Dealing with risky or inappropriate illness behavior

If the person is manic, very hypomanic or in a mixed episode their behavior may become inappropriate or risky (e.g. spending sprees, sexual indiscretions, reckless driving). Although you cannot control the person’s behavior, you can control how you deal with it.

Below are some ideas for trying to prevent or reduce inappropriate or risky manic or hypomanic behavior:

Put precautions in place

To prevent risky behaviour from re-occurring, when the person is relatively well you could:

  • Discuss with the person precautions they can take to prevent risky activities and negative consequences (e.g. give their credit cards to you temporarily to prevent reckless spending, give their car keys to you to prevent reckless driving, or stay at home if promiscuity or socially inappropriate behavior is a problem).
  • If severe negative consequences have occurred previously, take more extreme measures to prevent them in the future (e.g. if the person has spent large sums of money you could arrange to put certain restrictions on their access to finances, such as requiring co-signatures for large expenditures and keeping separate bank accounts).

Set limits on certain behaviour

Where to set limits to protect yourself (or the family) from illness related behavior you find unacceptable is a personal decision. Be careful that you don’t simply accept verbal, emotional, physical or financial abuse because the person is ill. If you let the person know what illness-related behavior you find unacceptable and set limits on this behavior, the person will know where they stand and have the option of doing what they can to prevent this behavior from re-occurring.

To set limits with a specific behaviour, when the person is relatively well either:

  1. Tell the person what behavior you are concerned about. Make a positive request that they find ways to try to prevent this behavior from re-occurring. Mention the benefits this would have for the person, yourself and the family.
  2. Tell the person that the behavior has overstepped a personal boundary and explain what this boundary is. Let them know what consequences will result if this boundary is not respected. It could also help to specify the benefits that will occur if this boundary is respected. If you mention consequences, you need to be prepared to follow through with them.

If the person tries hard to prevent this behavior in the future, it is essential to acknowledge their effort. Knowing that the person is trying to respect your boundaries can be reassuring.

What can you do when risky behavior is about to occur?

If the person who is about to do something risky is experiencing a bipolar episode, they need medical help. There may be a brief opportunity to reason with the person to reduce risky behavior before they become too manic and lose insight into their condition. If you have this opportunity, consider the following options:

  • Tactfully try to stall decisions about risky projects (e.g. “I need to give that idea more thought.”).
  • Ask the person not to pursue the risky behavior, and mention the benefits this will have (e.g. if the person is hypomanic: “I would like us to stay home rather than go to the party, as we can have a nice quiet evening together and you might find it easier to get the sleep you need“).
  • Point out the link between their bipolar mood and the risky idea or activity.
  • Ask the person to consider whether their thinking about a certain project has become so over-optimistic that it is difficult to see the risks or negative consequences.
  • Encourage the person to postpone acting on a risky idea until they are well, by defining a specific wellness goal (e.g. “How about you hold off acting on this idea until the doctor says your mood is stable” or “until you have managed to sleep through the night for a week”).
  • Recommend that the person avoid alcohol and other drugs, as these substances increase the risk of acting impulsively.

If the person is offended because you do not agree with their risky ideas or plans, consider telling them that you care about them and are concerned about the consequences. Although physical aggression is not common, if they are at risk of becoming aggressive, leave to ensure your safety (see if the person is physically aggressive). For ways to respond to the person who is ill, irritable and very critical of you without being drawn into arguments see if the person is ill, irritable and very critical of you.

Although at times it is possible to prevent risky behavior, sometimes this behaviour does occur ( see dealing with negative consequences of risky behavior).