Friday, June 1, 2012

Mental Disorders in the One You Love

I know I'm crazy... I eat nutella instead of jelly on my pbj. I name my pets after participles. I read books upside down for fun. But this post is about the craziness of being in a relationship with someone who is diagnosed.

My own situation is crazy to an extreme. My wife is bipolar (BP), has borderline personality disorder (BPD), and a rampant history of self-medicating through drugs and alcohol. She was diagnosed a few months ago although her disorders go much farther back. I was the kind of schlep every borderline dreams of- I was supportive, attentive, allowed her to be her own moral guide, and took whatever she said for face value. It has been at least six years, maybe ten, that she has shown behavioral traits which may have helped diagnose her and get her help. It is somewhat unsettling to me to think that being the supportive husband, committed family-man, and respectful partner I always had aspired to be had enabled her to suffer for so long. I'm wracked with as much guilt over this as I am with anger at what she has done over the past few years. That's the point of this post. Maybe someone out there will read it and figure out their own situation before it gets into that hand basket and goes straight to hell.

How to Get Help Fast

The first time I tried to get my wife to a psychiatrist was a nightmare. I called 30+ offices and found only a few that took my insurance (I had really good insurance too). Those that did, either weren't seeing new patients or were focusing in on the elderly market. I finally found one to go to but they were scheduling 3.5 months in advance! It was almost hopeless to try to go see a shrink... I eventually found a quick way in. I wouldn't recommend it though. At one of our marriage counseling sessions I said I was going to go away for a weekend to cool off and my wife snapped. She said she couldn't deal with it and said she'd probably hurt herself. I immediately took her to the hospital ER for a psych evaluation. They enrolled her into a partial hospitalization program and she was able to see a shrink the next day. I wouldn't recommend this approach unless you're actually in fear for their safety but it did get her in the door and get her the help she needed right away.

Nota Bene: I'm not a shrink. I'm just a dude who has to deal with this sh*t on a daily basis. What follows is my opinion. Take it for what it's worth.

Bipolar (BP)

Formerly called manic depression, bipolar is caused by chemical imbalances in the brain. It is generally treated with medication and behavioral therapy. A very important note is that antidepressants alone can cause this disease to get worse.

General Traits

Mood swings between depression and manic phases. Depression is a common term thrown around these days but BPs have clinical depression. Clinical depression is a long term period of low mood that interferes with daily life. It can cause a loss of pleasure in once enjoyable activities, constantly feeling helpless, sleeping too much or too little, eating too much or too little, lack of energy, thoughts of death and suicide. The BP will have shifts in mood from the depressed state to a manic state which can occur quickly or over a prolonged period. The mood shift is often unconnected with events in real life. There are two types of BP; Type 1 (manic) and Type 2 (hypomanic).

BP Type 1

This is the mainstream bipolar. They have crippling depression followed by a feel-good manic phase. The manic phases are really, truly highs where they feel invincible, unable to make mistakes and euphoric. Type 1s are often trying to get back to being manic when they are in their depressed state.

BP Type 2

Type 2 is a subset of BP where the manic phase isn't a real high, it's a hyper-energized state of anxiety. The manic phase can often be seen as irritable or angry to an observer. BP type 2s often have crippling depression intermixed with crippling panic and anxiety which leads to further depression.


Type 1s and Type 2s often have similar traits in manic phases. The Type 2 doesn't have the euphoric high and may have less extreme traits.
  • Easily upset
  • High energy levels, talking a lot, racing thoughts
  • Little need for sleep
  • Poor judgment
  • Reckless and impulsive behavior, over-spending, gambling, substance abuse, hypersexuality


Most BP develops between 15-25. Some potential causes are genetics, drug use, and (proving kids can actually make you crazy) childbirth.

Resources for BP

Borderline Personality Disorder (BPD)

BPD is a cognitive disorder rather than a chemical imbalance. It's a learned set of coping skills, usually created from a distressed childhood or unstable family setting, which are ultimately destructive. BPD gets its name from the old terminology used for the disorder: 'borderline schizophrenic'. It is also commonly referred to as being a 'sociopath'. There's a lot of stigma being diagnosed with BPD. Some shrinks treat BPD with medication but ultimately therapy is needed.

General Traits

People suffering from BPD often feel uncertain about their identities, see things in a black/white or all/nothing perspective, change interests and personalities quickly, have a fear of abandonment, frequently feel bored/empty, have inappropriate displays or acts of anger, are impulsive (gambling, hypersexuality, substance abuse), and can often be in crisis or attempt self-harm. They can feel like they're "wearing masks" when they need to interact with others. BPD sufferers often have moods swings that occur more frequently than BPs and are more rooted in reactions to events in their lives.


There are a lot of classifications within BPD. The most often referred to is Narcissistic Personality Disorder. However, most discussions make a distinction between high-functioning and low-functioning. The high-functioning BPD is the type which is most difficult to treat. The disorder itself has roots in self-preservation, pursuing selfish goals, and a profound lack of empathy for any of the people they may wrong in said pursuits. Low-functioning BPD are at least aware that something may be wrong and they may have hurt people.


Bad news folks. BPD has long been said to be untreatable. There are some docs which prescribe medications for mood stabilization and depression. The therapy options available for BPD are often classified as behavioral (mentalization, transference) or cognitive (dialectical behavior therapy (DBT), schema therapy). The dialectical therapy seems to be the go-to treatment option for many and has shown moderate success. However, the time commitment for patient and therapist is quite significant and it is a costly treatment program. I haven't gone far enough down the rabbit hole to offer a personal opinion on treatment.. Yet.

Resources for BPD

Substance Abuse

For us this was an out growth of BP and BPD but it is a huge issue in-and-of itself. No healing or emotional growth can occur while drugs or alcohol are in the picture. Some shrinks won't even start therapy or medications until the substance abuse problem has been addressed.

Resources for Substance Abuse


Get help! A BP, BPD or abuser of substances will not seek help as long as they're not at rock bottom. As long as you, the spouse, is supporting them by tolerating their behavior or protecting them from the consequences of their actions they will never hit rock bottom. The hardest thing in the world I ever had to do was to look at the woman I've loved for 15 years, my wife and mother of my children, and tell her that I wanted her out of my life. There was no way we could continue as we had. I just hope you can address these issues if they are present in your life before they destroy everything.


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