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Can a relationship survive mental illness?

Mental illness can put a huge strain on relationships. When one partner is struggling with anxiety, depression, bipolar disorder, or other mental health conditions, it affects both people. The healthy partner may start to feel like a caretaker and might feel overwhelmed or burned out. The partner with mental illness might feel like a burden and withdraw. However, many couples do survive mental illness. It takes work, commitment, good communication, professional help, and viewing mental illness as something to manage together rather than something to blame.

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How does mental illness affect relationships?

Mental illness affects relationships in many ways:

Communication struggles

Symptoms like low mood, low energy, irritability, and poor concentration can make it hard to communicate effectively. The ill partner may withdraw or lash out during an episode.

Role changes

The healthy partner often takes on more responsibility for things like finances, chores, and childcare. They may start to feel more like a caregiver.

Intimacy problems

Depression and anxiety frequently interfere with sexual intimacy. Medications can also blunt libido. Partners may stop feeling emotionally close.


Partners stop engaging in fun activities together. The ill partner spends more time isolated while the healthy partner shoulders more responsibilities alone.

Financial stress

If mental illness interferes with work, relationships often struggle financially. Affording treatment also strains budgets.

Poor Boundaries

The healthy partner sometimes gives too much or enables destructive behaviors. The ill partner may blame their condition for poor treatment of others.

Role reversal

Children sometimes take on emotional support roles for a parent with mental illness. This role reversal strains the partnership.


The healthy partner often experiences exhaustion from compensating in so many areas long-term. They may develop resentment.

How can couples support each other through mental illness?

Partners need to approach mental illness as a shared challenge to overcome together rather than an individual problem. Steps couples can take include:

Seeking treatment

A combination of medications and psychotherapy is important. Partners should be patient and understand treatment is an ongoing process.

Adjusting expectations

Couples should set small, manageable goals and celebrate small victories. Perfectionism stresses relationships.

Good communication

Regularly discussing feelings and needs in a caring way keeps couples connected. Partners should listen without judgement.

Sharing the load

Making accommodations like having the healthy partner handle more chores can prevent burnout. But the ill partner should contribute what they can.

Being compassionate

Couples should remember they are on the same team. Blaming each other creates distance.

Respecting space

Time apart helps the healthy partner recharge. But staying engaged is still important.

Planning fun

Making time for simple pleasures reminds couples of their love for each other.

Setting boundaries

Partners must reinforce respect in the relationship. Enabling destructive behaviors helps no one.


Therapy helps both partners process emotions and communicate constructively.

Support groups

Connecting with others going through the same challenges reduces isolation.


The healthy partner also needs outlets to manage their own stress. Burnout makes supporting their partner impossible.

What are signs a mentally ill partner is abusive?

Sometimes mental illness co-occurs with verbal, emotional or physical abuse. Warning signs include:

Crossing major boundaries

This includes behaviors like physical violence, abandoning major commitments or stealing money.

Refusing treatment

An abusive partner denies having a problem or refuses treatment to avoid being held accountable for their actions.

Blaming mental illness for everything

While mental illness contributes to behaviors, it does not excuse crossing big boundaries. Abusers use it to escape responsibility.

Picking and choosing symptoms

Abusers conveniently have symptoms when it meets their need and act fine at other times. Genuine symptoms are more consistent.

Having capacity to meet their own needs

Abusers can mobilize capacities likes energy, concentration, money management, etc when they want to. Illness impairs these capacities more uniformly.

Making threats

Threats that instill fear are rarely due to illness and usually are tools of control.

The victim feels afraid

Targets of abuse often rightly sense they are in danger. Their intuition should be respected.

The behavior is entrenched

Someone who has shown a pattern of abuse over time is unlikely to change. Promise of change often hooks victims.

Isolating victim from support

Cutting a victim off from others allows more control. This is purposeful behavior.

Mind games and gaslighting

Messing with someone’s sense of reality is abuse.

Warning signs a relationship can’t survive mental illness

Though many relationships manage mental illness successfully, some warning signs indicate conditions are toxic:

Things are getting worse, not better

Despite repeated efforts at treatment or setting boundaries, the situation continues to deteriorate.

Caregiver burnout is severe

The healthy partner has completely depleted their mental, physical and emotional reserves. They have nothing left to give.

Repeated major boundary violations

The ill partner regularly crosses big lines like violence, infidelity, or financial abuse with no change.

The ill partner blames their condition for everything

They take no responsibility for hurting others and show no remorse. Everything gets excused.

Substance abuse issues

Untreated substance abuse disorders exacerbate mental health conditions. The partner refuses to get help for either.

The ill partner exploits their condition

They wield their illness as a weapon or use it to manipulate others.

Kids are suffering

Children feel abandoned, engage in risky behaviors, or develop mental health issues themselves.

All joy is gone

The relationship feels like miserable drudgery. Partners cannot recall the last time they had fun together.

A partner is in danger

A mentally ill partner engages in severe physical violence, threats, refusing medical treatment for kids, or other dangerous behaviors.

No trust

A betrayed partner no longer feels safe being vulnerable or dependent after many violations.

No honesty

The ill partner deceives the other repeatedly about symptoms, treatment compliance, or behaviors like substance abuse.

No shared future vision

Partners want fundamentally incompatible things like having kids or pursuing careers that conflict.

Is breaking up always the answer?

Ending a relationship should not be the default answer when mental illness puts strain on a couple. While unacceptable abuse or toxicity sometimes does require splitting, other situations may be workable.

Factors to consider before giving up include:

How does the partner with mental illness behave between episodes?

Someone who is caring and committed when well may deserve patience.

How long have symptoms gone unmanaged?

Getting into treatment can significantly improve the situation over time.

Is your partner willing to acknowledge the problem and seek help?

Someone in denial who refuses to get care likely won’t improve.

Are you still bonded and in love during stable periods?

If so, affection could see you through.

Do you have a strong past foundation as a couple?

Long history together makes weathering the storm easier.

Does your partner show remorse and willingness to change?

If so, they may do better in the future, especially with treatment.

Are your dealbreaker lines still intact?

Violence, infidelity or other major betrayals may cross lines that can’t be uncrossed.

Are children involved?

Unless the situation is dangerous, preserving stability for kids may be worth trying.

Have you tried counseling together?

If not, professional help may still improve communication and increase understanding.

When is it time to let go?

While sticking it out through mental health challenges can be worthwhile, sometimes reaching the end of the road is the right choice. Consider splitting if:

Your safety is threatened

You should not stay in a relationship that puts your physical or emotional safety at risk. Seek help.

Trust and respect are broken

Patterns of dishonesty and boundary violations destroy bonds. Without them, moving forward seems impossible.

One partner is unwilling to get help

You can’t force someone to get treatment. If they won’t pursue it voluntarily, the situation may be unworkable.

Efforts to improve have failed

Despite counseling, treatment, boundary setting and sincere efforts, the core issues remain.

Children are being harmed

If the ill partner engages in child neglect, violence, substance abuse or other behaviors that threaten kids’ well being, separation may be necessary.

Caregiver burnout is terminal

Supporting someone with severe, untreated mental illness is unsustainable long term. Save yourself if you’re depleted.

Abuse is present

You should always leave relationships that involve domestic violence or other abuse. Set the boundary that this is unacceptable.

Your visions don’t align

Over time, one partner wanting marriage, kids or a career that the other doesn’t agree to usually necessitates splitting up.

The cons outweigh the pros

Make a list of all the good and bad aspects of the relationship. If the cons tilt the scale after honest evaluation, it may be time to go.

How should you break up with a partner with mental illness?

If splitting up is the right choice, consider these tips for ending the relationship with someone struggling with mental health:

Have the conversation at a stable time

Don’t break up while your partner is in crisis or extremely symptomatic. Wait until they are relatively calm.

List your reasons objectively

Don’t get dragged into blaming. State why it is not working matter-of-factly.

Share your decision compassionately

You can acknowledge love while still explaining why the relationship is no longer tenable for you.

Avoid threats or demands

Ultimatums don’t help. Simply state your choice.

Have practical next steps mapped out

Discuss logistics like moving out, separating belongings or telling family and friends.

Get professional help

Therapists can mediate challenging conversations like break ups. Having support present is wise.

Check on their support system

Ensure your soon-to-be ex has others to lean on so they don’t spiral into crisis.

Set boundaries

Be clear on what contact, if any, you are willing to maintain going forward. Refusing to engage around accusations also helps.

Have self-care planned

Take comfort in knowing you have counseling, friends or activities lined up to help you through the transition.

Suggest constructive parting thoughts

End by expressing hope your partner will take care of themselves, rather than with criticism.


Mental illness presents huge obstacles in relationships. While tough, many couples do successfully manage conditions like depression or anxiety together. They take a team approach of mutual support, compassion, open communication, professional treatment and reasonable accommodations. However, sometimes mental illness or refusal to get help can irreparably damage bonds of trust, respect and safety. At that point, splitting up, even though painful, becomes the only viable option. Having social support and self-care practices in place makes both weathering mental health challenges and dissolving relationships easier. With planning, understanding and the right assistance, it is possible to endure or escape toxic relationships and build satisfying partnerships.