In Part I of this two-part series, we examined the role that genetics likely plays in the onset of bipolar disorder and learned that genetics contributes up to 80%, with environmental factors contributing about 20% or more. (This means that if someone has bipolar disorder, the cause of it is 75-80% due to genetics. It does not mean an individual in a family with a history of bipolar has a 75-80% chance of developing it. See Part I for statistics on the inheritability of bipolar.)

It appears that for most people there needs to be some environmental factors that “turn on” the genes responsible for one’s vulnerability to bipolar disorder. Many of these environmental triggers may occur early in life and may include things such as:

• Prenatal exposure to toxins – which can include drugs and alcohol but could also include environmental toxins
• Psychosocial stressors (especially severe ones) in early life such as abuse, neglect, or other things that disrupt the infant making sound attachments to a caregiver
• Possible head trauma in childhood or other medical events
• Unknown environmental agents or events
• The brain at risk for bipolar disorder may experience certain events as stressful that a brain without bipolar genes might perceive as minor. So it could be that it doesn’t take a really big stress to turn on the gene – it depends on the genes and the severity of the vulnerability.

So “insults” – both large and small – to the growing brain may be part of what “turns on” the bipolar genes. But there are other events that occur later in life that are believed to be possible triggers as well. These can include:

• Stress of all kinds from work, family, relationships, finances
• Sleep and wake cycles and schedules – bipolar genes appear to be quite closely related to our circadian rhythms
• Toxins, including tobacco, drugs, and alcohol
• Diet
• Illness, infections, or other health related stresses or trauma
• Unknown environmental agents

Again, the brain wired to be at risk for bipolar may be stressed by events that would not stress a brain that didn’t have the wiring. So it may not be a big event that is required to trigger the illness.

Obviously, you can’t do anything about the genes you inherited, and your own early childhood events cannot be reversed. You’re pretty much stuck with those. But can you do anything about those other factors that contribute to the bipolar genes actually being expressed? If you have a genetic vulnerability to bipolar disorder, is there anything you can do to improve your odds of not developing it? If you have children, can you improve their odds of dodging the bipolar bullet?

Don’t Play the Blame Game

If you have a child or a loved one who’s been diagnosed with bipolar disorder, the most important thing is not to play the blame game. My co-author for Bipolar Disorder For Dummies, Joe Kraynak, has bipolar in his family, and has told me that he feels (in hindsight) that he could have done more to prevent it. (By the way, Joe and his family gave me permission to talk about their situation.) Joe’s been dealing with this for some time, so he’s well aware that these what-if scenarios are kind of silly, but he thinks about it all the same.

If you feel the temptation to blame yourself, stop it. Most of the triggers are probably things that you could not control – we don’t have a good handle on what triggers are most important and when they have to occur to cause illness. Furthermore just general life stress – unavoidable in everyday life – may be all it takes. We just don’t have enough information to be able to clearly state what to do and what not to do. So blaming yourself doesn’t make any sense. And furthermore it won’t do any good and will make you miserable for no good reason. This can reduce your own emotional strength to manage stress and illness in yourself and your loved ones.

Learn a Lesson from the Pros

No studies have shown that creating a particular emotional environment can prevent the onset of bipolar disorder or any other mental illness, but it makes sense that a less stressful environment is more conducive to mental health. So, how do you create such an environment? Take a lesson from the pros – people with bipolar disorder who live with it on a daily basis. Most of them know full well what they can do to reduce the stressors and triggers in their lives:

• Try to develop and maintain as regular and predictable a schedule as possible within the demands of everyday life.
• Work toward everyone in the family having regular sleep schedules and getting 8-10 hours of sleep per night.
• Follow Ben Franklin’s advice of doing everything in moderation.
• Identify and avoid or defuse high-stress situations as much as possible.
• Cultivate a family culture of respect and compassion – keep the criticism, judgment, and demand down to a dull roar. This applies to children and adults.
• If you’re raising a child who’s in a higher risk category for developing bipolar, be a little extra vigilant for signs of any sudden and serious shifts in moods or behaviors (without being too worrisome).

Remember: Even if you do everything “right,” you can’t control everything in anyone else’s life let alone your own, and even if you could (and did), there’s no guarantee that it would prevent the onset of bipolar disorder. Establishing an atmosphere of mutual respect and kindness is most important – it could help keep bipolar out of your home, and if bipolar does manage to get in, you’ll have developed stronger relationships that help you deal with it as a family.

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» Bipolar Disorder & Heredity – The Genetic Link: Part II (July 29, 2008)

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    Last reviewed: 29 Jul 2008