More threads by Daniel E.

Daniel E.

daniel@psychlinks.ca
Administrator
How to Care for and Cope With a Bipolar Spouse
Health.com

If you're involved with someone with bipolar disorder, the romantic relationship may be exciting, exhausting, and stressful. But it will rarely be easy, especially if the object of your affection doesn't comply fully with treatment.

Bipolar disorder can be nearly as traumatic for the partners of those with the disorder as it is for the patients themselves. The episodes of depression and mania that bipolar people experience—which can lead to emotional withdrawal, out-of-the-blue accusations and outbursts, spending sprees, and everything in between—have been shown to induce stress, sexual dissatisfaction, and money worries in their partners, as well as depression. Depressive phases, during which the bipolar partner feels hopeless and sad, can drag a healthy partner down, too.

"Mental illness is, on some levels, a contagious disease," says David Karp, PhD, a professor of sociology at Boston College who has studied interpersonal dynamics within bipolar couples. "It brings out very strong negative emotions and feelings of isolation in the partner, who struggles so hard to separate the illness from the patient."

Relatively few studies have been conducted on the effects of bipolar disorder on relationships, but the research is nearly unanimous that the disorder tends to cause both practical and emotional difficulties for couples.

For starters, the ups and downs of bipolar disorder can disrupt the rhythms and routines of a household. In a 2005 survey of people with bipolar partners published in Bipolar Disorders, more than half of the participants reported that their partners illness had reduced their socializing, required them to assume more household responsibilities, forced them to take time off of work, and caused financial strain. The participants also reported that their sex lives sagged when their partner was in a manic or a depressive phase; three-quarters of the women who were interviewed and 53% of the men complained of infrequent sex when their spouses were depressed.

Another study of bipolar caregivers found that 86% of the participants characterized the stress they experienced as a result of their partners illness as "major." And 9 out of 10 said they found it difficult to keep the relationship going.

Building a team for support
Many people enter into relationships with a bipolar person unwittingly, thinking it will be smooth sailing, says Adele Viguera, MD, a psychiatrist at the Cleveland Clinic who works with bipolar couples seeking to start a family. "Maybe they meet the person when the person is hypomanic, not realizing that mood can change," she says.

Tim, 37, tried for three years to sustain a relationship with a woman eventually diagnosed with bipolar disorder. "She would cycle between extreme happiness and depression," he says, recalling her paranoia, impulsiveness, and self-destructive insecurity. "She broke up with me and started dating other people, and then when I dated other people she tried to win me back." Like many people with bipolar disorder, Tim's girlfriend also struggled with drug and alcohol addiction and got deep into debt—with his credit card. Tim eventually broke down emotionally himself, ended the affair, and tried to forget the experience. "Half of me moved on, but half of me will always love her," he says.

Divorce and separation are common in relationships involving bipolar disorder, but according to Dr. Viguera, such relationships don't have to be destructive and separation is hardly inevitable. Both parties have to participate in its success, however. "Taking care of bipolar disorder is a team effort, involving the two people and a psychiatrist or other mental health professional," she says. While she would never speak to a spouse without her patients consent, such open communication empowers both parties to make treatment decisions that lead to a healthier relationship.

Mental health professionals aren’t the only ones who can lend a hand. The stigma of mental illness can make couples hesitant to look elsewhere for help, but Karp emphasizes that extended family members and trusted friends can all provide invaluable support. "Spread it around a little bit," he says. "People need support systems. By keeping the illness a secret, people place an additional burden on themselves." Karp also recommends that anyone who cares for someone struggling with bipolar person find a support group in their area.

Bipolar marriages can work
Fred and Kristin Finn, of Grand Rapids, Mich., describe their marriage as loving and supportive, despite that fact that Kristin was diagnosed with bipolar disorder as a teenager. Their teenage daughter has also been diagnosed with the disorder.

The pillars of their success, both say, are open communication (Fred is free to reign in Kristin's clothes spending when he thinks she is manic) and predictable schedules. Kristin says carving time out for her own sleep is crucial, as is making time for each other. "We make sure that every Friday night we set aside time for each other,” she says. “Every single Friday night he comes home from work, we turn on some music, we sit, and we talk. My family and friends know—nobody calls us during that time period. Nothing can keep us away from our Friday night, because its our time to connect."

For his part, Fred says he would encourage anyone involved with a bipolar patient to educate themselves as much as they can about the disorder. You may not always like what you learn, he warns, but keeping surprises to a minimum makes your relationship easier to navigate. For example, he says, he is worried about the long-term effects of medication on Kristin's health. And while both his daughter and his wife comply with medication and therapy, neither is symptom-free.

"No matter what you're doing, there will be symptoms," Fred says. "Once I learned about how the symptoms manifest themselves, once I started reading that and becoming more familiar with that, it gave me a better understanding of how to cope with these things. Getting angry because a person has bipolar disorder won't help anything. Bipolar is treatable, medications and counseling help a great deal, but there's still things about bipolar disorder that I don't think I'll ever figure out."

This is a perfectly healthy stance to take, according to Karp. He urges people with bipolar partners to remember what he calls the "four Cs": I can't Control it; I didn't Cause it; I can't Cure it. All I can do is Cope with it.
 

Daniel E.

daniel@psychlinks.ca
Administrator
My advice (mostly learned the hard way):

1. Avoid partnering with someone who thinks therapy is a waste of time.
2. Do not "engage" when being yelled at. Walk away.
3. If overspending is an issue, secretly save some money in a separate bank account just in case. This also gives you more freedom to leave the relationship or temporarily separate if need be.
4. Develop friendships and spend more time with your other family members. You will need them when the going gets tough.
5. Pick your battles but don't walk on eggshells.
6. Go to therapy yourself, especially if your support system is lacking or you have a disorder yourself.
7. Go on more "date nights" even if you have to encourage your spouse into doing so until it becomes routine.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Now my spouse has again the "more is not enough" syndrome. He wanted a goat this morning. When I told him the realities of taking care of a goat, now instead he is repeating his desire to get a fifth dog later at some point -- since he still wants a big dog even though he is the one who adopted three dachshunds and a chihuahua. We already agreed (I thought) not to get any more pets given the cost involved. And it would be hard enough to go on a road trip with four dogs since most hotels only allow two per room. We have no money saved for retirement.

I am thinking of leaving him sooner than later again because it is just exhausting having these arguments every few months. When he was insisting on getting a goat this morning, I told him I would leave him.

Things finally got good after we had a huge argument a few months ago -- which he started when he was having another bipolar episode. And now he is trying to rock the boat again. After our last huge argument, I drove away and told him I was done. But I came back after driving 300+ miles to New Mexico.

Now he has calmed down but I'm sure he will bring up the dog issue again within a couple months. But I am thinking of leaving him regardless since I am getting tired of it all.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Bipolar and narcissism: Is there a link?

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) does not list narcissism as a symptom of bipolar disorder. However, when a person with bipolar experiences an episode of mania, they may display some narcissistic behaviors, such as high levels of confidence, feelings of self-importance, elevated energy levels, and grandiose self-perceptions.

Because bipolar and NPD have some similar symptoms, the two conditions can be confused. This can result in people with bipolar being diagnosed with NPD and vice versa.

During periods of depression, a person with a bipolar disorder might also display narcissistic characteristics. For example, a person might neglect caring duties, avoid social contact, or appear insensitive to the needs of others.

This might seem to be narcissistic, but it is more likely that the person is so overwhelmed by their own negative emotions that they may not notice others people's feelings.

To diagnose someone with a personality disorder such as NPD, a doctor must be sure that another condition cannot better explain their symptoms. So, when narcissistic behavior is due to depression or mania, the DSM-5 argues that it is not appropriate to make a diagnosis of NPD.
 

Mari

MVP
I am thinking of leaving him sooner than later again because it is just exhausting having these arguments every few months. When he was insisting on getting a goat this morning, I told him I would leave him.

What a difficult position to be in! Curious, why does he want a goat?
 

Daniel E.

daniel@psychlinks.ca
Administrator
Yes, including Abilify. And he self-medicates with medical marijuana, which is fortunately less expensive than it used to be.

It's just hard to be excited about a relationship when you know for sure you will be yelled at sooner or later for something trivial. And some of our values are still very different. He doesn't care about me saving for retirement since he is already in retirement age. He is 60, and I will be 43 this year.
 

Daniel E.

daniel@psychlinks.ca
Administrator
What a difficult position to be in! Curious, why does he want a goat?

He wanted a goat for the novelty factor and to eat the weeds. But I convinced him the goat would ruin our cars unless he paid to fence more of our property. So now he has no interest in a goat -- for now anyway.

(A number of people in our area have goats, but goats are good at escaping and he doesn't even like goat milk/cheese.)

And he reluctantly seemed to agree today that he won't get a big dog. But he has done that before. We actually got a big dog last year, but it kept trying to run away. So we gave it to a friend. And then he got a chihuahua instead.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Intermittent explosive disorder - Wikipedia

Intermittent explosive disorder (sometimes abbreviated as IED) is a behavioral disorder characterized by explosive outbursts of anger and violence, often to the point of rage, that are disproportionate to the situation at hand (e.g., impulsive screaming triggered by relatively inconsequential events). Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst (e.g., tension, mood changes, energy changes, etc.).

The disorder is currently categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the "Disruptive, Impulse-Control, and Conduct Disorders" category. The disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder...

Bipolar disorder has been linked to increased agitation and aggressive behavior in some individuals, but for these individuals aggressiveness is limited to manic and/or depressive episodes, whereas individuals with IED experience aggressive behavior even during periods with a neutral or positive mood. In one clinical study, the two disorders co-occurred 60% of the time. Patients report manic-like symptoms occurring just before outbursts and continuing throughout.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Today is going well, as did most of yesterday. I am checking his pill box each morning -- at his request -- since he forgot to take his meds two mornings in a row (on Wednesday and Thursday this week).
 

Daniel E.

daniel@psychlinks.ca
Administrator
Hopefully I will be moving out soon. I was on the receiving end of another rage/verbal attack. It is getting real old. I took care of him all day today and yesterday since he had a minor procedure on his foot. And my reward is being yelled at to the point that all of the dogs are afraid and under the bed. I was hoping he would get better with age or something but it feels like trying to expect a dog not to bark.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Ironically, I would probably cope better with his BS if I were in therapy. But he gave such "tantrums" about the cost of therapy, that I stopped going after two sessions since he agreed to save money and stop getting marijuana. Of course, that was another lie/delusion.
 

Daniel E.

daniel@psychlinks.ca
Administrator
As usual, he apologized today and things got back to normal by late morning. Every time this happens, I try to tell him that there is no reason to yell, e.g. who did I kill? :D And I reminded him that it activates my fight-or-flight response, e.g. I was looking at apartments last night and thinking of moving to another part of the country.

He already talks loud, so when he yells, it is really, really loud. I did find another suggestion on dealing with rages -- to try to switch the target to something else.
 

Daniel E.

daniel@psychlinks.ca
Administrator
My advice (mostly learned the hard way):

1. Avoid partnering with someone who thinks therapy is a waste of time.
2. Do not "engage" when being yelled at. Walk away.
3. If overspending is an issue, secretly save some money in a separate bank account just in case. This also gives you more freedom to leave the relationship or temporarily separate if need be.
4. Develop friendships and spend more time with your other family members. You will need them when the going gets tough.
5. Pick your battles but don't walk on eggshells.
6. Go to therapy yourself, especially if your support system is lacking or you have a disorder yourself.
7. Go on more "date nights" even if you have to encourage your spouse into doing so until it becomes routine.

I would add to my list:

Remember why you liked him/her in the first place. And as with most disorders, there is usually a positive side somewhere, like being the life of the party or being more alive/exuberant, driven, charming, or outgoing in general -- "the bipolar advantage."
 
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