What does research tell us about the bipolar spouse?
Is it possible to have a happy and healthy relationship if you have bipolar disorder or are married to someone with bipolar disorder?
The picture that comes out of the studies done to date is very mixed. What is particularly striking is the difficulty in separating cause and effect. Is it the chicken or the egg?
For example, we know that bipolar disorder erodes the quality or ALL interpersonal relationships, and marriage is no exception.
Perhaps for many of us the intuitive thing is to assume that a person with bipolar disorder will have poorer interpersonal skills and be harder to get along with than a "regular" person.
How many of us look at it the other way around?
What I mean is, have you ever considered that marital problems may be a trigger for mood episodes, and it is stress somewhere in the relationship that is making the bipolar spouse worse?
Overall, my guess is that the former applies. However, there is still some room for a complex interplay between marital tensions that arise from the behavior of the bipolar spouse during a mood episode, and possible increasing and/or triggering of episodes of mania and/or depression because the bipolar spouse is so vulnerable to any problems that arise in the marriage.
It is easy for a couple to fall into a downward spiral where the spouse with bipolar disorder behaves in ways both highly provocative and highly reactive. This leads to conflict with their partner, whose negative responses to this "bipolar behavior" makes the bipolar spouse more stressed and insecure, in turn triggering even more episodes of mania and/or depression.
Bipolar spouses can be trapped in a cycle of "acting crazy" and knowing it, creating stress that just triggers more mania and/or depression.
There is also sometimes an infectious, contagious type of quality to bipolar disorder when one spouse is afflicted.
The non-bipolar partner, and the marriage itself, takes on a "bipolar life of its own" as the non-bipolar spouse see-saws between solicitous and extreme care-giving during their bipolar husband's or wife's depressive episodes, and feelings of blame, resentment, anger and betrayal when their spouse is in the manic phase of bipolar disorder.
Thus the relationship can be very turbulent and uncertain. It is common for spouses of people with bipolar disorder to understand and be extremely, even overly, solicitous in response to depression in their partner, but to have more difficulty in seeing manic episodes as part of the illness.
Manic behavior is more likely to be perceived as malicious and deliberate, especially after the partner with bipolar disorder has been stable for a while and acting in a more loving, consistent, and predictable manner.
Being in a committed relationship with someone who has bipolar disorder is a tremendous challenge.
A huge proportion of the emails and messages I receive are from people who need information and support for relationship issues that arise out of one (or both) partner's bipolar disorder.
The best resources I know of are:
2. When Someone You Love Is Bipolar, by Cynthia Last.
For me, as a person with bipolar disorder, maintaining a healthy and happy relationship involves committing to a Treatment Contract with my spouse, and sharing a lot of information such as my mood charts, having a transparent medication regime, visiting my psychiatrist together and so forth.
It will come as no surprise to learn that bipolar divorce rates are high. The statistics vary according to the source, but most experts quote rates two or three times higher than the national average.
A common - but staggering - statistic that gets bandied about is that 90% of marriages involving at least one bipolar spouse will end in divorce.
Why is this figure so high? During episodes of mania, someone with bipolar disorder is likely to do things that are particularly destructive. Examples include:
1. Outbursts of anger.
2. Reckless spending or gambling.
3. Substance abuse.
4. Compulsive and obsessive behavior or grandiose schemes that alienate their husband or wife.
5. Staying up late, being undependable in their job, around the house, in their co-parenting and so on, all of which are far more destructive and disruptive than they may realize.
6. Sexual obsession, including hypersexuality, preoccupation with inappropriate or uncharacteristic sexual activity, and infidelity.
What are the consequences of bipolar divorce?
For the spouse who is NOT bipolar, the consequences of divorce are pretty much the same as for anybody else:
1. They may get on with life and be happier and healthier, either as single people or as part of a new couple.
2. They may regret the break-up of the marriage and wish they had sought counseling and other solutions.
3. They may reconcile with their ex-spouse.
4. They may repeat the pattern and end up with another spouse who has a mood disorder or other mental health problem.
The secret to a happy and healthy marriage with a bipolar spouse is simple - an accurate diagnosis and compliance with an effective treatment plan.
For the bipolar spouse, the divorce may lead to a number of difficulties that compound their mental, emotional, physical, and financial difficulties.
As Goodwin & Jamison point out in the most authoritative textbook on bipolar disorder, "Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression", many studies show that living alone or being single often leads people to stop taking their medication and complying with their treatment plans in general.
Divorce is often a prelude to "downward drift" where the person with bipolar disorder seeks and receives less treatment, suffers more frequent and more serious mood swings, encounters problems with employment, the legal system, and life in general, and experiences deteriorating finances and physical health.
Does this mean a bipolar marriage is doomed?
In fact, research has shown that there is little or no difference between the state of the marriages where one spouse has bipolar disorder but is in remission, and other married couples in general.
Further, both groups had similar perceptions of significant events during the course of their marriages. They shared the same feelings about their courtship, first year of marriage, and the degree to which the marriage had met expectations.
In other words, marriage to a person with bipolar disorder who is in treatment and not experiencing any episodes is pretty much the same as being married to a "well" person.
Spouses with bipolar disorder are likely to have a different impression of their marriage than their husband or wife.
For example, a married person with bipolar disorder is often not aware of the full impact their disorder has on their partner, children, or other family members.
A 2001 study by Dore and Romans found significant others reported serious difficulties in their relationships with the bipolar partner when s/he was unwell, with considerable impact on their own employment, finances, legal matters, co-parenting and other social relationships.
Violence was a particular worry for partners when their spouse was manic. However, in spite of all this, many people stay emotionally committed to their bipolar spouse and are very patient and forgiving of problem behaviors.
This study has one serious limitation in that it included only committed spouses - not those who have divorced the bipolar sufferer. (And as the divorce statistics show, there are a great many of these.)
What is being presented here is a conflicting and contradictory portrait of the bipolar spouse:
On the one hand we are see the huge divorce rate, on the other we have research showing marriage to someone with bipolar disorder is pretty typical of marriage in general.
The difference lies in getting treatment so that mood swings and episodes are greatly reduced in both frequency and intensity.
Once the bipolar spouse is stable, it is possible for both partners to gain insight into bipolar disorder and its impact on both partners - both as individuals and on their marriage.
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