Expert: Libby Bonner - 11/28/2008

Question
My wife and I have been married for 7 years. Four years ago, she was involved in an auto accident that has left her with the need for pain management. Prior to the accident, we had incidents that fall within the symptoms of bipolar disorder. Sudden violent outrage at minor issues. Followed by crying and remorse. Sudden spending sprees when finances weren't there. Then 1 or 2 days later, regret it and penny pinch again.
Since the accident, she has escalated. Her rage has gotten more physical. She has had affairs (sexual). She has disappeared for a couple of days at a time with the children. She left one Friday fter the children got out of school and didn't come home until Sunday. Had traveled to upstate and spent time with a "guy" she had recently met. Then everything was to be back to normal with never mntioning it again. She requires this silence of the subject on almost all of her actions. (If I love her, then I wouldn't mention it and we move on.)
Just recently, we were all lovey dubby for days, to the point our children said they were being grossed out. Then it changed in a mattr of 2 hours. One minute I'm washing her back, next minute she's gotten dressed and goes out "by herself" until 3AM. Two days later, I'm out of house, she takes kids and has a "sleepover" at a guy's house who was the "good samaritan" and unlocked her van when she left kids inside.
She's always taken Xanax since I've known her. Now since the accident, her varieties of medications are methadone, oxycodone, valium, something called flex-something or other for muscle spasms, xanax, amd relpax? for migraine headaches. She's had moments of dizziness, and has gotten where she forgets a lot of things. As well as times of extreme fatigue.
What can I do? And how? I still love her, but if something doesn't happen, I need to leave so she doesn't bring her wrath on the kids.

Answer
I'm not sure I have answers to your very difficult question/s.  You have been going through a lot, and I'm sorry.  

I hope that if you leave, the kids will go w/ you.  Yes?  Or custody  would be awarded to you?

I am amazed that she can drive safely w/ that med load, by the way.

Now, I need some info re the accident and events following.  Did she have a concussion or other severe closed injury to her head?  If so, that might account for behavioral changes.  [The med load is a possibly a factor causing current behavior, perhaps.]  Did she need in-patient rehab?  Out-patient rehab?  How long?

Has she ever been a pt, in- or out-, at a pain center?  How many docs are prescribing for her?  One doc, or more?  Doc/s is/are: family doc, neurologist, pain specialist, other ???  If other/s, pls name the specialties.

Have you ever been w/ her to any doc appts?  Could you go with her to some appts?  

If more than one doc is prescribing, it's possible none knows all of her Rxs.  Something you could do immediately would be to make all docs aware of her meds.  IF they cannot talk w/ you, they do have to listen to you:  you can write to each, or you can leave a detailed message w/ a doctor's NURSE [not any other office person.]  This would have to go into her chart/s, and it will get read.

The behavior you describe prior to the accident doesn't strike me as typical bipolar behavior.  It's certainly inappropriate behavior, but the rage, the spending, all seem too brief.  And the remorse is unlikely, typically.  More typically, the pt would barely be aware OF the behavior and very unlikely to be repentent....and very unlikely to be able to rein in the behavior.  It would also be more likely that the spending, the rages, would be intermixed and occur roughly within the same span of days/weeks.    ---- I don't however, have an alternate diagnosis to suggest, unless it might be a personality disorder.    --- The sex, even, doesn't seem to be bipolar....the bipolar hypersexuality would be inexplicable, probably even to the pt, and would co-occur w/ the spending, the rages, the everything.

I would be glad to have you provide more info.  If I shouldn't hear from you, I would be hoping that one of the current docs would suggest a psychiatric consult.  [If she were to be referred to a pain center at this time, you could assume that there would be a psychiatric evaluation, among many other tests and evaluations.] And I would look hard at the accident again, re head injury.  AND I certainly would want to know about those meds....

There is a book that I often recommend to families to help them manage communications w/ pts more effectively.  It may help you to negotiate some of your issues w/ her but - again - all bets are off to some extent, again because of the meds.  But it's inexpensive and well worth the money if it will help you contain some of this behavior and help you feel less powerless.  Author is Woolis.  Title is When someone you love has a mental illness.

Last thought.  If you two share the same family doc, make an appt for yourself, tell your story, and see if that doc won't collaborate in getting her into the office for a look-see.  It's a start.