Expert: Ivan Goldberg, M.D. - 8/21/2010

Question
Dear Dr. Goldberg,

I have been hanging on for dear life to my 14-yr marriage with my husband who suffers from Bipolar II, ADHD, sleep apnea and underlying personality disorder for 7 years now since his diagnosis.  We have 2 children, ages 6 and 9.  My husband sees a psychiatrist for medications but does not see a therapist.  I am a fulltime nursing student.

My questions relate to the ongoing damaging behavior that my husband exhibits - screaming and creating chaos over little things, not being able to resolve an issue fully, bringing up past issues and arguments over and over after they have already been addressed, getting very nasty when he's angry, distorting the way problems happen and why they happen, constant blame of his problems on me.  It seems he can never focus on the issue at hand or remember anything we have previously hashed out.  Because of this, each time there is an explosion on his part or a disagreement or argument, he keeps repeating the same negative things over again.  He makes up things about me and lies and then believes his own lies, which then distorts his perception of what is really going on.  It is unbearable to live this way and feels as though nothing will work.  One day he is calm and easy to talk to, another day he is raging and impossible to talk to.  Is this typical behavior for someone with bipolar or ADHD?

I am at my wits end and so upset.  He will not seek therapy and of course blames all the problems on me.  Now that I am angry and have had enough, the problem according to him, is my anger and the fact that I have threatened to leave the marriage.  I have been so patient and supportive all these years, but enough is enough.  We all love him but it is an unhealthy environment for both myself and my children.

He does not seem to care whether I leave the marriage or not, and this is heartbreaking to me as this is our family.

Any insight you can provide on his behavior will be so helpful and much appreciated.

I just don't think it is possible to have a healthy interpersonal relationship with him with this illness.

Thank you so very much.

Answer
Hi Tara . . .

Both ADHD and bipolar disorder lead to impulsive behavior and poor executive functioning including poor prioritizing and sequencing. People wit the disorders seems not to profit from experience and often repeat th same poorly adaptive behaviors again and again. To make things worse, sleep apnea makes it particularly hard to successfully treat someone with a mood disorder.

The only strategy I can think of is for you to go to your husband and for you to suggest that the two of you do couples therapy "so that I can discover what I am contributing to our current state of unhappiness." I have seen this strategy work more than once.

I wish I had more to suggest, but unfortunately I do not.

Best regards . . .

Ivan
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