Bipolar Disorder and High-Conflict People
I’ve been asked how to deal with High-Conflict People (HCPs) with bipolar disorder. Bipolar disorder causes wide mood swings of depression alternating with manic episodes – which sometimes include confrontational, high-conflict behavior. It’s an “Axis I” disorder in the DSM-IV manual of the American Psychiatric Association. Most HCPs have traits of personality disorders which are Axis II disorders. But there’s an overlap with bipolar disorder for almost 40% of those with borderline personality disorder and/or narcissistic personality disorder.
How can you deal with them in relationships, at work or in disputes? The most successful treatments have included medications, which often help Axis I disorders but not Axis II. In my book “It’s All YOUR Fault!” I describe a man with bipolar disorder and narcissistic personality disorder. He received treatment for his bipolar disorder with medications that were successful, but he was still a high-conflict person because of his personality disorder – and he had his license to practice medicine taken away.
Managing the high-conflict behavior of those with bipolar disorder usually involves getting them on medications, into individual counseling and getting family involvement. When a person is well-managed with this disorder, they can function very well and there are many books written about and by people with bipolar disorder. However, if they stop taking their medications and go into a manic episode, they can be quite difficult and may be unable to resolve conflicts in a rational manner. It is best to avoid attempts at conflict resolution – such as mediation or court hearings or couples counseling – during these episodes.
When they are stable, but struggling, all of the methods for dealing with HCPs can be helpful – from using E.A.R. statements to focusing them on tasks to setting limits to educating them about the possible consequences of their actions. It helps to point out that they always have choices, but that each choice has consequences. When I have mediated conflicts involving a person with a known bipolar disorder, I have encouraged bringing a support person to help him or her think through proposals and decisions.
What has helped you?