The Impact of Bipolar I on Love, with Roger Rivera, DNP, PMHNP

Roger Rivera, DNP, PMHNP

Credit: Mente Suave Psychiatry and Medicine

Bipolar I disorder (BD-I) profoundly impacts the way individuals express and receive love. In an interview with The Educated Patient, Roger Rivera, DNP, PMHNP, of Mente Suave Psychiatry and an educator at the University of Florida, discusses the challenges couples face when navigating BD-I, from the emotional highs of mania to the withdrawal of depressive episodes. By understanding how BD-I influences love languages and emotional needs, partners can develop adaptive strategies that foster connection, stability and mutual support.

How can BD-I impact the way a person gives and receives love?

Roger Rivera, DNP, PMHNP: BD-I is a complex and dynamic condition that significantly influences emotional regulation, interpersonal communication and intimacy. The way love is expressed and received is often shaped by the fluctuating mood states characteristic of BD-I, making consistency in relationships challenging.

During manic episodes, heightened emotional intensity can lead to impulsive romantic gestures, excessive verbal affirmations and even grandiose expressions of love. While this can foster moments of deep connection, it may also create unrealistic expectations, boundary violations or a sense of emotional unpredictability for the partner. Conversely, depressive episodes often bring emotional withdrawal, diminished self-worth and decreased libido, which can make it difficult for individuals with BD-I to reciprocate affection. This shift can be misinterpreted by their partner as disengagement or rejection when, in reality, the individual is struggling with the internal weight of their mood state.

For relationships to remain stable and fulfilling, it is essential for both partners to recognize how BD-I influences emotional availability and to develop adaptive strategies that maintain intimacy through the highs and lows. Education, therapy and a mutual commitment to understanding the disorder can help couples navigate these complexities with patience and resilience.

Why is understanding love languages important when one partner has BD-I?

RR: Love languages serve as a fundamental framework for emotional connection in any relationship, but their significance is even greater when one partner has BD-I. Mood fluctuations can change how love is expressed and received, requiring adaptability and mutual understanding.

During manic phases, a person with BD-I may demonstrate affection through excessive verbal affirmations, impulsive gift-giving or an intense desire for closeness. While this may seem exciting, it can sometimes overwhelm the partner, particularly if boundaries are not respected. Conversely, depressive episodes often lead to emotional distance and low motivation for affectionate gestures. Individuals in this state may need words of affirmation, physical touch or quality time, yet they may struggle to verbalize these needs or actively seek connection.

By identifying love languages during euthymic (stable) periods, couples can create a road map for maintaining emotional closeness, even when mood fluctuations occur. This proactive approach allows the supporting partner to recognize behavioral changes as part of the disorder rather than a reflection of the relationship itself, fostering greater patience, empathy and emotional security.

What are some common challenges couples face in the context of BD-I?

RR: Couples navigating BD-I may face an array of challenges, with emotional instability and unpredictability being among the most significant. Rapid shifts between manic hyperengagement and depressive withdrawal can make it difficult for partners to establish a stable emotional foundation. This inconsistency may lead to relational uncertainty, where the non-BD-I partner feels unsure of where they stand in the relationship at any given time.

Intimacy is another common challenge, as hypersexuality during manic episodes and decreased libido during depressive episodes can create mismatched expectations between partners. Without open communication and mutual understanding, these changes may lead to frustration or misinterpretation of the partner’s needs.

Financial strain is also a frequent concern, as manic impulsivity can lead to excessive spending or high-risk behaviors that erode trust. Additionally, the non-BD-I partner may take on a caregiving role, which, over time, can lead to emotional exhaustion or even resentment if proper boundaries and self-care are not maintained.

While these challenges can feel overwhelming, they are not insurmountable. With proper education, structured communication strategies and external support, such as couples therapy or psychoeducation programs, along with the consistent use of medications as prescribed by a psychiatric provider, couples can navigate these difficulties while fostering a deep, enduring connection.

What are some healthy ways for couples to communicate during mood episodes?

RR: Effective communication is a cornerstone of any relationship, but when BD-I is present, it requires additional care, structure and emotional intelligence. One of the most effective strategies is establishing a communication plan during euthymic periods, where both partners can set clear expectations for how to navigate difficult conversations during mood episodes.

Using “I” statements — such as “I feel concerned when you haven’t slept in days” — can help express worry without triggering defensiveness. Validating emotions rather than dismissing them is equally important, as phrases like “I understand that you’re feeling overwhelmed, and I’m here for you” can help de-escalate tension while reinforcing emotional support.

During manic episodes, where irritability and pressured speech may be present, it is beneficial to maintain a calm, neutral tone, to set clear boundaries and to avoid engaging in confrontations that may escalate. On the other hand, during depressive states, offering support through presence rather than pressure such as sitting quietly together or providing small, reassuring gestures can be far more effective than urging the partner to “snap out of it.”

Encouraging professional support, such as therapy or psychiatric care, including appropriate utilization of prescription medications, can also provide an additional space for processing emotions outside the relationship, reducing interpersonal strain and fostering healthier communication dynamics.

What are some simple, everyday ways a partner can show love and support to someone living with BD-I?

RR: In relationships where one partner lives with BD-I, consistency, patience, and small, meaningful gestures can make a significant impact. Checking in regularly with open-ended questions like “How are you feeling today?” allows for emotional expression without pressure. Maintaining stability through predictable routines, such as shared meals, regular sleep patterns and planned activities, can reinforce mood regulation while creating a sense of security in the relationship.

Offering words of affirmation, even in brief moments, can serve as a grounding mechanism during emotional fluctuations. Simple acts of service, such as preparing a meal, offering a comforting touch or assisting with daily responsibilities, demonstrate support in a tangible way. At the same time, it is crucial for the supporting partner to maintain a balance between offering help and fostering autonomy, ensuring that care does not transition into an unhealthy dependence.

Ultimately, love in the context of BD-I is not about grand gestures, but rather the quiet, steady presence of a partner who is willing to walk alongside them through the ups and downs with compassion and understanding.

How can couples discuss their love languages and emotional needs in a supportive way?

RR: Discussing emotional needs can feel vulnerable, particularly in the context of BD-I, but having structured and intentional conversations can strengthen the relationship. The best time to have these discussions is during euthymic periods, when both partners are emotionally regulated and can engage in meaningful dialogue.

Framing the conversation in a collaborative way such as “How can we support each other better?” creates a shared approach rather than placing blame. Using tools like love language quizzes can make the process engaging and informative, helping both partners understand how they naturally give and receive love. Additionally, practicing reflective listening, where each person paraphrases what they heard before responding, can prevent misinterpretations and foster deeper emotional understanding.

How can partners avoid feeling neglected or disconnected during difficult mental health episodes?

RR: One of the greatest challenges in relationships affected by BD-I is maintaining connection during mood episodes. A crucial mindset shift is recognizing that mood symptoms are not reflective of the partner’s feelings toward the relationship but rather a manifestation of the illness itself. Establishing predefined check-ins can help maintain a sense of emotional continuity, even when engagement is low.

External support networks such as therapy, support groups or trusted friends can also provide an outlet for both partners, preventing emotional burnout and maintaining relational balance. Setting realistic expectations during depressive episodes, such as agreeing on small, manageable interactions like watching a show together, can sustain intimacy without overwhelming the individual with BD-I.

How can partners set realistic expectations while keeping romance alive?

RR: Maintaining romance in a relationship affected by BD-I requires balancing realistic expectations with intentional effort. Recognizing mood cycles allows for adjustments in socialization, intimacy and communication, helping both partners navigate changes with patience. Small, meaningful gestures, such as a handwritten note, a spontaneous “I love you” or a simple act of kindness, can sustain emotional closeness.

Prioritizing therapy, medication treatment adherence and overall wellness fosters stability, allowing both partners to build a strong, lasting foundation of love that endures beyond mood fluctuations.

Bipolar I disorder introduces complexities into relationships, but with structured communication, mutual understanding and intentional strategies, couples can cultivate a resilient and deeply fulfilling connection. Through empathy, education and shared commitment, love in the presence of BD-I can flourish, not despite its challenges, but because of the strength it fosters.