Expert: Ivan Goldberg, M.D. - 6/30/2008

Question
I have been a dating a man for a little more than 2 months. He was diagnosed with BP disorder about 7-8 months ago, takes Depakote and sees his therapist monthly. He told me of his diagnosis on our third date. Given that he has accepted his diagnosis and sticks to his treatment, I decided to continue to date him. I have a sibling that has BP disorder, but he refuses treatment, so I only knew of this disorder from the point of view of it not being treated.
In the two months we've been together, there have been a couple of incidents of inappropriate over-reaction from him. At the very beginning of our relationship, he accused me of stealing an old watch that had been his grandfather's, which I most certainly did not (come to find out, he may have miscounted how many timepieces there were); he's thought he's told me things, but didn't and his has led to misunderstandings, to which he over-reacts rather immaturely (i.e., hanging up on me and
shutting off his phone, storming out over a request to lower the volume of the t.v., etc.). Just this past week, he brought back all of my things that were at his house and collected all of his things from my house, but forgot to bring back my spare keys. Naturally I got them back. He had let himself into my house without my knowledge or permission while I wasn't home to collect his things/drop my stuff off. Then proceeds to call me while I'm work to tell me he thinks we should end the relationship. When I tried to explain to him these were inappropriate things to
do and why, he just gets defensive and wants to know if I can "get over it" and can we "work through this".  His rationale was that if I had been forewarned before he got his things, he thought I'd be vindictive and ruin his possessions. Based on what, I asked. He had no answer, just
that it was his paranoia that made him think like that, he knows I'm not that type of person. He apologized for his actions and admitted that he had been disrespectful and that what he had done was wrong.
So, I can only presume this has to be part of his disorder. My question is, is it possible to have a successful relationship with someone who has bipolar disorder and is actively trying to treat it? I was hopeful because he is treating his disorder, does not self-medicate with illicit drugs or alcohol, has no addictions and doesn't lie. I come from a very dysfunctional family and have had relationships in the past that revolved around my partner and their needs, while neglecting me and mine. I have been in therapy and now recognize the pattern of losing myself in my partner's issues because I'm comfortable with being ignored. I no longer want that for myself, that's why I was in therapy. But being involved with a person with BP disorder makes me wonder if I'm slipping into my old patterns, or if I'm making too much of it and it's simply
that we need to work on our communication.
Any insight would be appreciated. Just don't know if I should risk getting further involved only to have the rug pulled out from under me, like this past week. We do have a good relationship otherwise, and that's the only reason I'm conflicted.
Thank you.

Answer
Hi, Jennifer . . .

People with bipolar disorder often show some psychopathology even when not in a (hypo)manic or depressive episode. They can have periods of being impulsive, irritable, inconsiderate and show less than wonderful judgment. Below are a few abstracts of articles from the medical literature that are relevant to your situations.

Best regards . . .

Ivan
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1: J Psychosoc Nurs Ment Health Serv. 1996 Mar;34(3):22-6.

The characteristics of women who stay married to bipolar men.

Clement M.

Family Treatment Program, Psychiatric Division, VA Medical Center, Los Angeles,
California, USA.

1. Although a body of knowledge allows intervention of and effective therapy for
bipolar affective behavior, only a few mental health professionals treating them
have focused on the quality of their marriages, or the specific attitudes of the
well spouses toward marital problems or divorce. 2. The present results showed
that women married to men with bipolar affective disorder have more problems with
separation-individuation than women married to men who are not bipolar. 3.
Unresolved anxiety about separation from a loved object, anxiety that dates back
to early childhood, may need to be discussed in detail before any progress can be
made in resolving the marital difficulties.

PMID: 8676287 [PubMed - indexed for MEDLINE]

2: Arch Gen Psychiatry. 1981 May;38(5):562-8.

The Family Attitudes Questionnaire. Patients' and spouses' views of bipolar
illness.

Targum SD, Dibble ED, Davenport YB, Gershon ES.

A newly devised Family Attitudes Questionnaire has been employed to quantify the
perceptions of 19 bipolar manic-depressive patients and their well spouses about
the etiology, familial risk, and long-term burden of bipolar illness, and to
assess their abilities about marriage and childbearing. In this study, 53% of
well spouses compared with 5% of patients (P less than .01) would not have had
children if they had known more about bipolar illness prior to making these
decisions. The overall data suggest that the bipolar patients, compared with his
or her spouse, minimizes the burden and denies the heritable/familial nature of
affective illness. These findings should be borne in mind for genetic counseling
as well as for psychotherapy.

PMID: 7235858 [PubMed - indexed for MEDLINE]

3: Arch Gen Psychiatry. 1981 Jan;38(1):65-7.

Marital conflict of manic-depressive patients.

Hoover CF, Fitzgerald RG.

Forty-two manic-depressive inpatients and their spouses, as well as 30 "normal"
pairs from the community, reported on marital dissension through the Conflict in
Marriage Scale (CIMS), an agree-disagree card sort. The marriages of
manic-depressives were significantly higher in acknowledged conflict then those
of community pairs, and the patients reported significantly more conflict then
their spouses did. There was no correlation between levels of conflict reported
by patients compared with their spouses though conflict levels of community pairs
were significantly correlated with each other. This leads to the speculation that
manic-depressive marriages may be characterized by more complementarity than
similarity of partners.

PMID: 7458570 [PubMed - indexed for MEDLINE]

4: Am J Psychiatry. 1981 Jun;138(6):764-8.

A comparison of nonpatient and bipolar patient-well spouse couples.

Frank E, Targum SD, Gershon ES, Anderson C, Stewart BD, Davenport Y, Ketchum KL,
Kupfer DJ.

The authors compared responses of 16 couples, in which one partner had a
diagnosis of remitted bipolar illness, to a lengthy self-report questionnaire
(KDS-15) designed to assess many aspects of marital adjustment with those of 16
matched nonpatient couples. The bipolar patient-well spouse couples had marital
adjustments closely resembling those of the nonpatient couples; three of four
global ratings of satisfaction failed to discriminate between the two groups.
Perceptions of the courtship, first year of marriage, and the degree to which the
marriage had met expectations were also similar for both groups.

Publication Types:
   Comparative Study
   Research Support, U.S. Gov't, P.H.S.

PMID: 7246805 [PubMed - indexed for MEDLINE]

5: Am J Orthopsychiatry. 1992 Oct;62(4):552-63.

Marital satisfaction among parents of the severely mentally ill living in the
community.

Cook JA, Hoffschmidt S, Cohler BJ, Pickett S.

Thresholds National Research and Training Center on Rehabilitation and Mental
Illness, Chicago.

Factors influencing marital satisfaction among 131 parents of adult offspring
with severe mental illness were explored. Those found to be most predictive of
marital satisfaction were parents' ability to comfort one another, parents'
gender, number of offspring, family income, and interpersonal sensitivity.
Implications of these findings for practical and policy approaches to preventive
intervention are discussed.

Publication Types:
   Research Support, U.S. Gov't, Non-P.H.S.

PMID: 1443064 [PubMed - indexed for MEDLINE]

6: J Affect Disord. 1995 Aug 18;34(4):269-74.

Personality pathology among married adults with bipolar disorder.

Carpenter D, Clarkin JF, Glick ID, Wilner PJ.

Department of Psychiatry, Cornell University Medical College, White Plains, NY,
USA.

The comorbidity of DSM-III-R axis II personality disorders in patients with
bipolar disorder has received less attention than for unipolar depression perhaps
because of the potential confounding of state vs. trait qualities. The current
study took steps to separate pathological traits of personality from behaviors
evidenced during discrete affective episodes in a sample of married, outpatient
bipolar patients. Data indicated that 22% of our patients met criteria for a
categorical diagnosis of personality disorder. Axis II pathology as represented
by both categorical and dimensional scores was associated with increased
psychiatric symptoms during subsequent treatment and poorer social adjustment.

Publication Types:
   Research Support, U.S. Gov't, P.H.S.

PMID: 8550952 [PubMed - indexed for MEDLINE]