How do you help a client with bipolar disorder determine who to inform about their diagnosis?

By Stephanie McMurrich Roberts, PhD

For many clients, the decision of who to inform about their diagnosis is a difficult one. Arguably, progress surrounding the stigma of mental illness has been made in recent years; however, the fact remains that many people have negative conceptions about bipolar disorder, and they may treat someone differently if they are aware of their diagnosis. There are some people, such as doctors and partners/spouses, where disclosure is necessary and important. However, there are other types of people, such as coworkers or friends, where it is not so clear if disclosure is the best choice. When I speak with clients about whom to inform, I listen carefully to their fears and concerns. I acknowledge that disclosing a diagnosis of bipolar disorder is not the same as disclosing test anxiety or grief surrounding a loss. I have found that the following series of questions can be useful in helping determine who to inform. These questions can be used as a written homework assignment, or can be discussed verbally in session.

1) What would be some risks of this person knowing you have bipolar disorder? For example, could you lose credibility at work if you inform a coworker or boss?

2) What would be some benefits to you of this person knowing about your bipolar disorder? For example, could informing a close friend make it less awkward when you have to cancel plans at the last minute because of a mood episode?

3) Is this person capable of keeping the information confidential? Don’t tell someone who is known to be a gossip.

4) Is this person likely to judge me negatively for having bipolar disorder? Although you cannot predict with certainty how anyone will react, certain information may serve as an indicator of response. For example, perhaps you know that this person has dealt with post-partum depression or has a loved one with a mental disorder. 

Stephanie McMurrich Roberts, PhD, is a clinical psychologist specializing in the cognitive-behavioral treatment of mood and anxiety disorders. Roberts has published a number of peer-reviewed articles related to bipolar disorder and depression. A former instructor in psychology at Harvard Medical School and staff psychologist at the Massachusetts General Hospital Bipolar Clinic and Research Program, she now works in private practice in Boston, MA.