Bipolar Disorder and Hygiene

While this isn’t a topic discussed very often, hygiene is one of the elements often noted by psychiatrists and therapists when diagnosing or tracking depression, bipolar disorder, schizoaffective disorder, and schizophrenia in patients. Poor hygiene can be a big indicator of depression, psychosis, or mania, and I thought today I would discuss my own experiences with this a little bit.

The simplest place for me to begin is probably with depression. I often use a three-tiered rating scale for my depressive symptoms, where a 1 is considered mild and a 3 is quite severe.

My hygiene usually starts to slip in phase two. At that point I have been struggling to keep up with things like daily chores, social situations, and my motivation might be completely devoid or I have lack of caring for most of the things going on.

When I feel overwhelmed and like I can’t catch up with all of the things I am supposed to be doing, it usually means I start cutting corners. I’ll eat my eggs with a spoon so I don’t have to do the dishes. I’ll wear the same thing every day for a week so I don’t have to figure out a new outfit. Likewise, my time in the shower will start to slip from every other day to every three or four days.

Part of it is about not feeling like I have enough time to get everything done, but another part is simply about not wanting to. When I am forcing myself to attempt to get the dishes done, it takes a lot of time and energy to do so. Generally the more depressed I get, the less energy and motivation I have. Activities that may have happened on a daily basis become less and less frequent, and that includes everything from leaving the apartment to showering.

Another aspect of the hygiene problem for me comes from the shower itself. If I am on the couch I might be able to keep my mind somewhat occupied by the TV. If I am in bed I could try to read a book. When I’m in the shower though, I am left entirely with my own thoughts. If I am depressed and take a shower, I feel almost exclusively worse coming out than I did going in. So what do I normally do in regard to triggers? I avoid them.

When phase 3 of depression rears its ugly head it means I am grappling with severe suicidality. Every minute feels like a constant battle with myself, and I care less and less about the things around me. In this place it is far more than a lack of motivation that keeps me from taking care of myself, it is like being caught in a net in my own mind, and if I don’t spend every waking moment trying to free myself from that net I will be trapped there forever.

When that happens, good hygiene is not even remotely on my radar. Everything external became extraneous, and I can’t help but be convinced that shaving my legs wont have anything to do with making it through the episode alive.

As far as mania is concerned (as I can perform everything fairly well while hypomanic) the issue is similar to phase three of depression, except that attention that I have turned inward when suicidal is turned outward when I experience mania. The attention and focus I have on one small detail often consumes me, and my priorities around normal external things (like sleep, eating, bathing) evaporate. It isn’t about losing motivation, on the contrary -I find my motivation so consuming I can’t think to focus on anything else.

Similarly, there are times when I am manic where I feel sort of above the law, if you know what I mean. Something larger or more meaningful than the average person, and in those moments I can say that my slightly delusional mind finds basic hygiene below me.

The issues I have regarding hygiene and psychosis might only really make sense if you have experienced it. There have been times where I have felt so paranoid and fearful that standing behind a shower curtain (and not being able to see what is on the other side) is impossible. Other times I have feelings of violence and rage so intense I don’t feel comfortable leaving my room or the presence of another person… which puts bathing somewhat out of the question.

Honestly, I think the issues we face in regard to maintaining good hygiene is not something understood by most people. Those that have not experienced the entanglement of depression, the overwhelming focus of mania, or the abrupt fear of psychosis may fail to grasp how difficult it can be to focus on oneself and follow through when there are so many symptoms guiding me away from bathing or changing my socks or brushing my teeth.

I guess I just wanted to make a point of explaining that poor hygiene isn’t always a product of laziness or a brazen lack of adherence to social standards. There are times when a lack of energy or motivation can put the kibosh on taking care of our hygiene, as well as times when our symptoms are severe enough to engross us so fully that our goal is merely survival and nothing more.

In a society where a “bad” outfit or poor hygiene can make one the product of ridicule, I think it is important to remember that there may be factors in any given person’s situation that we may not know about. When people can be so quick to judge, sometimes I feel like the most support can come from the person who simply gives me a break.

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19 responses to “Bipolar Disorder and Hygiene

  1. I’ve struggled with this for my whole life. I don’t talk about it much because I feel like people will judge me. It’s definitely a function of my depression, but my anxiety also plays a huge role, especially when it comes to showering.

  2. AMEN! This is spot on. Dr. CaresALot had to call me earlier this week to ask me if I’d showered and then told me to shower. I’m not a dirty person – I end up sobbing in the shower. Your brain, when it’s not functioning is essentially telling your body – you can die now… so you don’t need to eat or bathe or care… just lay there and die. At least that’s what mine does. So every time I am faced with showering or dressing or eating a meal – it’s like I’m stabbing my brain where it hurts the most and it’s exhausting. It’s freaking exhausting.

  3. And i read this as I sit here not having bathed in 3 days… Manic or depressed? Not even my hygiene can tell me. Great post 🙂

  4. Me and my perpetual furry legs salute you and this post!

    Like are you kidding me I would put up with days of discomfort because I cant bend down to reach them.. just to have shiny legs.. that are too tired to be shown off…..

    Now I just embrace my inner (and now outer) hippy 🙂

  5. Just Plain Ol' Vic

    Great article. I am quite OCD about keeping the house neat and at times very much at odds with my wife, especially if she is depressed. We now better understand each others triggers, so it does not become a huge point of contention.

  6. If I manage once a week, I’m happy. Woo chronic fatigue and scumbag brainery… and dry shampoo.

  7. cutting corners .. that sounds like me every day. I dress like a slob, I “recycle” clothes, I put off showers for days, I just don’t care. It gets worse during a nasty spiral, but every day is bad enough. Unfortunately, I have to keep up appearances at work every day, so I can’t let things go too long. I know people notice, but I can’t bring myself to care. Just showing up at work and performing my job takes all the energy I have.

  8. This sounds exactly like me, when I am in the depths of my depression. Your post is really good, and explains what it is like very well. As hygiene definitely tends to take a back seat..when you are stuck in that awful depression place.

  9. Just me, my thoughts, and this scolding water hitting my skin. Nothing to fear. Maybe if I try a bath I’ll relax and that’ll be better…? Bath time, more sobs! You can’t escape the incompatibility that comes along with hygiene and your mental state at times.

  10. Love this. Just did a blog entry on showering myself. Spot on!

  11. Thank you for this great post. I’ve found that taking a bath is less overwhelming and exhausting, and that shower curtain stays open!

  12. Great post! I really struggle with not wanting to get wet. I feel like a cat sometimes. When I am depressed I hate to shower. When I am manic I have no patience for it. But when I am hypo manic I am always clean and well put together, because I need to share my greatness with the world! If only I could be hypo manic all the time. ..life would be great!

  13. How does someone approach a loved one who you suspect has a bipolar disorder (has terrible issues with hygiene for herself and kids) who has admitted to feeling depressed and exhausted- but refuses to see her doctor (because meds don’t work for her). She’s impoverished and therefore feels unable to afford “decent” help for her depression ( which I feel, through observation, is much more than depression). There has been diagnosis of bi-polar, anxiety disorder, depression in her extended and immediate family.

    Your blog has offered me hope for her – I just need to understand how to approach her in a loving and supportive way so that she accepts that she needs help.

    • I know firsthand that this is a really tough spot to be in and unfortunately there isn’t much that can be done when someone is refusing to seek help for themselves but this post (a sudden change of behavior in a loved one) has some ideas on how to broach the topic in a caring way. In many situations I’ve found that simply encouraging someone to see a counselor can be very helpful because often counseling can provide the tools to help people recognize that they need help in the first place, and if this person has had a hard time with medications in the past counseling might be a good option anyway because it can provide ideas for other ways of coping with depression (or more). Ultimately it is important to remember that treatment for this person is not something within your control, and while I realize that is the most difficult part it is also one of the most important elements for keeping yourself healthy. Good luck!

  14. Does anyone know of or recommend a similar post/blog/forum covering schizophrenia/schizoaffective disorder?

  15. I thank you for your post. I thought maybe it was just me – but now I know it is not and that alone feels better. I have found that I get panic attacks in the shower and just going near it makes me a nervous wreck. I do have one thing that helps a little bit and that is loud music that you enjoy played in the bathroom while you shower. If you try to sing along or hum, or whatever – it tends to act as the TV does in the living room to divert your mind from going to places you cannot tolerate going. It helps me at times, but at this moment, I am sitting here 9 days unbathed so I guess it is obviously no cure-all either. I say to any and all who are reading this – please try to understand people with mental issues – we are not as you seem to like to label us – like lazy, weird, gross, etc. We struggle with the smallest of things and we would not wish an hour in our heads on our worst enemies….and to those who are reading this who are the other unbathed people out there – hang tough! I can’t say anything perky and positive to make you feel great suddenly – but do keep putting one foot in front of the other. Some days you will see that it is worth the effort. 🙂

  16. Great article. Thank you for your honesty. Now, I don’t feel alone with my hygiene struggles. I tell myself, “you have to shower, brush your teeth, etc.” because that is what a normal (not mentally ill) person does. Cheesy, maybe, but it works.

  17. I am beyond that. I can go a month without showering. It’s gross.

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