way someone with bipolar disorder thinks, feels, acts, and communicates with their partner, according to the United Brain Association. For instance, during a manic episode, someone with bipolar disorder may experience intense irritability toward their partner or may have a higher chance of engaging in risky behaviors like unprotected sex or heavy spending, which could lead to tension or mistrust in a relationship, per the United Brain Association. 

If you haven’t talked about your condition with your partner, it can be difficult for them to know what to say or do to help.

When It Comes to New Healthcare Providers …

It’s also crucial to be up-front about your diagnosis with any new healthcare providers you see, Fast Adds. They need to know about your health history and any medications you take. Research shows that certain medications, such as corticosteroids like prednisone, can trigger mania and psychosis in people with bipolar disorder.

That’s why Fast told her doctors before a recent minor surgery that she was not comfortable being prescribed steroids, which are sometimes used to help reduce inflammation. “When they suggest steroids, and so many doctors use steroids, I explain why I can’t use them,” she says, adding that her doctors were receptive to her needs.

Some antidepressants, such as fluoxetine (Prozac),  also trigger mania in people with bipolar disorder.

When It Comes to Your Friends and Family …

When it comes to telling friends and family, it might take you some time to feel comfortable doing so — and that’s okay. Prioritize telling close friends and family members that you interact with frequently and who you feel understand you well — rather than people you rarely interact with, Fast advises.

Before sharing your diagnosis with friends or family, Dr. Ambrose recommends asking yourself the following questions:

• Do you feel ready to share?
• Is there anything pressing or urgent happening that makes it important to tell them sooner rather than later, such as the onset of a mood episode?

When It Comes to Your Employer …

When it comes to your work environment, it’s important to weigh the possibility of discrimination, says Ambrose. You could look to see if the company has in recent years tried to reduce mental health stigma, which research suggests could make the workplacemore welcoming for workers with mental health conditions. 

And if you don’t feel comfortable revealing your specific diagnosis, that’s okay. You can still bring a note from your healthcare provider asking for accommodations based on how your mental health condition impacts your functioning, according to the U.S. Equal Employment Opportunity Commission.

7 Tips for Talking About a Bipolar Disorder Diagnosis

If you feel ready to share your diagnosis with someone else, here are seven expert tips to get the conversation started.

1. Prepare Yourself for All Sorts of Reactions

Just as people diagnosed with bipolar disorder may have a range of reactions to their diagnosis, reactions from others can vary, too. “We can allow the other person to ask whatever questions they want, have any type of response that they want,” says Fast.

Although some people may react positively to hearing about your diagnosis, others may react in a negative way. “Remember that your self-worth is not determined by a diagnosis of bipolar disorder or others’ reactions to your disclosure of a diagnosis,” Dr. Quigley says.

2. Talk About How Your Bipolar Symptoms May Affect Others

During a manic episode, some people with bipolar disorder may be more prone to engaging in risky or hurtful behaviors, such as cheating or lying. This can be common for people who are undiagnosed, Fast adds.

Whether you’ve just gotten your bipolar disorder diagnosis or you’ve received treatment for a new mood episode, it could help to reach out to people who may have been harmed by your words and actions during the episode. It could be a message like, “I’d love to talk to you about my diagnosis because I know my behavior impacted you,” says Fast.

But it’s important to recognize that not everyone will want to engage in this conversation, especially if they feel really hurt by actions like cheating or stealing, for instance, Fast adds.

If behavior related to a bipolar diagnosis hasn’t yet come up in your relationship with someone else, the person you’re telling may have questions about how it could affect the relationship in the future. Be prepared to discuss how any episodes could manifest.

3. Have a Summary on Hand

After sharing a bipolar disorder diagnosis, some people may have follow-up questions about your symptoms or, in the case of work, any accommodations you might need. “In certain situations, your loved ones [or employer] may know very little about mental health conditions, so it may be helpful to prepare a short summary about the condition,” Ambrose says.

The summary could be either written or verbal (or both), depending on what you’re most comfortable with.

4. Work With Your Therapist on a Plan to Tell Others

If you feel nervous or worried about sharing your diagnosis with others, your doctor or therapist could help you come up with the best strategy for you for sharing your diagnosis, says Fast. “Share most of your concern and your worries with your healthcare professionals because they’re trained to handle it,” Fast says.

5. Understand Your ADA Rights (and Note That They Vary by State)

While the Americans with Disabilities Act (ADA), which prohibits discrimination against people with disabilities at work and all other areas of life, is a federal law in the United States, some states offer more protections than others when it comes to employment laws related to disability discrimination, says Ambrose.

“Given the complexity of work-related rights, you should learn more about your specific state’s legal statutes,” Ambrose says.

If you’re in an area with less protection, it might be worth talking to a third party, for example your state labor office, about the best approaches for disclosing a bipolar diagnosis at work. State government offices belonging to the U.S. Department of Labor can help you better understand your rights as a worker in the state you live in. The Department of Labor has a directory of state labor offices.

6. Offer Different Information in Different Situations

If you’re only comfortable disclosing the entirety of your diagnosis to some people and not others, that is perfectly fine. “You may choose to discuss certain parts of your experience with bipolar disorder and not others,” Quigley says. “It is okay to maintain boundaries and not share everything.”

7. Give Yourself Grace

It can be difficult to figure out how to tell others about your diagnosis. It’s important to take care of yourself during this time. “It’s even more important to cultivate a sense of empathy and grace for yourself during the process,” Ambrose says.

Julia Métraux

Author

Julia Métraux is a journalist whose work touches on disability, mental health, and chronic illness. She went to the University of California in Berkeley Graduate School of Journalism. Métraux lives with vasculitis, a traumatic brain injury, and hearing loss.

See full bio

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I know how hard telling others about your mental illness can be, especially family members. Many family members looked at me differently because they were from a different generation that did not believe in mental illnesses. I did not tell friends or my employers because it wasn’t their business. One of my employers fired me from a high-level job because they found out I had a mental illness, yes I could have sued the billion-dollar company but why go down that multi-year road through the rabbit hole. I caution everyone to think hard before telling your employer, it can be held against you and they can find a way to fire you.

Melinda

By Julie A. Fast 

Medically Reviewed by Allison Young, MD

Last Updated: 21 Aug 2024

Although it’s incredibly frustrating when someone is in denial of having bipolar disorder, it’s important to remember that acceptance cannot be forced.

It can be upsetting, stressful, and downright incomprehensible when someone with a diagnosis of bipolar disorder denies the mental health condition and refuses treatment. You may find yourself watching helplessly as behaviors tied to untreated bipolar lead to family distress, broken relationships, problems at school and work, money woes, and alcohol and drug abuse.

If you try to help someone in denial, you will probably be accused of interfering if you even mention the word “bipolar.” This is confusing, because it’s very easy for you to see what’s wrong, and naturally you want to point out the problem in hopes that the person will then get help. Often, however, your attempt just makes things worse.

RELATED: 8 Essential Things to Know When First Diagnosed With Bipolar Disorder

It hurts when a person in denial shuts you out, but, sadly, it’s common.

What’s even more confusing is that you can have an honest conversation about bipolar when your loved one is stable, reviving your hopes that the person will enter or stick with treatment. Then … boom! Here comes the denial again.

Learning to Accept That Your Loved One Is in Denial About Their Bipolar Diagnosis

It may be cold comfort to learn that it is very typical behavior for people with bipolar disorder to deny they are “sick” and to avoid treatment, even if they have been in the hospital or taken medications for bipolar in the past.

Also, it’s important to remember that people in denial are usually miserable, in a great deal of internal pain, and can’t see a way out. It’s easy to believe they really can’t see what’s going on. But unless denial is a result of a mood swing — such as strong mania or paranoia — the affected individuals usually know what is happening. They respond to your concern with aggression, because they are trying to protect their decision to deny the brain-based disorder.

It hurts when a person in denial shuts you out, but it’s common. The person prefers to be around others who don’t mention bipolar, and will paint you as the “bad guy” because you are the one who is stating the truth.

RELATED: 10 Ways to Support Someone Who Has Bipolar

There is good news, however. I’ve talked with hundreds of people who moved through denialto eventually admitting that bipolar is at the root of their problems and they needed help. Over and over again, I’ve been told how, despite their relentless inner pain and confusion, they refused help and pushed away the people who cared about them.

It’s when someone realizes they no longer want a life controlled by bipolar disorder that they begin to listen to loving advice instead of fighting back.

Steps to Take When a Loved One Is in Denial About Their Bipolar Diagnosis

If your loved one continues to be in denial of their bipolar diagnosis, here are a few things to keep in mind.

• Find the sweet spot: Are there periods when your loved one is more open to discussion? Oftentimes, people are more receptive during a mild depressive episode. Once you see a pattern in your loved one’s moods, you’ll have a better sense of when to gently start a conversation.
• Set expectations: If a loved one with bipolar is living with you, you have the right to set expectations for behaviors, such as drug use, drinking, yelling, staying in bed all day, staying out all hours, and yes, refusing treatment. You are always in control of what works best for you. It’s not always about the person with the mental health condition. It will be up to you to decide the consequences — and set and reinforce boundaries — if your expectations aren’t met.
• Understand the challenges: Always remember that bipolar is a mental health condition. No one chooses to have bipolar disorder. People in denial can be very unpleasant, and it’s easy to walk away from them, but don’t forget they are suffering. It’s okay to address this directly. Go ahead and say you understand that it must be hard to have someone tell you what to do. Say that you can tell they feel misunderstood. People in denial may get angry or refuse to reply, but they have heard you. Many times, when they get better, they will tell you they heard you.
• Hold onto hope: I’ve known many people who accepted treatment after years of being in denial, often when loved ones learned simple strategies and got them help at the right time. It isn’t easy to hang on until then. Nothing with bipolar disorder is easy! But bipolar is treatable, even for those who currently refuse to admit they are unwell and need help.

UPDATED: Printed as “Fast Talk: The Denial Factor,” Summer 2011

Julie A. Fast

Julie A. Fast is the author of the bestselling mental health books Take Charge of Bipolar Disorder, Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner, Getting It Done When You’re Depressed, OMG, That’s Me! (vol. 2), and The Health Cards Treatment System for Bipolar Disorder. She is a longtime bp Magazine writer and the top blog contributor, with over 5 million blog views. Julie is also a researcher and educator who focuses on bipolar disorder prevention and ways to recognize mood swings from the beginning—before they go too far and take over a person’s life. She works as a parent and partner coach and regularly trains health care professionals, including psychiatric residents, pharmacists, general practitioners, therapists, and social workers, on bipolar disorder and psychotic disorder management. She has a Facebook group for parents, The Stable Table, and for partners, The Stable Bed. Julie is the recipient of the Mental Health America excellence in journalism award and was the original consultant for Claire Danes’s character on the TV show Homeland. Julie had the first bipolar disorder blog and was instrumental in teaching the world about bipolar disorder triggers, the importance of circadian rhythm sleep, and the physical signs of bipolar disorder, such as recognizing mania in the eyes. Julie lives with bipolar disorder, a psychotic disorder, anxiety, and ADD.

Melinda