Engaged, pregnant, blended family on diff continents, bipolar? HELP!

fml_ said:

I have damn good reason to believe that he is bi-polar....he is in a deep depression again ...I go through this at least twice a month.

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FML, welcome to the TAM forum. I strongly recommend you see a psychologist -- for a visit or two BY YOURSELF -- to obtain a candid professional opinion on what it is you and your future child will be dealing with. Even if your fiance does have bipolar disorder, it is important that you also become familiar with the symptoms (i.e., the red flags) for BPD (Borderline Personality Disorder). I advise this for several reasons.

One reason is that a recent study (pub. 2008) found that half of those diagnosed with bipolar-1 also have full-blown BPD. Significantly, this was NOT a small, isolated study undertaken by a single university or hospital. Instead, the study took four years to complete, covered nearly 35,000 American adults (in face to face interviews), and was funded by NIMH (the National Institute of Mental Health).

A second reason is that your fiance's going through these mood changes "at least twice a month" is NOT typical of bipolar. Rather, such frequent mood changes are far more often associated with BPD mood changes. Because bipolar moods are caused by gradual changes in body chemistry, they typically take two weeks to develop and another two weeks to fade away. And they usually are so infrequent that just 4 mood swings a year is considered "rapid cycling." Granted, in some people, ultra-rapid bipolar cycling can occur every week or two (or even every day or two) but it is quite rare (far below the 6% incidence for BPD).

In contrast, BPD mood changes typically occur so rapidly that no "swing" has time to occur at all. Instead, the person flips from loving you to devaluing you (even hating you) in a few seconds. I mention this because some of the mood changes you see -- if not most -- may be the result of strong BPD traits.

This rapid change is possible because BPD mood "flips" are not caused by body chemistry changes. Rather, they are event-triggered by minor things you say or do. Importantly, you don't have to do a thing to CREATE a BPDer's anger. It has been there since early childhood. You therefore only have to do some trivial thing that TRIGGERS the anger that is already there.

This is why BPD sufferers tend to have far more difficulty controlling their anger -- and tend to be far more vindictive and mean -- than is true for bipolar sufferers. And this is why I find it troubling that you describe your fiance's bad moods as "mean, nasty, hateful, and wanting to ignore the world and make it pay."

If you would like to read more about the major differences between bipolar and BPD behaviors, I suggest you read my post at Confused. I identify a dozen differences I've seen between my BPDer exW and my bipolar-1 foster son.

A third reason for learning to spot BPD traits is that, if your fiance is diagnosed with both BPD and bipolar, it is very unlikely his therapist will mention "BPD" to him, much less to you. It is widely known -- both inside and outside the psychiatric profession -- that psychologists and other therapists usually withhold this information from their BPDer patients -- for the protection of those patients.

The therapists know, for example, that all Axis-1 disorders like bipolar are covered by insurance but BPD and the other Axis-2 disorders typically are not. And there are several other important reasons for withholding the information. If you would like to read about them, please see my post at It's official, I'm getting divorced. Significantly, although it is easy to spot the red flags, only a professional can determine whether those symptoms are so severe as to meet 100% of the diagnostic criteria for "having BPD."

Whenever BPD is a serious risk -- as is often true whenever bipolar-1 is diagnosed -- relying on your fiance's therapist for candid advice would be as foolish as relying on his attorney for candid advice during a divorce. His therapist is not your friend. It therefore is important you see a professional who is ethically bound to protect YOUR best interests, not his.

Finally, if you would like to read more about spotting the red flags of BPD, I suggest you read my description of them in Maybe's thread at My list of hell!. If that description rings some bells, I would be glad to discuss them with you. Take care, FML.

Thank you for the info on BPD, Uptown. I think you might be on to something. He gets absolutely angry if I suggest he has a "problem". He would probably throw things and scream at me if he could get away with it. Which I think is sad. I, myself, have some issues. I have suffered from depression and anxiety since a child when my father passed away from cancer... only to be made much worse when my mother passed away from cancer when I was 20.

I understand these things. I am so understanding, completely empathetic to him. I feel it when he does. I feel it to the point that I know it's coming just from the air around the house.

This morning, after making a trip to walmart to get him some medicine and tissues.. I could just feel it as I pulled into the driveway. I knew today would be one of those blow up days. And I am still afraid to put my little one to bed and talk to him.

He makes me feel crazy!

This is how I can explain him... He will be outside, looking at the house, decide it needs painting. So great! We'll check out colors online, decide when we have time to do it, go to the store to pick out our paint... While we're picking out paint he will all of a sudden be baffled, and question if he even wants to live in America any more.

That has never happened (yet), but it could happen so easily..

He seriously makes me feel like I am losing my freaking mind!!!

fml_ said:

He makes me feel crazy! ...He seriously makes me feel like I am losing my freaking mind!!!

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The vast majority of people having full-blown BPD do not feel like they are going "crazy." Rather, the disorder makes their abused partners and spouses feel that way. Indeed, of the several dozen disorders listed in the diagnostic manual, BPD is the one that is most notorious -- by far -- for making the partners feel like they may be losing their minds. This is why therapists see far more of those partners -- who are seeking therapy to find out if they are going crazy -- than they ever see of the BPDers themselves.

This "crazymaking" effect of BPD on partners is so well known that the websites founded by spouses and ex-partners have slogans and website names referring to it. See, e.g., "Welcome to Oz" at BPDcentral.com, "Land of Oz" at StopTheAbuseBlog.com, and "Out of the Fog" at OutoftheFog.net.

The most common name for it, however, is "gaslighting." It is named after the classic 1944 movie, Gaslight, in which a husband (Charles Boyer) tries to drive his new bride (Ingrid Bergman) crazy so as to have her institutionalized -- and thus be able to run off with her family jewels. Actually, this movie is a poor choice for the name because BPDers usually sincerely believe most of the outrageous allegations coming out of their mouths and they are not trying to drive their spouses crazy. Instead, they are trying to control them to prevent abandonment (half of the time) or trying to push them away to prevent engulfment (the other half of the time).

Of course, your "feeling crazy" does NOT imply your fiance has full-blown BPD. I mention it only because it is a red flag. Again, I suggest you see a psychologist -- by yourself -- to obtain a candid professional opinion.

I am so understanding, completely empathetic to him. I feel it when he does.

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I suspect your problem is not being empathetic but, rather, having such low personal boundaries that you are an excessive caregiver -- as I am. That is, you cannot tell where your own problems stop and his begin, with the result that you don't allow yourself to be any happier than he is.

If so, you likely will benefit greatly from reading therapist Shari Schreiber's explanation of how we caregivers get to be that way during our childhood. Her article is at DO YOU LOVE TO BE NEEDED, OR NEED TO BE LOVED?. Please be patient when reading it because the last half is even better than the first.

Uptown is right. I would suggest paying attention to his/her posts. In my experience as the spouse of a BPD, it's maddening, and their behavior is incredibly resistant to treatment. BPD is often comorbid with Narcissistic Personality Disorder. The initial diagnosis only suggests trait dominance, however, thinking about a diagnosis as a representation of PRESENT behaviors and a suggested treatment model is much more appropriate than a "defective" stamp on a person's forehead.

A good book for your investigation is "Walking on Eggshells." Available in most municipal libraries, it will convey a decent description of associated behaviors. Nevertheless, suicidal ideation (thoughts, threats, acts of intentional self-injury) is no longer considered as criteria for Borderline Personality Disorder.

curlysue321 said:

Personality disorders are not always present with bipolar disorder. There are many people with bipolar disorder who are successfully medicated who lead productive lives and have successful relationships. If a personality disorder is present that is not treatable with medication. I have never heard of narcissistic personality disorder occuring with bpd. I have bpd and know a lot of people with the disorder. That being said, I am sure there probabaly are some narcissists who also have bpd it is just not common as they are two completely separate illnesses.

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I disagree. The DSM-IV isn't a big book of mental disorders; it's a guide for treatment. In the same way that obesity can have several causes, the model for treatment is fairly consistent across those causes. Extending the metaphor, exercise and a balanced diet is the treatment for obesity whereas the collection of behaviors we know as Borderline personality disorder are usually responsive to Dialectic Behavioral Therapy.

To reduce psychological diagnostics to an overly simple model isn't helpful. Even in autism there are several biological and ecological causes for the associated behaviors. In fact, autism is commonly comorbid with generalized anxiety disorder, attention deficit disorder, attention deficit hyperactivity disorder, and bipolar disorder. Each subset requires slightly different treatment just as each subset of borderline personality disorder (what factors are present, prominent, and what other diagnostic criteria is evident in the personality) requires slightly different treatment.

There are biological risk factors for BPD, just like every other psychological disorder. Some pharma has been shown to work to relieve symptoms temporarily. The same holds true for NPD, and in fact, is more apparent in NPD. Narcissism is a generally distributed personality trait. An individual without any narcissistic qualities would not be able to function in daily life. It is actually adaptable to American culture which is one of the reasons that those with NPD often don't seek treatment: their lives, as they view them, are not lessened by their disorder. In other words, they're quite happy being NPD. They just make everyone else miserable.

curlysue321 said:

Personality disorders are not always present with bipolar disorder.

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CurlySue, yes, that is my understanding too. As I noted in post #3 above, only half of bipolar sufferers have BPD during each year studied. See Table 2 of Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. For the remaining half of bipolar sufferers not having BPD, I've not seen any statistics on the co-occurence of PDs other than BPD.

I have never heard of narcissistic personality disorder occuring with bpd.

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At the link above, Table 3 shows that 39% of BPDers were also found to have NPD. These results were obtained in the large-scale study of nearly 35,000 American adults I referred to in post #3. I am not surprised by this finding because my experience is that, whenever any of us is very sick or in pain, our narcissistic traits quickly flair up. It seems natural to become more self-focused when one is hurting badly.