Bipolar Disorder or Abusive Personality?

Reader’s Question

My husband was recently diagnosed with Bipolar Disorder. I had threatened to leave him because of the emotional abuse that he has put me through. He was put on Lithium and has been taking the pills for several days, but there hasn’t been enough time yet to see progress. He will, on a daily basis it seems, get mad at me over little things — like leaving a piece of trash on the kitchen counter — and make me feel like I can’t do anything to make him happy. He is very possessive and will frequently check my phone and computer to make sure that I am not talking to any guys, even though I have never cheated or given him a reason to doubt me. He has also several times followed me or gone to my work if I have to work late to make sure that I am actually there. He has never been physically abusive with me, but he has been so in the past with our pets. He also pressures me into having sex and will not leave me alone until I finally give in.

My question is whether my husband is emotionally abusive in nature or is his behavior strictly caused by his Bipolar condition?

Thanks.

Our Clinical Psychologist’s Reply

Some individuals with bipolar disorder can experience periods of heightened irritability and anger during manic or hypomanic periods. And some individuals with psychotic levels of mood disturbance can even display other unusual behaviors of the kind you have described. However, many of the things that you describe are likely not fully explained simply by a bipolar condition.

Many times, a person’s problem behaviors cannot be attributed to a single, simple cause or condition. People often have several problems on multiple dimensions. So, it’s possible for a person to have a disturbance of mood like bipolar disorder but to have other conditions as well, sometimes including disturbances of personality. Because of its special nature, and because even a general physician practitioner can diagnose and prescribe, it’s important that your husband’s treatment is being handled by a professional with the expertise to make a comprehensive psychiatric, behavioral, and personality assessment. And, because of the degree of impact on you, that professional should also be willing to work with you or refer you to someone who can help you deal with your husband’s problematic behavior.

Bipolar disorder has come under challenge recently by many professionals who worry that it is over-diagnosed or misdiagnosed. Medications used primarily to control the symptoms of bipolar disorder can be very helpful in helping an individual regulate their mood and control their impulses. This sometimes leads to the diagnosis of bipolar disorder being given to a person who might not actually suffer from the disease. There are other professionals who argue that many behaviors which used to be characterized as stemming from other factors such as an “abusive personality” were really the signs of an untreated mood disturbance such as bipolar disorder and that for years the disorder was under-diagnosed. The best course is to be sure the professional treating your husband has the range of expertise necessary to address all the problem behaviors your husband is displaying, completes a comprehensive psychological and psychiatric assessment, and displays sensitivity to the concerns you have about the impact of his behavior on your relationship.