Expert: Ivan Goldberg, M.D. - 4/25/2010

Question
I have some decent experience (2 years) with a past ex who exhibited many and very obvious signs of MPD (Multiple Personality Disorder), now the new correct term, I believe is Dissociative identity disorder (DID). A dear friend has many signs, but quite different and unfamiliar to me. She's virtually impossible to broach the subject with, due to extreme denial and defensiveness, even anger. It has been brought up in the past, to my knowledge, by mental health professionals and her ex husband of 10 years.  She's also diagnosed with bipolar and I was wondering how the 2 interact and how one can worsen or trigger the other. I don't know if I have the energy to sustain this relationship. I would love to. She's an amazing friend, but I'm so very confused as to what to do to help or cope. Any advice is welcome.

Answer
Hi Amanda . . .

I think there is only one way that you can maintain a friendship with your friend. That would be for you to just be her friend, enjoy sharing experiences, and in no way trying to confront her with the reality of her problems. Because of the complex nature of her psychopathology even this will turn out to be a challenge. The more involved you get with discussions of her problems the more rapidly the relationship will become impossible.

You might find the following to be of some use to you:

Things to Say to Someone With Depression
Posted: 12 August 2007 Comments: 115

A recent post was titled Ways to Insult Someone with Depression. This post is the flip-side, with things to say that are helpful.

1. Be On Their Side
The depressed person will often be defensive, so an accusatory tone is not helpful. Try to convey a sense of understanding. It isn’t helpful to say “Why can’t you just get out of bed?” Instead try “You seem to have trouble getting out of bed in the mornings. What can I do to help you in this area?”

The person may have lost perspective on how big a problem actually is. They will find it hard to hear that what is insurmountable for them is actually not such a big deal. It is unhelpful to say “What’s your problem? You’re upset about nothing.” Instead try “You seem to be finding this issue a big deal at the moment. Can we solve it together?”
When I was very sick, I often thought that my wife was trying to ruin my life. To counter that kind of thinking she would often say “We are a team. I am on your side.”
Depression is an awful illness, a whole world away from pure sympathy-seeking. So you should treat it as such. “I trust you. If you had a choice in the matter you wouldn’t choose to have depression. How about we search for some solutions together?”

2. Give Plenty of Reassurance
Many people suffering with depression feel unworthy of being loved. You need to reassure them frequently. For example “I love you for who you are. I am not going to leave you.”
In a similar vein, they may have lost the ability to recognize their positive attributes. You might reaffirm them with “You are a sensitive person who cares for others” or “People really love you a lot. They think you’re a great person.”
If said repeatedly and with absolute sincerity then it is helpful to say “If you ever need a friend, I am here.”

3. Give Understanding and Sympathy
People with depression can spend a lot of time ruminating on their situation and feeling sorry for themselves. Pointing it out to them is not helpful. Instead, try to sympathize.
“I can’t imagine how hard it is for you, but you have all my sympathy.”

“All I want to do is give you a hug and a shoulder to cry on.”

“I can’t honestly say that I know how you feel, but I want to help in any way I can.”

4. Offer to Help
“Let me do anything you need me to do to help.”

If you ask “What is the best thing I can do to help you right now?” don’t be offended if the reply is “Leave me alone”. Sometimes, that is the most helpful thing you can do at present.
Well meaning people often attempt to immediately fix the problem. “Have you tried aromatherapy? There was an article about it in the paper…” . This kind of comment can come across as trivializing the illness. If you want to introduce a treatment idea, make sure you are respectful about the seriousness of depression. “It’s important that you stay on your medication and keep seeing your doctor. I’ve found some information on aromatherapy. Would you like to look into it with me?”

While it is important to accept the person in the state they are in, don’t let it totally consume your life. Otherwise, you’ll fall in a heap and won’t be much help to anyone. You need to take care of yourself. “I am committed to you and to helping you. But I also need to eat / shop / go out for coffee / ring a friend / see a movie to recharge my batteries. Then I can look after you better.”

Source: http://www.findingoptimism.com/blog/healthy-mind/ways-to-build-up-someone-with-d...

Best regards . . .

Ivan
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