An Uncertain Impairing Traumatic Relationship within the Circle of Rejection, Anger, and Freedom: An Interpretive Phenomenological Analysis of the Subjective Burden of Caregivers of Patients with Bipolar Disorder

Introduction: Bipolar disorder is a huge burden for the caregivers of patients. Negative impact of living with individuals with mental disorders can be either objective or subjective. Subjective burden is more complex than the objective burden and less studied. This study aimed to investigate subjective burden through the lived experience of caregivers in their interactions with patients with bipolar disorder. Method: This study was carried out qualitatively through the Interpretive Phenomenological Analysis (IPA) framework. A semi-structural interview was used for Iranian participants in 2020 that was conducted online via WhatsApp and Skype applications. Eight caregivers of patients with bipolar disorder were selected via targeted sampling. Results: Three super-ordinate themes were identified: achieving an objective view of the patient (denial of bipolar disorder, accepting the existence of a problem, a paradoxical perception of the patient, making a subject-object relationship and different explanations for bipolar disorder); the cycle of rejection, anger, and freedom (rejection of patients by caregivers, patients' anger, decreased caregivers' freedom and decreased patients’ freedom) and the process of psychological trauma in caregivers (emotional contagion, fusion between the patient and the caregiver, anxiety and trauma). Conclusion: Results specified the principles of appropriate communication with patients for caregivers which can reduce subjective burden in caregivers. Future studies can benefit from this phenomenological approach in developing novel psychological interventions for caregivers of patients with bipolar disorder.