Sarah is a mother of two, married to John, who used to be the heart of every family gathering—always making everyone laugh, full of energy, and the person everyone turned to for support. But over the past few years, something started to change. John became increasingly unpredictable. Some days he would be bursting with energy, staying up all night with grand ideas, while other days, he would retreat into a dark, irritable mood, shutting everyone out.
Sarah tried to keep the family together, but it felt like walking on eggshells, never knowing which version of John she’d face each day. The children began to notice too, their once lively and loving home now filled with tension, fear, and uncertainty. Arguments became more frequent, and Sarah found herself feeling more isolated, confused, and helpless with each passing day.
Desperate for answers after months spent in this pattern, Sarah gave John an ultimatum: seek help or risk losing the family. It was only after this painful confrontation that John agreed to see a professional. That’s when they finally learned what was behind the turmoil—John was diagnosed with Bipolar Disorder.
But even with this new understanding, the challenges didn’t disappear. The family now had a name for what they were dealing with, but living with a loved one who has a mental health disorder brought its own set of difficulties. Sarah still struggled to find a balance between supporting her husband and protecting her children, all while trying to manage her own emotional exhaustion and responsibilities.
Understanding the Impact of Mental Health Disorders on Family Dynamics
Although the above vignette isn’t based on a true story or specific individuals, this is a reality for many families, and may sound familiar to you too. As a licensed psychotherapist with over 20 years of experience working with families and individuals, I have had the privilege of supporting many people through these very challenges. Whether it’s Bipolar Disorder, Schizophrenia, a personality disorder, depression, or ADHD, the impact on family dynamics can be profound, affecting each member in ways that are often unexpected and deeply felt.
Over the years, I’ve seen how these diagnoses can reshape relationships, create new responsibilities, and introduce a level of unpredictability that is challenging to navigate. It’s not uncommon for families to feel overwhelmed, unsure of how to support their loved one while also maintaining their own well-being.
How a Licensed Psychotherapist Approaches Living with a Loved One Who Has a Mental Health Disorder
As someone who has worked closely with families in these situations, I understand the emotional toll it can take. Family members may experience a range of emotions, from sadness and fear to frustration and anger. These feelings are natural responses to a difficult situation, but they often go unexpressed, leading to further strain on relationships. In my practice, I’ve learned that addressing these challenges requires a dual focus: caring for the affected relative and ensuring that family members also prioritize their own self-care. Let’s explore these two critical aspects.
The impact of a mental health diagnosis on family dynamics can be profound, affecting each member in ways that are often unexpected and deeply felt.
Building or Regaining Your Personal Space and Self-Care
You may have grown up in a family where a member had a mental health issue, so from a young age, you may have learned to live with this situation. Unfortunately, it’s likely something you were never prepared for. Families often adjust to a reality they don’t fully understand, especially when the issue isn’t initially treated with professional help. This often occurs in families where one member is suffering from an addiction.
Understandably, this can be incredibly difficult and frustrating. Expectations from family members and the emotional ups and downs of not knowing what to anticipate from the affected relative may leave you with a mix of emotions—sadness, fear, frustration, anger, and confusion—that are often suppressed. You might not have had the space to feel these emotions, or you may have felt guilty for having negative feelings, thinking, “How can I be angry at someone who is unwell?” Blaming yourself for emotional reactions or outbursts after repressing your feelings is also common.
When a family member is diagnosed with a mental health disorder, the entire family is affected.
These situations are familiar to many. It’s normal to have negative feelings when circumstances are tough, when your personal space isn’t respected, or when you feel pressured or hurt. Even if these emotions stem from someone else’s struggles, they tell you that things aren’t working for you. Acknowledging them is the first step toward making changes.
If your family member’s mental health issue develops later in life—during adolescence, young adulthood, or after a trauma—it brings significant changes to the family. This often includes grieving the loss of the person they used to be, and potentially a major shift in your role within the family.
Human nature pushes us to survive, but the coping mechanisms we use aren’t always effective. Often, families lack the knowledge needed to make healthy decisions for their loved one and themselves, leading to unhealthy dynamics that hinder the family’s ability to move forward in a healthy way.
You may feel overwhelmed, unable to make time for yourself, pressured into doing things you don’t want to do, and even experience anxiety, panic attacks, or periods of hopelessness. Guilt is another common feeling.
Often, families lack the knowledge needed to make healthy decisions for their loved one and themselves, leading to unhealthy dynamics that hinder the family’s ability to move forward in a healthy way.
The Role of Guilt in Living with a Loved One Who Has a Mental Health Disorder
Emotions give us important information about our situation and motivate us to take action. They are largely adaptive in nature. Guilt, in particular, arises when we go against social or family expectations, or when we feel we haven’t met certain standards. Guilt can be helpful—it helps us understand when we need to take action. Even when it’s not possible to repair things, guilt can still teach us valuable lessons for the future. However, guilt can become problematic when it gets stuck and begins to weigh us down. This is especially common in families dealing with mental health issues, where internal and external pressures can intensify feelings of guilt.
It becomes very difficult to make any changes or feel better when you believe you don’t have the right to prioritize yourself, or when you feel that your family member needs more than you, or that your decisions will negatively affect others. These thoughts are often based on irrational expectations, not reality. But the good news is that there are options for making changes, improving your life, and even enhancing your relationship with your loved one.
Guilt can be helpful—it helps us understand when we need to take action. Even when it’s not possible to repair things, guilt can still teach us valuable lessons for the future.
If we don’t act on what’s hurting us, it can lead to resentment, which in turn damages the relationship with our loved one. This resentment can manifest in our behavior and negatively affect the person we care for.
Getting an early diagnosis and support services for both the family and the person with the mental health issue can significantly improve the family’s overall situation. Coping strategies and skills are critical to the well-being of both the caregiver and the individual with the disorder. By improving our personal lives, creating space for growth, and fostering a more cooperative relationship with our loved one, we can move toward a healthier dynamic.
To bring about positive change, you need to build a foundation that makes sense to you. This will help you overcome the resistance that will inevitably come and allow you to give yourself permission to seek a better life. You have the right to live your own life, and it’s okay to claim your own space. It’s also normal to feel anger or upset when things impact you, even if those things stem from a loved one’s illness. Begin by thinking about your needs and then work on setting boundaries.
How To Set Boundaries with a Loved One Who Has a Mental Health Disorder
As you may already know, your family member with a mental health condition often struggles to provide the empathy and self-awareness needed for a relationship. This means you’ll need to adjust your expectations, but it doesn’t mean you have to give up on having healthy relationships in your life. In fact, it’s essential to seek other sources of support. Spending time with friends, family, or even engaging in activities with others can help you regain a sense of ownership over your life. Setting small, manageable goals to carve out time for social activities outside of the family can bring new, positive experiences and emotions.
It’s also important to recognize what stress feels like for you and identify the situations that trigger it. Once you understand what causes your stress, you can better prepare to manage it when it arises. Establishing healthy routines—like making sure you get enough sleep, eating well, and practicing self-calming strategies—will help you care for yourself. Even when you’re responsible for caring for others, you must take care of your own health first. These basic steps are easier to implement than you might think, but they require conscious attention and effort.
It’s also perfectly fine to involve other family members in supporting your loved one. You don’t have to do it all on your own. Focus on improving communication with your family so that you can support each other effectively.
Talking about your experience—whether with a doctor, support group, mental health professional, or religious leader—can be an excellent way to gain support for yourself. Living with a loved one who has a mental health disorder can be challenging, but reading and reflecting on all of this is a great first step. Preparing yourself to take action is the next step. A professional can guide and support you through this journey, helping you grow along the way.
