Expert: Ivan Goldberg, M.D. - 9/9/2007

Question
Hi,
My husband has bipolar and we have a great relationship when he is stable and we are very much in love. As with most bp patients, he snaps and tells me to leave, tries to kick me out, etc. We are currently separated. His pdoc assured us that 75% of her 250 patients live "normal" lives and have successful marriages. Everything I read seems to say otherwise- that it's almost always a roller coaster, changing meds, etc. and never getting over the episodes that rip a marriage apart. Do people ever really get stable enough to be in a marriage?? Is his doctor just being optimistic? I don't expect her to be negative and tell him there is no hope, she in fact seems like a great doctor,but I wonder if she is really being truthful. I can't find any cases on the internet or in books that tell of people who successfully recover and stop having bipolar symptoms that tear people apart. Are there really success stories? and if so, why can't I find any??

thank you!

Answer
Hi, Kristin . . .

In my practice most of the people I see who have bipolar disorder improve but from time to time continue to have occasional mood swings. Most of the patients who come to me married, stay married, but there certainly is a good deal of marital conflict that originates in the impulsive, thoughtless behavior of the partner with the mood disorder. Marital therapy is something that I VERY strongly encourage.

For your information I have included below a number of abstracts of articles from psychiatric journals about bipolar disorder and marriage.

Best regards . . .
Ivan
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1: Bipolar Disord. 2005 Oct;7(5):431-40.

Burden and marital and sexual satisfaction in the partners of bipolar patients.

Lam D, Donaldson C, Brown Y, Malliaris Y.

Department of Clinical Psychology, Institute of Psychiatry, London, UK.
spjtdh@iop.kcl.ac.uk

OBJECTIVES: Bipolar disorder can be traumatic for both patients and patients'
partners. Hence, partners' stress, burden, marital and sexual satisfactions are
important areas to investigate. However, there have been problems with past
attempts to identify the determinants of marital satisfaction in bipolar patients
and their partners. The present study aimed to address these issues and provide
an accurate description of relationship functioning in these couples. METHODS:
The sample involved 37 partners of bipolar patients. A semi-structured interview
assessed the impact of bipolar disorder on aspects of everyday functioning and
partners' attributions for patients' disturbing behaviour. Standardized
instruments assessed partners' sexual and marital satisfaction across the
different affective states. RESULTS: Despite couples staying together,
significant numbers of partners reported strain as a result of socioeconomic and
household changes. More male partners reported premature ejaculation and female
partners reported sexual infrequency when patients were depressed. Overall,
partners were less sexually satisfied when the patient was ill. Marital
disharmony was greater when patients were ill and worse during manic than
depressed phases. Marital disharmony was also more likely when partners believed
the patient could control their illness; they had increased domestic
responsibilities; or were sexually dissatisfied. CONCLUSION: Reductions in sexual
satisfaction during affective episodes may be the result of illness-related
changes in sexual interest, responsiveness and affection. Partners who attribute
control for the illness to the patient may use strategies to influence behaviour
that disrupt marital harmony. Interventions involving education, problem-solving
strategies and sex therapy components may help to reduce marital dissatisfaction.

PMID: 16176436 [PubMed - indexed for MEDLINE]

2: 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]

3: 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]

4: J Affect Disord. 1991 Jan;21(1):15-8.

Psychoeducation of partners of bipolar-manic patients.

van Gent EM, Zwart FM.

Psychiatric Center Willem Arntsz Huis, Utrecht, The Netherlands.

The partners of 14 bipolar-manic patients attending psychoeducation sessions were
compared with 12 controls. After the sessions and 6 months later they showed more
knowledge of the disease, medication and social strategies. Patient compliance
did not change over the next year. The risk of this procedure is the initially
increased level of anxiety of the patients.

PMID: 1827472 [PubMed - indexed for MEDLINE]

5: Can J Psychiatry. 1983 Aug;28(5):362-6.

Hypomania and marital conflict.

Lesser AL.

The author treated seven bipolar patients over seven years whose presenting
problems were chronic marital conflict. The bipolar diagnosis had previously been
made in only one case. Conjoint or family assessment was essential for accurate
diagnosis. Lithium was the cornerstone of treatment and the best results were
obtained with bipolar patients who were lithium compliant and whose marital
conflict was resolved in conjoint therapy. Marital conflict clearly preceded the
bipolar disorder and was not prototypical. Neither a family systems model nor a
psychopharmacological model alone were sufficient for treatment. The diagnosis of
bipolar disorder must be considered with chronic marital conflict.

PMID: 6627193 [PubMed - indexed for MEDLINE]

6: 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]

7: 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]

8: Am J Orthopsychiatry. 1975 Oct;45(5):854-66.

The married manic.

Ablon SL, Davenport YB, Gershon ES, Adland ML.

In group psychotherapy and follow-up studies, the interpersonal relationships and
psychodynamics of the married manic depressive patient and spouse were studied.
Prominent among these subjects were massive denial of grief, rage, and dependency
in the context of symbiotic relationships; and the absence of a father during
early development. Clinical expressions of these factors are presented, and
therapeutic implications are discussed.

PMID: 1190309 [PubMed - indexed for MEDLINE]