The problems often creep in slowly. Your partner may express unhappiness about work, or about your finances, or about the kids. At first, it seems pretty normal–after all, no one is happy all the time. Gradually–or sometimes not–you realize that the person you thought you knew is not there anymore.

That person now calls out sick from work frequently, sleeps all the time, lets chores and other responsibilities go by the wayside, doesn’t have any interest in a social life or sex, and is generally unpredictable. Maybe they even talk about how life would be better if they just weren’t around anymore.

Depression affects millions of Americans, and you are not alone if you are in a relationship with someone with depression. However, this situation can be lonely, especially when not only have you lost the partner you once knew, but you don’t know how or where to get help.

Anne Sheffield, author of Depression Fallout (and several other books about the impact of depression on partners), discusses the stages partners might go through when they are living with someone who is depressed.

Boundary-setting can be challenging in the best of times, trying to balance your needs with the needs and wants of your partner. When mental illness exists in the relationship, boundaries can become non-existent as you try to compensate for your partner.

Why is setting boundaries so hard? Common reasons include:

• You may be uncomfortable expressing your own needs and wants.
• You may be afraid of being seen as selfish.
• You may be feeling guilty about setting limits because you know your partner is struggling.

The problem is, without boundaries, you are going to burn out. Virginia Morris, author of How to Care for Aging Parents, urges people caring for a loved one to get rid of the little voice in their heads that says, “I can do it all. I am responsible for everything…and whatever I do, it’s not enough.”

A popular book by Dr. Gary Chapman, The Five Languages of Love, describes five different ways people express their love for people they care about. He explains that trouble in relationships often occurs when the partners are not “speaking the same love language,” such as when one partner shows love through physical touch but the receiving partner really values receiving gifts as a sign of love more.

Reconciling those differences and making an effort to “speak the language” of your partner can make a difference in the relationship.

How can this apply to your relationship with a partner who experiences mental illness? You can look at it from two perspectives: identifying your partner’s “language of health” and their “language of illness.”

Wednesday’s post discussed obsessive-compulsive disorder (OCD). Hoarding–with lots of debate–is currently considered a type of OCD, but deserves a blog post of its own because of its unique impact on you and your partner’s life.

Let’s start with a definition so that we’re clear that “hoarding” is not the same as “pack rat.” Drs. Randy Frost and Tamara Hartl of Smith College are credited with the widely accepted definition of compulsive hoarding. It is the behavior that consists of: “accumulation of a large number of possessions that seem useless to others; creating living spaces that are difficult to use; and being prone to impairment such as indecisiveness, disorganization, perfectionism, procrastination and avoidance that isolate them from others.”

In layman’s terms: if you as the non-hoarding partner decide one day that you are “gutting the place” because you can no longer sleep in the bed, take a shower in the bathroom, or get to the stove because of the sheer amount of “stuff” around, your hoarding partner is most likely going to have some serious issues with you.

You did it again. You didn’t fold the laundry right, you didn’t wash your hands long enough before touching the lettuce to make a salad for dinner, or you threw away what looked to you like trash, but now has your partner rifling through the garbage can to retrieve because it was “important.”

The rest of the day is ruined and your partner can’t relax until they do something to “make it right again.”

Welcome to the world of obsessive compulsive disorder (OCD).

What people often don’t realize is that OCD is a form of extreme anxiety for the person experiencing it. They can’t stop the thought in their head that they need to do whatever the behavior is, even if they realize the thought is distorted, unrealistic, or out of control.

People with OCD have a “short” in their brain’s wiring system that controls the brakes on distressing thoughts. Like all other mental disorders, it is not something the person can just “snap out of,” although they desperately wish they could.

What must it be like to live with a brain that says you are constantly in danger, and the only way to protect yourself is to perform a certain behavior? And as the partner of this person, what can you do to help?

You come home from work and he’s lying on the couch, much in the same position you left him eight hours ago.

She doesn’t want to go with you anymore to do the things you used to enjoy together.

You find yourself making excuses to others as to why s/he isn’t with you at the party.

Nothing you do seems to help to bring a smile to their face, despite your best efforts, time and time again.

This is the face of depression.

Depression affects not only the person who is struggling, but everyone else the person interacts with as well. As the partner of a depressed person, you can easily wear yourself out, both physically and mentally, trying to make the situation and relationship better. Not only is that not healthy for you, but it is not healthy for the relationship. So how do you keep things in balance?

Bipolar disorder is one of those diagnoses that can be difficult for a medical professional to figure out, let alone someone who has no mental health training.

Bipolar disorder can show up in many different forms, and for both the person experiencing it and their partner, the shifts in mood can be baffling and frustrating. Getting upset can make it worse, but so can not doing anything, either.

If your partner has a bipolar diagnosis, there are a number of things you need to know in order to be a supportive partner.

Even during the best of times in a relationship, misunderstandings and disagreements occur.

When a partner is experiencing an illness, whether it’s mental or physical, the chances of struggles in communication skyrocket. Miscommunication during an illness can literally be deadly if the ill partner does not receive needed treatment because he/she was not able or willing to speak up.

Here are some tips to help with communication during tough times:

• Have a plan before illness strikes. On a basic level, talking with your partner about what to do when illness occurs can prepare both of you for what will happen. Deciding what symptoms or signs of illness equate putting the care plan in motion can relieve stress of the unknown for both partners.

Psychiatric advance directives are similar to medical advance directives in that they are planned out while the patient is healthy, but are used when the patient is ill and perhaps cannot make the best decisions about care. This is typically used by healthcare providers, but must be given to them in order to be followed. Some states have online registries that the staff can access in an emergency. In states that do not, someone must provide the directive to the healthcare staff every time.

Self-care is vitally important when you have a partner who experiences mental illness.

For some people, having an ill partner is a reality of everyday life; for others, their partners may have a period of stability and then relapse, throwing the relationship a curveball and requiring quick adjustments to accommodate.

For either situation, having consistent routines and self-care strategies in place all the time will help you ride the wave of illness and land safely on shore.

Fear.

That’s the “f-word” people often try to avoid or deny, especially when it comes to the implications of mental illness. Partners often report getting angry with their ill loved ones, but psychologists will tell you that anger is a secondary emotion that masks a primary emotion.

That primary emotion is often fear: fear of the illness’ effects on your partner, fear of the illness’ effects on you, fear of what will happen to your relationship, fear of not getting what is needed, whatever that may be, etc.