From Lebanon: i dont know how to start and to tell u the truth im a little pessimistic now.im 22 my brother is 25 and he is diagnost with bipolar syndrom.but the problem nothing we do is helping,he dont get out of his room,hes afraid to do that,when hes out he thinks that evrybody’s pointing at him so he will get mad and start to yell,hes often saying that he hears voices or that somebody is whispering in his ear,he often wakes up scared or have bad dream.at one point he was very dangerous,5 years ago he used to scream indoors ,throw things in the house,threat me and my parents,he even started working with bad sporits,but now thank to god hes not doing it anymore.hes been to therapits,psychatrists,psychologs but no one seems to know what he has,they can all diagnos and give him pills.Well the pills helped to be calm and relaxed,but didnt help him to move on with his life,or let him think to have a job,ahd get a life.HES afraid to do that,and hes even not happy about it ,he wants help but i dont think were being able to do that,although my parents did their best and still doing it.,this last doc is going to give him seraquel,and hes even treating him with neadles…but till now no change,hes only been with him for like a 3 months maybe.MY brother needs help.We tried everyone,priests,elders,psycholigists,psychyatrits,,,, and still no use.HES 25 years old ,when is he going to h ave a normal life.he doesnt have a job,hes depending pn my parents till when,,,??? in shi condition he cant work.,I dont know if writting here is going to help me but franctly im kinda hoping u can help me even though im in the other way of the world.PLEASE HELP

A: Your brother is a lucky man to have a family that loves him and wants so much to help him. You already know that your brother is seriously mentally ill. He probably does need the medications that his psychiatrist is prescribing. Unfortunately, I don’t know anything about the services available in your country. All I can tell you is what I would suggest to someone in the U.S. and hope that it is somewhat useful to you.

My first concern would be whether your brother is accurately telling his psychiatrist about how he behaves and what he feels. If he will let you, I suggest you accompany him to his appointments and ask that you be allowed to share your observations with his doctor for at least part of his session. The remainder of the session is for his private conversation with the doctor. I also suggest that you and your family start some family therapy or get involved in a support group for family members of people with severe and persistent mental illness. Having a family member who is so ill is very, very stressful on any family. A therapist or a support group will give you all both support and some practical advice for how to handle your brother so his illness doesn’t tear up your family. A family therapist may want to include him in some of your sessions together to help him accept your help.

Finally, I don’t know if there are any community services available in your country for people like your brother. At least in some parts of the U.S., there are staffed group residences and work programs that serve those with severe mental illness. When someone doesn’t respond optimally to treatment, such programs can at least give the person a home, meaningful work, and the “safety net” of staff who make sure they get to their appointments and live a reasonably safe life.

I’m very sorry that I can’t be more specifically helpful. Perhaps your brother’s psychiatrist can give you and your family some guidance about what services are available in your own country.

I wish you well.
Dr. Marie

I think I have Bipolar Disorder and find it hard to talk to someone in person. Well basically looking back over the last 2-3 years ive shown all the classic symptoms of bipolar disorder. It started when i was sexually taken advantage of when under the infulence of alcohol, which then made me drink more, I was about… 15 at the time. I then took up smoking, and started showing signs of a developing eating disorder for roughly two months, as I got into what i know believe to be a depressive phase. My behaviour caused friends to resent me and family arguements at home. My mood shifted, and everyone assumed the “old me” was back. For a year the mood pattern continued, for a few months at a time, quite a slow paced cycle of moods.

Recently however, my moods have been rapidly changing, the pace started quickening from months, to weeks, days, and now i even seem to be experiencing extreme mood swings in one day. My work colleagues have picked up on my mood swings, and i can tell it is beginning to annoy them, I’m not sure how long it will take before it becomes an issue. At some points I experience both extreme sadness and happiness at the same time which is really confusing, and a lot of the time I can’t explain the cause of my moods.

Early this year, I was suffering with Bulimia, in what i think was a depressive episode, i don’t think the eating disorders are that dangerous to me, as soon as my mood shifts and i’m happy again, my eating habits return to normal, but it doesn’t stop me thinking about it returning, when i “relapse”, or however you’d like to word it.

I’ve been known not to leave the house for a week or two because my self esteem is so deflated, and with work i feel this is not possible. I block myself from the world and become hostile.
When i believe im manic, I become very sexually active and don’t think of the consequences i indulge in alot of strong alcohol, and my behaviour is disruptive.

I went to my doctor earlier this year and told him he referred me to a counceller, but i didn’t go because i found it really emotional just talking to my doctor about it, and i felt ashamed of my behaviour. I’m not sure if he took me seriously because I was so nervous I don’t think I worded it very well.

When I feel hyper, my brain races, and I believe I have the answer to all lifes questions, but obviously I don’t, I see it as I fall in love with myself again, meaning when im depressed i have self hatred which has lead me to cutting before and suicidal thoughts, but after normally a normal mood shift and I begin to experience “mania” my self esteem inflates, and I beleive I will be really successful, because I’m so brilliant. The changes of self doubt to over confidence is quite tiring. And i only feel i can talk about it when I am in quite a normal mood state.

On this site i took the bipolar screening quiz, these were my results: You scored a total of 60.
Based upon your responses to this bipolar screening quiz, you appear to be suffering from severe symptoms associated with a bipolar disorder. People who have answered similarly to you typically qualify for a diagnosis of Bipolar I Disorder and have sought professional treatment for this disorder.

I don’t want to tell my family, and i don’t want to disappoint anyone because of being mentally ill. I find this very draining, and just want some advice. I don’t see the need for diagnosis apart from councelling because i’m not going to take medicines. What do you think i should do? I’ve state everything that i can remember which is important from the top of my head. Thank you.

A. You asked what I think you should do and my answer is that you should seek treatment. It would be unethical to diagnose you over the Internet but your symptoms are characteristic of bipolar disorder. Bipolar disorder is a very treatable illness but if left untreated it can seriously compromise your life. I fear that it already has. You have experienced serious symptoms that require treatment.

I suspect that you don’t want to seek treatment, mainly because of fear. Maybe you’re unsure of what the treatment process would be like. Perhaps you have heard negative stories about psychiatric medication. You had a bad experience with attempting to see a doctor and that probably factors in as well. Fear can be crippling if you let it take over your life. Maybe if you knew more about the treatment of bipolar disorder you’d be more willing to attend. It might also be helpful if you spoke to individuals who have had treatment and who were successful in getting the illness under control.

There are several ways to access treatment for bipolar disorder. One is that you can see a therapist. The therapist could help you know whether you have bipolar disorder, identify the cycles of the disorder, learn how to recognize and manage the symptoms, and teach you better ways to manage your emotions. The therapist may also suggest medication, which is usually prescribed by a psychiatrist. Many individuals with bipolar disorder are able to tolerate the medication and find it very helpful. The main way it can help is that it can stabilize your emotions. It can provide relief from drastic mood changes or prevent them altogether. It seems like you currently have or have had in the past, extreme mood changes. They can make life difficult. A low dose of medication may be what is necessary to stabilize your mood. Mood stability could greatly improve your life.

I would suggest searching for an online bipolar disorder group or speaking to individuals who have bipolar disorder. Some people have found support groups very helpful. People like support groups because it makes them feel as though they are not alone. They can also see firsthand that recovery is possible. The National Alliance for the Mentally Ill (NAMI) has groups across the country that hold meetings on a regular basis to discuss issues related to bipolar disorder and other mental illnesses. You may want to consider attending one of their groups.

Another great resource can be found right here on Psych Central. Candida Fink, M.D. and Joe Kraynak write an informative blog about bipolar disorder. Visit their blog.

I understand that you do not want to seek treatment but I hope you will reconsider. Bipolar disorder does not go away on its own and if left untreated it can become progressively worse. You state at the end of your letter that you do not want to disappoint anyone by being mentally ill. I’m not certain why you think being mentally ill would be a disappointment. You are making the assumption that being mentally ill is your fault, as though you chose to be mentally ill. Mental illness happens to people and it is not something that people do to themselves intentionally. Anyone who would be angry at you for having bipolar disorder simply does not understand the nature of mental illness. The only right course of action at this point is to seek treatment even if you are afraid. You don’t want the illness to become worse. I hope you will consider treatment.

If you’d like to find a therapist in your community I would encourage you to search this directory. A good way to find a therapist is to call approximately 5 to 10 and speak to them about what your issues are. Perhaps if you spoke with several therapists on the phone you may feel less apprehensive about meeting them in person. Thank you for your question and I wish you the best of luck.

I am 18 and I have bipolar. I am on Lamictal, Lexapro, and Risperdal. My bipolar is getting worse. I am starting to see people look at me and I get very uncomfortable. I think they are talking about me. I feel like I’m being followed at all times. I hear footsteps behind me. I see shadows in the dark. I can’t think straight. I can’t even talk right, anymore. I feel scared whenever I’m in public. I am afraid of being abandoned. I am afraid of being attacked. I argue with myself. I can’t make up my mind. I also feel emotionless anymore. I don’t feel concerned about people anymore. My voice even lacks emotion. I hear my name being shouted when no one is there. Why is my bipolar starting to change like this?

A. There may be several possible reasons why your bipolar disorder seems to be getting worse. One is that you’re not on the right medications. That could explain why they are not helping. Also it’s possible that bipolar disorder is a misdiagnosis and you have a different condition such as schizophrenia or another psychotic-based disorder. If you had schizophrenia, for instance, but were being treated for bipolar disorder then this could account for why the medications are not effective and possibly making the situation worse.

Another possibility is that your medication doses are too low. You did not specify what the dosages are. Maybe a dose increase could help with symptom control.

It is difficult to know what the problem is. What we do know is that your symptoms are not well controlled at this time. It is important that you contact your psychiatrist or prescribing physician as soon as possible to let him or her know about this problem. The sooner your doctor knows about the problem the sooner he or she can work to get it under control. That is why it’s important to contact your doctor immediately. I hope you’re able to remedy the situation quickly. Thank you for your question. Please take care.

My Wife has displaying odd behaviour such as delusional, grandiose, irrational, and illogical thinking. My wife was sexually, physically and verbally abused as a young child starting at the age of about five. For how long the sexual abuse was, I’m not sure, but the physical and verbal abuse continued until she was a young adult. (For example, her mother horse whipped her in the shower when she was about sixteen.) To this day, she is now forty-three, some members of her family still mistreat her in some form (both her parents have passed away). I know that she is severely affected by her past. She is highly sensitive in nearly every regard. There are moments when she makes sense in what she says and does. Then there are moments when she is very delusional. Sometimes she has threatened suicide, and has said things like “you’ll miss me when I’m gone.” She spends a lot of time on Facebook. There she really appreciates all the nice things people will post about her. I warn her, nicely, that many of those people may somewhat be misrepresenting who they really are. She never did believe me. During this past summer she decided to fly off to a far-away city to meet with one of these people. In her mind, she was going to make a music CD with someone who said they had a recording studio. (She sings karaoke. -She does sing pretty good too.) After a night in this far-away city she phones me while I’m at work. She’s crying, and telling me how bad this perosn is, and that she loves me, etc. (None of it turned out the way she fantisized it would.) When she got home she made up some excuses as to why things turned out the way they did. She removed those people from her Facebook page. She still spends a lot of time on Facebook and is a little wary but not much. She will eliminate anyone from her life, friends or family, who she feels is a negative person. This could be a dirty look she ‘thinks’ she got from someone, something someone said that she misinterprets, could even be something someone fails to say like a cashier not saying “hello, how are you?” She can get very upset at cashiers, waitresses, etc. She will often tell them off. I try to explain to her that maybe they are just having a bad day, but she refuses to accept that. She now refuses to see most members of her family and all members of my family. (She gets very mad when I visit my old parents.) She feels both sides of the family have done her wrong in some way, shape or form and are negative people that she doesn’t want in her life. This happens with friends she meets. At first she places them high on a pedestal (she can’t stop gushing about them), then something is said or done and my wife then separates from them (whether a friend or employer). She was having crying spells for no apparent reasons (for years). I asked her to see her doctor and he prescribed antidepressants. They stopped her crying spells but her opinions and reactions to people stayed the same or maybe even got worse. I managed to get her to go to a psychologist with me so that we could work out these problems as they severely affect our marriage. I went first and explained the problem. When we started therapy together my wife, at first was reluctant to even show up. I know why, she is severely affected by her early and mid childhood. The therapist thought otherwise, which is fine, I explained to the therapist whatever it takes. The therapist recommended we have separate counselling. Before I know it my wife is off her medication, having severe crying spells, planning to make a music CD (which is fine -could be done in our own city but she had other ideas), and wanting to leave the marriage. She also stopped seeing the therapist. I got to the point where I finally said, if you want to leave then pack up and leave. You’ll have to get a job, place to stay, etc. (All in a calm, relaxed way. I don’t argue with her anymore as I’ve learned from research that she may be looking for an argument to stimulate some part of her brain.) Well, she never does leave when things get like this and within a day she’s calling me terms of endearment like ‘babe’ and ’sweetie’. At first I was really confused but now I can predict these odd behaviour patterns. She has problems at any job she has ever had (always with the complaint that certain people ‘treat her bad’), and now refuses to work to help out with expenses. For that matter, she refuses to want to plan for retirement, or be responsible in any fashion with expenses, holidays, etc. She says I should be lucky that I have her (basically indicating that I should be glad to keep working just to have her around no matter what age I should have to work to and that she could have married a millionaire.) She barely keeps the house clean. She has all kinds of body aches and pains, she sleeps late, refuses to go on outtings, for drives, or even out together much anymore. If we do she winds up arguing about silly things (basically gets herself worked up over very little things, complains about other drivers, me not signalling in time, just about anything will do it.) Also, she can’t go out of the house without full make-up on, won’t even answer the door. She looks completely different with make-up then without. I tell her she looks great without make-up and that she doesn’t need it. At first she really doubts what I’m saying but reluctantly agrees (still never goes out without it though). She always thinks she’s overweight. I always tell her she looks great. She used to be fairly overweight as a teenager and young adult but has since lost the extra weight. She can really fool people, in that no one we know realizes she’s as mixed up as she is. We’ve been married sixteen years and have no children. I love her and want to help her but I’m not sure what to do now. The psychologist was no help at all. In fact, the psychologist made things worse. She won’t go to the family doctor for her bodily aches or depression. I think she may need the services of a psychiratrist. Surprisingly I have come to terms with this state of affairs. Although I think I’m going to get counselling for myself. I hate to end our marriage and would rather get help for my wife. Is there anything I can do for her that might help her to seek good help? Or, anything I can do on my own to improve our lives? Thank you.

A. It is possible that your wife is suffering from bipolar disorder, schizophrenia or schizoaffective disorder. It is impossible for me to know what her diagnosis is or if she merits a mental health diagnosis, but much of what you have described is characteristic of one or more of those disorders. It is abnormal to be delusional, to have thoughts of grandiosity, to be irrational and to engage in illogical thinking. It is typically a sign of a serious mental health disorder.

There are many other aspects of your letter that lead me to believe that your wife may have a serious mental health disorder. One is the fact that she met someone (or a group of people) on Facebook and then decided to fly to another state for a meeting. The meeting apparently did not go well and unfortunately there’s no way to know with certainty what happened. All that you were able to gather (based on her response when she returned home) was that the meeting went very badly. That was a very risky thing for her to do. This is one example of her delusional and irrational thinking.

Other concerning symptoms include the fact that she misinterprets the actions of others. That is another sign of a serious mental illness. Other concerning symptoms include crying spells, the unusual manner in which she relates to friends and family, and her threats of suicide. In addition, it seems as though she is not functioning at an appropriate level.

You also mentioned that she complains of body aches. Body aches may be a sign of hypochondria, which is the belief that one is suffering from a physical ailment despite medical evidence to the contrary. She may in fact be suffering from a medical condition and the body aches may be real, but it is noteworthy because hypochondriasis is characteristic of some psychotic disorders, schizophrenia in particular.

You decided to seek treatment for yourself and that was a very wise decision. I also think it is important to have a therapist who understands the nature of serious mental health disorders such as schizophrenia, schizoaffective disorder or bipolar disorder. Again, I cannot verify whether your wife has any one of those disorders, but her symptoms are indicative of some type of psychotic-based disorder.

You think your wife should see a psychiatrist. I wholeheartedly agree. She may also benefit from psychotherapy. The goal is to find a way for her to enter treatment, whether it is with a psychiatrist or another mental health professional, or both. You may also want to consider couples counseling. Perhaps you can do that in tandem with your own individual counseling. Consider family therapy if there are children or other relatives involved.

I think the most important aspect of this situation is the fact that your wife seems to be actively psychotic and is not in treatment. Antipsychotics could help her reduce her psychotic symptoms. Many people, understandably, do not like to take antipsychotic medication. There are many side effects, but perhaps she could take a low dose of an antipsychotic drug. It could help her and your marriage.

It is also important to know that many individuals who have psychotic disorders, schizophrenia in particular, often refuse to take their medications. It is a very common phenomenon. That is why it is important that you surround yourself with support. A competent therapist could provide that support for you.

Undoubtedly, you are dealing with a very difficult situation. You are headed toward divorce, most likely because of your wife’s bizarre behavior. Tragically, schizophrenia and other related disorders have led to many divorces and family breakups but that does not have to be the case for you. Realize that your wife may be very sick and needs help. If she were in treatment and her symptoms under control, then it might actually save the marriage. It may also save her life. Getting her into treatment should be the most important goal at this time. I would also encourage you to educate yourself about psychotic-based disorders and surround yourself with supportive people.

Please write back if you have any more questions. I will gladly answer any followup questions you may have.

I feel like I’m bipolar.. am I??? My dad is bipolar, and has been my whole life, He has gotten worse because of his heart attack in June. When he’s manic, I love it! He does funny, and risky stuff, and I take part. My younger brother (15) doesn’t like it as much as I do and I don’t know why. I feel like I also get manic sometimes. I feel like my thoughts are rushing, and I act crazy and obnoxious without thinking at all, it feels like an impulse. I have anxiey issues though, and I take anti-depressents for it. Why do I find it so fun when my dad is acting crazy when he’s manic, and other people around me hate it, or is embarassed? Am I bipolar too?

A. Bipolar disorder tends to runs in families. Your father has it and therefore you are at an increased risk for developing the disorder. I cannot diagnose you over the Internet and just because your father has it does not necessarily mean that you do, but you might. If you do have it, this may explain why you find it fun and entertaining when your father is manic (i.e. you can relate). Perhaps he’s more “fun” when he is manic because being manic is like being high on drugs. Everything seems and feels better than it actually is. People with bipolar disorder commonly say they like the feeling of mania. Tara Parker-Pope’s Well Blog in the The New York Times last year featured a number of individuals discussing their experience with mania. One interesting quote came from Carter Goodwin, a 42-year-old artist with bipolar disorder, who said “I miss the mania…I love the mania. It feels so good to feel like I can do anything and like there is something really special about me. But it’s all chemical. It’s not true.”

You mentioned feeling impulsive while manic. Mania and impulsivity go hand-and-hand. If you are manic then you are not thinking clearly. If you are not thinking clearly then you are less likely to make well-thought out decisions and more likely to engage in less calculated or reckless behavior (i.e. impulsivity).

As for your brother, perhaps he’s concerned or embarrassed because he knows that the manic behavior is abnormal and unhealthy. To be manic is to be unstable. Some aspects of your behavior are apparently disturbing to him. That could explain his reaction to you and the reaction of others.

When your father is manic and you join in with him, you make be inadvertently making his situation worse. You take antidepressants for depression but you are not currently treating the mania-like symptoms (i.e. rushing thoughts, impulsivity). My suggestions for you are to realize that you are at risk for bipolar disorder (because of a family history), to limit or eliminate the manic-like activities that you engage in with your father, and to consider being assessed and treated for bipolar disorder. It is important to seek treatment as soon as possible so that you can decrease the chances of developing full-blown bipolar disorder. You may also want to consider family therapy. Since your father experiences mania, he may benefit from treatment as well. In addition, if he were being treated, it might make it easier for you to stabilize your manic symptoms. If you’d like to find a therapist in your community, please search this directory. I wish you and your family the best of luck.

I have treated for major depressive episodes but think i should have been found to have borderline personality disorder. Even as a child i always felt different from my family & friends and so when as a teenager i had to see a psychiatrist no-one was really surprised. i had my finger on the self-destruct button for most of my teenage years (and for many other periods in my life) my self-harm took on many forms. taking too many drugs, alcohol, picking up men for sex that i never enjoyed, making rash dangerous decisions then being scared of the dark or a tiny insect. my sister called me a freak of nature and it is true. I was sexually abused by a family friend and also bullied by an older brother who loved seeing me in pain (it was his friend who abused me)i got in trouble with the police on several occassions i have been on various medications over the years from anti-depressents, anti-psychotics and mood stabelisers and although for some of the time i felt ‘better’ i never felt normal and still dont. i have now stopped all medication and seeing the psychiatrist but see my G.P. who is a good man. I tried explaining to him that the medication and the ECT may have stopped me committing suicide they never stopped me self-harming or make me feel normal. he suggested i may have been born this way, and that it might be part of my personality. is this possible. would this explain me being as i am. I am currently married and this relationship started in my early 30s, this was my 1st real relationship, as i went between picking up men and kissing women. i get very angry for no reason and my moods are very intense and passionate often within the same day and all of this was when i was still taking the medication and was one of the reasons i stopped. after speaking to my GP i went online and i quickly discovered that my symtoms may well be a personality disorder that has been plagued by depression. is this possible. i eagerly await your reply.

A. If I understand your question correctly, you want to know whether you have borderline personality disorder vs. major depressive disorder (MDD). You seem to meet some of the criteria for borderline personality disorder and depression. It’s also possible that you have bipolar disorder (vs. your current diagnosis of MDD, not in addition to). Some of your symptoms match that disorder as well. Please keep in mind that I can’t be certain of your diagnosis. I would need to meet with you in person and review your extended personal history, but based on the information provided, borderline personality disorder or bipolar disorder are plausible diagnoses. These are possibilities, not definitive diagnoses.

You also want to know if it’s possible to be born with certain problematic traits or personality characteristics. This is a matter of long historical debate. It is a question of nature vs. nurture. In essence, you want to know if you were born this way or if your environment shaped your personality and led to a mental illness. Science has not determined the answer to this question. Some believe mental illness is purely a brain disorder and the problem is caused by a chemical imbalance. Some believe that behaviors are learned or that our parents and the way we are raised shape our personality. Many theories exist but none have been definitively proved. Many scientists believe that mental illness is a result of a complex combination of biological or genetic risk factors and environmental stimuli.

I usually try to discourage people from focusing on gaining an exact diagnosis. There are two basic “schools of thought” on whether a mental health diagnosis is helpful. On one hand, if an individual suffers from a series of symptoms and then learns there’s a name for this specific set of experiences, it can be a relief. It can also be a validation. On the other hand, learning of a specific diagnosis is not always very informative. Nor is it easy to know whether the diagnosis received is accurate. Mental health diagnosis is not an exact science. In addition, getting a diagnosis may make an individual feel upset, overwhelmed, hopeless, and even stigmatized.

What’s most important is that you find a way to relieve your symptoms and live a happy and fulfilled life. Troublesome symptoms make it difficult to function. It can make life miserable and you unhappy. You may not need medication but at the very least, consider individual therapy. You mentioned that you have problems managing your mood. Therapy can help with this. You also said that you are struggling with relationship/marriage problems. Again, this is the type of issue for which therapy could be very helpful. Try asking your general practitioner (I’m assuming this is what you meant by GP) or your psychiatrist about referral to counseling. You may also want to try searching this therapist directory. Thank you for your question and I wish you the best of luck.

My wife was diagnosed with bipolar disorder a little over two years ago after a manic episode. Since then, she’s been on several medications but nothing has seemed to work. In addition, her body is very sensitive to the side effects to the meds.

After becoming aware of her condition, I tried to learn as much as I could about bipolar and realized that she meets every criteria there is except for the promiscuity and spending sprees.

My wife’s suffers from auditory hallucinations. In April, she tried to overdose on clonazepam. After telling me what she had done, she starting to throw things at me saying that she “needs a break” and made a beeline for the door. Since I was afraid that she might run into the street, I grabbed her pushed her onto the couch and called 911. Very little was ever said about this “incident” until much later.

A few weeks later, her new psychiatrist took her off all previous meds and put her strictly on Topamax. By the first of June, she began a downward spiral. She initially went into a deep depression and became very withdrawn. This was followed by countless days with very little sleep and an obsession with Facebook.

In early August I had to go out of town for work and had to send my wife to stay with family in Massachusetts for a week. Upon arriving, she informed me that she was never coming home to Florida because she was scared of me and didn’t trust me. She refuses to talk about us. She tells me that she loves me and she has never mentioned divorce herself. Yet she seems to be making irrational plans for her future that seem so permanent. She told me not to come visit her.

A few days ago she agreed to go to the hospital after the voices told her to harm herself. According to my wife, the doctor told her that she simply had Obsessive Compulsive Disorder and that the voices were her own thoughts because she worries too much. Yet he prescribed Zyprexa which I have learned is for schizophrenia.

What is wrong with her? Can the symptoms that I talked about have anything to do with OCD? Please help me. I love her so much and want her to be healthy.

A. Your wife was originally diagnosed with bipolar disorder but it may not be the correct diagnosis. You also said that your wife was told that she has obsessive compulsive disorder (OCD). She may have bipolar disorder in some capacity and she may also have obsessive compulsive disorder but there is a realistic possibility, given the symptoms you have described, that she also has schizoaffective disorder or schizophrenia. Schizoaffective disorder is like having bipolar disorder and schizophrenia. Typically schizophrenia or schizoaffective disorder is diagnosed when the individual experiences psychosis. Psychosis is a break from reality. It means that an individual no longer believes in things that are logical and rational. Psychosis presents itself in the form of delusions, hallucinations or paranoia. It seems that your wife is experiencing voices and paranoia. The paranoia is directed toward you. This may explain why your wife decided to abruptly leave you and move to another state.

I would advise you against taking her decisions personally. She is not thinking clearly. She is psychologically ill and is unable to form coherent thoughts at this time. I understand your fear and concern in this situation. Anyone in your position would feel this way.

I have several recommendations for you. I would advise you to read about bipolar disorder, schizophrenia and schizoaffective disorder. There is a realistic possibility that she has at least one of these disorders. Please keep in mind that from my vantage point it is difficult to know this for certain, but based on your description of her symptoms it may be a possibility.

The second recommendation, as I a mentioned before, is to try not to take her symptoms personally. This is difficult to do, especially as her husband. If your wife mentions that she no longer wants to be with you and wants a divorce, I understand it is extremely difficult not to be hurt by this, but please keep in mind that she is not rational. She is unable to make clear decisions and her thoughts are likely being driven by paranoia and delusions.

A third recommendation is that you surround yourself with support. If you don’t have friends and family for support (and even if you do) contact the National Alliance for Mental Illness (NAMI). This group is designed to help and support individuals who have a loved one with a mental illness. Many of the individuals who run the NAMI support groups are seasoned veterans of mental illness and the mental health system. They can be a great resource for you.

My fourth and final recommendation is that you try, when possible, to be involved in your wife’s care. She may not want you to attend doctor’s appointments or visit her in the hospital but you should go anyway. She reported to you that a doctor diagnosed her with OCD, told her it was this disorder that was causing her to hear voices and prescribed her medication for schizophrenia. As you pointed out, this information does not make sense. It may be that she does not fully understand what the doctor is saying, possibly due to her symptoms. It is important that you attend her appointments and hear what the doctor says versus having her tell you what she thinks he said. It is also important that you attend the appointments to ask questions and to get the doctor’s advice about how you should handle this situation. Whenever possible, speak to doctors and social workers, but keep in mind that you may have to ask her permission.

I hope this answer helped you in some small way. If you have further questions please do not hesitate to write back. I will do my best to answer any questions you have. I wish you the best of luck.

It’s very complicated, but I’ll try to explain as best as I can, because I desperately want to know what is wrong with me.

I am sad. All the time. I feel lonely, and needy. I loathe myself. I purposely push myself away from others, before they can reject me (which they surely would.). I hold things in for long periods of time and slowly let the pour out. I cry a lot.

Sometimes I cut myself. I’m not always sure why I even do it, but most times it’s to numb the pain inside me, to distract myself. I have picked on my younger sister since we were toddlers and I can’t seem to stop. It brings me all kinds of guilt. Thoughts come into my head, as if someone else is thinking them. I want them to stop, but they never do.

I have dreams that are very random and often disturbing. I think about ways to kill myself frequently, and occasionally about killing others. But I could never kill another person, I tend to empathsize with people to an extreme level. It seems like I am constantly looking over my shoulder, expecting someone to be there.

I seldom feel wanted. I don’t want to tell anyone, yet I desperately want help. I can’t hope, I believe it is stupid. I feel helpless, and lost. I feel like I am alone is this world. That I’ll never get better, that I’ll always be damaged and unwanted.

I am never hungry, yet I eat grand amounts. I stay awake at night and want to sleep during the day. I feel the need to distract myself from the real world, and hide my pain. If I read about famous people who feel or felt the way I do, I usually become obsessed. I have recently discovered that “my” goals, were actually just what my parents wanted, that my whole life I’ve just wanted to please them.

For some reason I can’t step on cracks and lines in the sidewalk or on tile. I don’t know why, I just can’t. It feels unsafe and scary. I am terrified of elevators. I take stairs if possible. If not, I squat in the corner, and that makes me feel more safe. I have a hard time trusting people, in fact I don’t even trust myself. Sometimes I have trouble focussing on one thing for long periods of time. I don’t like public areas or speaking in class or even to classmates because I know I’ll say something stupid. I am fat and ugly and worthless, at least in my eyes.

I know I’ll never amount to anything. I resent people who try to “help” me, or counselors at school who think they know how it feels to be me. I hate many things. Hate, not dislike. My sister has Bipolar disorder (She’s my half sister, but my cousin on the side we share has it, too.) and I think maybe that puts me at risk for similar disorders, I’m not sure. I don’t know. I really don’t.

I just want to know what’s wrong with me, and if I can find someway to get help. I’m not sure what I’ll do…. or if I even will… Sometimes I feel like I’m just putting on a show, that I want attention, but that is just a sad hope. I long to be normal and interesting. I wish I could accomplish something. Anything. But I usually talk myself out of doing things like that, to excuse myself from the embarassment it’ll surely cause.

Something most people don’t know is the year after my house burned down and we moved (four hours away from everything I love) My grandmother died. She was like a second mother… ANd everyone acts like it was no big deal.. Am I a baby for feeling so crushed over it? Everytime I think of her there is this sharp pain in my chest and I usually cry for an hour… I remember her promise she never got to keep (“I’ll be right back, honey. I promise.”) and how she looked while she was in her coma.

It seems like I latch onto people I love and I fear their death. I frequently end up crying from the mere thought of my family dying. I have these images that feel forced inside my head of them dying, or getting hurt. I have a friend that verbally,emotionally, and occasionally physically abuses me, yet I can’t leave her. She’ll be moving and it is tearing me up. Am I insane for feeling so attached and loving to her? She’s nice a lot of the time, and she’s the onl one who truly understands me… I don’t know. I’m just in this war raging inside of me. All I want is answers. I hope someone can answer them. (Sorry for the lack of organization of my thoughts, I’m bad at keeping my thoughts together.)

A: Hello and thank you for your letter:

It sounds like you are going through some horrible things right now and I’m sorry that you are suffering.  I could say something stupid like, you’re young, you’ll be fine, but in all honesty, you won’t feel fine for awhile. You are confused, scared, angry, tired, and very, very depressed.  Thoughts of killing yourself or someone else are normal when you are feeling this terrible.  You are absolutely right in saying that you need help. You do need some professional help, and maybe even some medications. School counselors are good at what they can do, but they are often limited by time and the ability to prescribe medications.

You are just entering adolescence, the hardest part of your life, and to have it complicated by losing your beloved grandmother, your home, your friends,  and all the pain you have suffered makes this time nearly unbearable. This time of your life is supposed to be about discovering life, yourself, and how to function in the real world. Unfortunately, right now you are grieving losses.

The good news is that you will work through these things. We never “get over” losses, but we grow through them.  It will probably take another year, but things will begin to look better.  You have every reason to be afraid of losing more people. You have learned too young and too deeply that tragedy can strike. It’s not fair, it’s really not. Being afraid of losing more things like your home, your friends and your family is a normal response to a very abnormal group of tragic events. That just makes us want to cling even more strongly to those things and people who are important to us. As far as being supportive, other family members and friends often don’t want to talk about things because they are hurting too.  They fear opening up wounds that are just beginning to heal, and avoid discussion. Not healthy, perhaps, but a very common way of coping.

You mentioned the mood swings and the fear that you may be bipolar. It may be possible. But the only way that you will be able to find out is again, by going to a doctor.  You should also get a medical checkup, since that can rule out things that can make you tired, etc. What I would suggest is that you ask your family to get you to a doctor who can diagnose what is going on with you and perhaps prescribe something that can help. A child psychiatrist would probably be best at this time, since your pediatrician probably doesn’t specialize in depression, loss and mood swings, let alone cutting.

Also, ask your parents if they will take you to a professional child therapist, and you can locate one in your area at Find A Therapist. 

But, understand this: if you take one thing away from what I have written, I want you to know that you are NOT damaged. You are depressed, wounded, and very sad. But not damaged. You are a very bright (yes, I can tell by your writing), honest, good hearted young lady and you deserve the best help that professionals have to offer.

I hope this helps,

Dr. Diana Walcutt

I have ups and downs, sometimes on the same day. I have been considering getting some help for depression because I have silently suffered my whole life…however i decided not to because I suddently got ‘better’ – excessive socialising, talking very quickly, getting by on little sleep’ low concentration and feeling elated. Then again recently I sank into depression with obsessive thoughts and planning and not being able to move around as well, feeling tearful and hopeless and useless. Then again today had a massive high and was chatty all day-very fast and then although only 4hrs sleep last night can’t sleep tonight 2 am, feeling very buzzy and excitable but really sad too. It really has hit me that I am quite ill mentally…but I am a single mum and terrified of what will happen!! I cope very well with my children.

A. Therapy can help you. You fear it but you already know the expected outcome should you decide against it. You’ll likely continue to silently suffer as you’ve done throughout your life. Isn’t it time for the suffering to end?

You’re not emotionally stabilized. One day (sometimes even on the same day) you’re deeply depressed and the next you’re the exact opposite. It’s not normal to vacillate between emotional extremes. Though the description of your symptoms was limited in length and detail, it seems that a bipolar-type disorder may be present. I cannot diagnose you over the Internet but there is a bipolar aspect to the symptoms you’ve described.

What is remarkable and encouraging is that you’re able to cope with your children despite your highs and lows. The concern is that you won’t always be able to maintain this ability. If you are indeed “quite ill mentally” as you suspect, then you can’t be certain of how you’ll behave in the future.

Seeking treatment for your mood instability would be a wise decision. Do it for yourself and especially for your children. Children need and desire consistency in their caretakers. It makes them feel safe, secure and protected. Mood instability by its very nature is unpredictable and can promote feelings of insecurity in children. Children need to feel safe around their parents and in their home environment. It’s essential for healthy psychological development.

Getting help is nothing to be afraid of. Nothing bad can happen to you or your children. Quite the opposite is true. Therapy can help you learn how to control and stabilize your moods. Since you’re not a resident of the United States I don’t have a link or a reference to give you that would help you locate a therapist in your community. I apologize for this. I searched for a national website or reference but couldn’t find one. I hope you reconsider therapy and are able to find help in your community. Thank you for writing.

My husband is bipolar. We are just now discovering this. In reflection, it is obvious that this has been a problem over the 25 years we have been together but it escalated last year. He is getting treatment and wants to be well. There are many things that he is overly guilty about that don’t really matter and on the other hand he admits to being sexually promiscuous over the years (unfaithful countless times) and feels no remorse. He also says that he has no feelings for me, that our relationship has been farce. We have had a good relationship for 25 years, and we have been great friends, we have raised 4 children together. Is it possible that his disorder is affecting his perception of how he really feels about me? He still acts the same towards me as he always has, he is affectionate to me, and he not leaving us. But when we talk about our relationship he says he has no feelings for me and he never has. It doesn’t add up. Is this the disorder creating false feelings for some reason? Please advise, thanks.

A. Based on your letter, your husband’s statements are not consistent with his behavior. You’ve described your marriage as being very good over the past 25 years. You’ve been great friends and you’ve raised four children together. He’s in treatment and seems to be managing the bipolar disorder well. It’s unclear why he would continue to behave positively toward you if he truly meant the negative things he said. Perhaps there has been a miscommunication. Something is amiss and it may simply be that his words have been miscommunicated or misinterpreted. He may also have said something when he was angry and didn’t mean what he said.

It’s unclear what effect his bipolar disorder may be having on this situation. If he were symptomatic that possibly could explain the discrepancy between what he says and how he acts. I would need to have many more details about this situation to determine what if any effect bipolar disorder may be having.

The good news is that, despite what he says, the two of you continue to have a fundamentally strong relationship. He is affectionate, has not changed his positive behavior toward you and he has no plans to leave the family. As the adage goes, actions speak louder than words. He’s acting as though he’s happy with you and the marriage and that is encouraging. Marriage therapy may help the two of you rectify what seems to be a lack of clear communication. Thank you for your question.

I’m extremely tired of dealing with our bipolar? schizoaffective? son. He’s a mean, angry, verbally abusive, person. My husband of 45 yrs had a cancerous kidney removed 1 1/2 yrs ago and is in a drug study at Johns Hopkins. The stress we deal with is definitely affecting our health. We’ve been to many NAMI meetings, but they haven’t helped our situation. He says that we should stay out of his life and we certainly would love to do so. He misses Dr. appointments. He has had 2 auto accidents with DUI charges that are going to trial for which we had to hire a lawyer. We pay all his living expenses yet he blames us for his problems. He’s a college grad with a psychology degree so he feels he knows he knows himself better than his therapists. The only time we feel that he’s in a safe environment for himself and others has been when he’s hospitalized. If we didn’t help, he’d be on the streets homeless.

A. You may be past the point of diminishing returns. There may not be anything left that you can do for your son. It seems as though you’ve tried to do everything for him and nothing works. He continually disobeys your rules and gets into trouble no matter what you do for him.

It’s very admirable of you to want to help your son and to want to ensure that he doesn’t wind up homeless. I can understand why you would want to prevent this. He’s your son and you don’t want to see him living on the streets. But you are doing this at the expense of the health and well-being of you and your husband. You’re doing all you can and it’s still ineffective. You are degrading your life to assist someone who may not be able to be helped, at least not at this point in time. You may have to make the difficult choice of letting go. I suspect that the help you are giving your son enables him to continually engage in problematic behavior. He may be bipolar but he is also an adult male who seemingly has no responsibilities. Has he never been forced to fend for himself? He’s probably never had to fully experience the consequences of his behavior.

I know what I’m suggesting may not be easy or what you want to hear but it may be the only correct way to handle this situation. Things may have to get worse for your son before they get better.

I would suggest that instead of or in addition to NAMI meetings, you and your husband consider seeing a therapist for guidance on this issue. It’s not going to be easy to change the way you interact with your son but it may be the only thing that saves his life and yours. If he won’t change his behavior then you must change yours.

In 2003, I sought treatment for what was the latest of several major depressions. It was a different kind of depression, as if I had been visited by every type of bad mood I had ever had, along with a sharp spike in my chronic insomnia. My primary care doctor prescribed Lexapro, but I did not improve. At six months, I was worse, and it was as if some irrational, bitchy, sleepless, weepy, hyperactive, anxiety-ridden woman had taken over my body.

After a year of this, I made an appointment with a psychiatrist and was diagnosed with bipolar disorder. It took almost another two years to get stable. My life was so awful, I found it almost unbearable, but the doctor, the therapist, and my husband all told me to be patient–the results would come. I got through it. My friends were not so resilient; they ALL bailed out as if they were embarrassed to know me. I was hurting, I was frightened, I was frustrated, but I was not badly behaved nor had I done anything to embarrass anyone except myself. Long before I got well, I realized I had been abandoned.

Overall, my life is better, but I still have no friends. I have acquaintances, I have an Internet friend who lives 800 miles away, and I have a lovely husband. My life is very busy and I work with people in a “helping profession” all day long, so I’m not isolated or withdrawn. I am terribly lonely, though, but I don’t know how to get past it. I can never, ever divulge that I have this illness. I know first-hand how well tolerated that information is. Having seen how quickly I was left alone by people who had known me for 20 or more years, I can’t see leaving myself open to that kind of betrayal again. It’s quite a conundrum. I am already exhausted from leading a life where I diligently manage an illness that can be unpredictable under the best of circumstances, so I can’t imagine how much trickier it would be to do that with someone who is new in my life.

How can I find a way to be more content with my situation? It’s really on my mind right now because I had a birthday this week and as is the way now, there were no greetings from anyone other than my husband, my mother, and my brother. Then again, that’s more than a lot of people get, right?

A. With regard to your friends leaving you after learning of your bipolar disorder, you did not specify the nature of those relationships. Were you all very close? Did you talk every day or only on special occasions? Did they live close by? Knowing the answers to these questions (and others likes these) might have provided some insight about what type of friends you were.

There may be several reasons to explain why they left. Maybe they weren’t your “real” friends. Sometimes people misjudge the quality of their relationships. It may be that you never really had a true friendship with them. If they were never “real” friends then the fact that they abandoned you isn’t surprising.

There may be other reasons to explain the behavior of your friends. It’s possible that you acted in a manner that drove your friends away. You mentioned that early on in your treatment you were “irrational” and “bitchy.” I am wondering how “irrational” and “bitchy” you were and in what ways? Perhaps it was partly your behavior that led them to end the friendship.

Another explanation is because you have bipolar disorder. I remember receiving a question from a mother a few years ago with regard to her daughter befriending an individual with a mental health disorder. The way in which the question was worded was essentially “how can I stop my child from being friends with this individual who has a particular mental health disorder?” I mention this because it was an example of stigmatization at its worst.

Unfortunately there continues to be a stigma attached to individuals diagnosed with mental health disorders. It’s a large part of the reason why some people never seek help for their mental health problems. You may have experienced this firsthand with your ex-friends.

Without knowing all of what happened, the nature of the relationships with your friends, exactly how you behaved towards those individuals, etc. my ideas about why your friends stopped contact are speculative.

With regard to making new friends, my general advice is not to reveal a mental health diagnosis early on in a new relationship. That’s because, as you may have experienced, it can be difficult for people unfamiliar with mental illnesses to fully understand mental illness. Unfortunately people still believe in myths regarding mental illness.

You desire more friends and are disappointed because you feel you do not have enough. Instead of being down on yourself for not having enough friends why not use this opportunity to find new friends? Are you engaged in social activities? This might be a good way to make new friends.

You also asked how you could be content with your current life as it is. Here is one way: Appreciate the reality of your life. I am not sure if you realize it but you have much to be thankful for.

You finally have the bipolar disorder under control. That took years. Now you’re stable. This is something to be happy about.

You are a physically healthy woman. Don’t take your health for granted. Realize that many people live with painful and horrific illnesses for which they’d give almost anything to live a day disease- or pain- free.

You have a loving husband. Many women cannot say the same. You’re very fortunate. You also have a career in a helping profession. This gives you an opportunity to help and be kind to others.

There seem to be many positive aspects about your life. Appreciating the personal richness of your life hopefully will help you feel content with what you have and stop you from focusing on what you believe you don’t have.

I have been treated for bipolar I for 12 years/now added dx of BPD. I am 54 years old & was have been treated for bipolar I disorder for the past 12 years with medication & seen different therapists on & off who have not been very helpful. The medications (I took a combo of 6) helped very much until I had a period of 5 mos. of hypo mania & didn’t report it to my meds provider as I didn’t know it was dangerous & it felt so good. My husband made a negative comment to me about the weight gain I have had (50 lbs.) since being on these medications & I overdosed. I had been relatively stable for 5 years before the episode of hypo mania & was seeing my provider every 6 mos. for check-ups since I was doing well.

I have had a very hard time with my moods since I was 15 when I had my first suicide attempt. My mother was also bipolar & committed suicide when I was 15 after many attempts & hospitalizations. My childhood was very chaotic with her (she was psychotic often). My brother claims she sexually abused him. I don’t know as I cannot remember much of my childhood at all except sort of “snapshots” of her calling me a whore (when I was 11 years old & didn’t even know what the word meant) & examining my genitals for venereal disease & locking me in the closet when she had her boyfriends visit or my father driving drunk & I would be crying & begging him to stop & he would be angry at me. In fact, he was very angry at me after my suicide attempt, too, as the boarding school where he had dumped us kids after my mother’s death made him take me home for 2 weeks “to get help”–which basically meant he left me alone while he went off to do whatever he was doing. He was an alcoholic & absent much of the time so sometimes I had to call the police when my mother was beating up my brother.

So since my overdose 2 1/2 years ago I’ve been in a mixed–moderate state & not doing too well (according to my meds provider’s diagnosis on the insurance form). She’s been changing some of my meds & I started dialectical behavioral therapy as someone in my support group said how helpful it was & I have found it to be VERY HELPFUL & VERY HARD to practice all that I am learning, but it is giving me such hope that I don’t have to live at the mercy of my out-of-control & over-reactive emotions. I am finally starting to get over my suicidal thoughts & making some progress in repairing my relationship with my husband.

He had no idea I would react as I did. He is remorseful & says we all have our faults & that our marriage is 90% good & we need to focus on that. We have companionship, etc. I can no longer even think about having sex with him as my self-esteem was destroyed with his remark.

I’m having a hard time trying to give the right info. so you can address my question! I have all the symptoms of bipolar–excessive spending, deep depressions & hypo mania (never full blown mania), mixed episodes, paranoia (thought my husband wanted me to kill myself) & delusional thinking (thought my husband was planning to poison me), insomnia, anxiety, etc. Also binge eat & binge drink & have feelings of unreality where I don’t feel “real”–like I’m a vapor or I look around & the world is not real. I “lose time”, have a very hard time being appropriate in that I reveal too much to people (blurt out info. about my mental illness or suicide attempts) so I feel like I’m not “safe to be out in public” & isolate myself. These do sound like symptoms of borderline from what I’ve read.

I’m very dependent on my husband’s approval & am constantly trying to read his facial expression or body language to see if he is “thinking bad thoughts” about me–though the DBT is helping me get over that. We have been married for 34 years & it is still hard for me to believe that he really loves me.
I started individual therapy with the therapist who is doing the DBT group & I noticed on my insurance form she put down the diagnosis of bipolar & borderline personality disorder. Can I have both or is she just seeing that because that is her focus?

I have been able to decrease my dosages of Lamictal & got off Abilify (caused weight gain) & Klonopin (mindfulness helping with anxiety) & Trazodone (insomnia is much better). Added Topa max to help maybe lose weight.

Since the symptoms overlap so much can I have both?–yet one is biologically based & the other has more to do with trauma (can’t remember any specific trauma though my therapist does say a lack of parental nurturing is trauma & I definitely did not have any nurturing or a feeling of safety in childhood or really any time at all except from my husband & that feels very fragile). And then there is the issue of treatment. Bipolar seems to require meds & borderline not. So do I need to take meds?

A. You’ve asked a number of specific questions but first I wanted to make a general comment about your letter. I hope that you are proud of your progress. You endured neglect and abuse by your parents. You were left to essentially fend for yourself as a child. No child should have to go through what you did. Your parents’ treatment of you (and your sibling) left you in the unfortunate position of essentially having to raise yourself. You had no guidance, no mentor, no stable individual in your life to teach you how to behave, to manage life, to think, to feel, to manage emotions, to encourage your psychological growth, etc. Now as an adult you have to heal yourself from all the damage your parents have done. It’s unfair but you are making a major effort to change and you are seeing progress. I hope you continue to work with your DBT therapist and support group.

With regard to your questions, it is possible to have bipolar disorder and borderline. They are similar in some ways but different in many others. Bipolar disorder may also be related to the trauma you’ve experienced.

Keep in mind that some believe that bipolar is biological whereas others do not. Science has not definitively identified the cause of this disorder (or any others). The same is true for borderline personality disorder. Some believe it’s biological but others would disagree. Until science has a clear-cut answer there will continue to be differing opinions.

Medications are typically helpful for individuals with bipolar disorders. Medications have been shown to be less effective for borderline personality disorder. The best treatment for the latter disorder is the one that you are currently engaged in, DBT. If your doctor believes that medication is helpful for the bipolar disorder at this time then it best to stay on the medicine, especially because it seems that you’ve finally found a medication combination that works for you.

Between your DBT, individual and group therapy and the medication, you seem to be engaged in all of the correct treatments. I would add that you should inform your therapist or your psychiatrist about the symptoms you continue to experience. Overall, however, you seem to be on the right track. Keep up the hard and effective work. Thanks for writing.

My husband has manic episodes…what is wrong with him? I am desperate. My husband has something wrong with him but he does not want to go to the doctor. I have read about so much and I still do not know what it is that is wrong with him. He has manic type episodes. He can be totally fine and then all of a sudden get mad about absolutely nothing, like losing a video game. He is a very religious and loving person but when he gets this way he curses god, says he hates god, says he wants everyone to die, tells me he’s going to kill me, hits me, chokes me, breaks things without any regard to what they cost. We have lived in our new apartment for a month and we already have two broken windows for example. He goes absolutely insane. It seems like he has no concept of reality. He says crazy things, talks a million miles a minute, screams, hits himself, scratches his face, pulls his hair out. The episodes last no longer than an hour and happen at least twice a month (approx.) After the episodes he is normal but tired. Most of the time the episodes end with him falling asleep. He never goes into a depressive state. No legitimate guilt to speak of. He doesn’t seem to understand the severity of his actions. About half of the time he is drunk during these episodes. The other half he is sober. He has been clean from crystal meth for about 6 months now…I’m thinking that may have something to do with it. What is wrong with him?

A. It’s not clear what’s happening with your husband. As you suspected, he may be having a manic or psychotic episode and much of it might have to do with the fact that he is using alcohol at times. These episodes may also be related to his past use of crystal methamphetamine. Yes, he is currently not using the drug but it’s possible that it’s still having an effect on him, perhaps because of brain damage. It’s difficult to know what precisely causes his episodes. He would have to be evaluated by a physician or a psychiatrist to know for certain.

You should also know that these periods of mania or psychosis are potentially dangerous for you. You noted that he goes “absolutely insane” and has “no concept of reality.” When these episodes occur he tells you he’s going to kill you, he physically abuses you, chokes you and destroys the apartment. Afterwards he has no recollection of what had occurred. The fact that he could engage in such destructive behavior and then have no recollection of it should be a major concern for you. He could “accidentally” hurt you or himself.

The next time one of these incidents occurs I would strongly suggest that you call for help. You may have to call 911 and have the police come to your apartment as a way to calm him down. The other option is to call the local crisis mental health team to help you deal with the situation. Please realize that this is a dangerous situation. He has episodes in which he loses complete control and attempts to harm you and himself. None of what you described is “normal” behavior. As I mentioned earlier, there may come a time where he actually does inflict great harm on you or himself. If you call the authorities or the local crisis team then they may be able to help you get him into treatment or at least, temporarily place him in a hospital where he can calm down and be evaluated by the appropriate mental health staff.

The truth is that he needs to be evaluated immediately. Please don’t risk endangering your life or his any longer and call for help when one of these episodes occurs. Calling for help when he has an episode may be the one and only way you can get him in for an evaluation or into some form of treatment. Thanks for writing.

After years of extremely abusing prescription pills and experimenting pretty much everything, my sister, age 27, has been diagnosed with Bipolar disorder. Until the past year, she was 100% functional, she went to school, work, and could have relationships with family and friends.

Within the past year and a half, she has quit school, moved home (in with me (age 21) with my husband and infant child), and became incredibly consumed in her drug life and the people whom that brings. This has caused many marital problems and we have asked her many times to move out. She straightens up long enough for us to say she can stay, and she goes right back to her old ways.

She blames ALL of her failures and problems on her Bipolar disorder, and cannot take responsibility for anything. She has been off work for a month, frankly because she talks her doctor (who is a Nurse Practitioner) into letting her been off work for weeks at a time. And when she is scheduled to go back, calls her doctor over and “emergency” and gets another week off.

She is EXTREMELY dramatic, and will do practically anything for attention. She says that no one in the family loves her and only her druggie friends are there for her.

Well, this week we have all cracked. We gave her the ultimatum to come home (she was incredibly wasted and couldn’t drive, so i offered to pick her up) or pack her bags, and she didn’t come home till the next day, so i called her and told her that she had to go. The next day she checked into a psych-ward in a neighboring town. You might see this as her trying to help herself, but i don’t. She knew that I have told the family that i am fed up. Fed up with her drama, her keeping drugs in my house, her causing problems, and her bringing questionable people around my child. My husband and I have never been into drugs, and felt sorry for her. She has used this against us.

My question in the end, even if the Bipolar disorder is “not her fault”. Could the Extreme pill addiction (that she still has) be affecting her Chemical imbalance??

A. You’ve done a lot for your sister. You gave her shelter when she needed it. You’ve taken care of her for longer than you probably should have given the fact that she was using drugs around your child and bringing shady people into your home. She might have bipolar disorder and that is unfortunate but she also is an adult who is irresponsibly engaging in drug use around your child. That type of activity endangers not only your child but also you and your husband. Given these circumstances, giving her an ultimatum was the correct choice. I know it was difficult because you’d hate to see your sister suffer but you have a family that you need to care for and protect. She was endangering your family and so she had to go.

I am not sure I understand your question regarding extreme pill addiction and how that might affect her chemical imbalance. If you are asking whether drug use worsens bipolar disorder the answer is yes, usually it does. It’s not clear whether the drug use led to the bipolar disorder or vice versa but undoubtedly drug use negatively impacts bipolar disorder symptoms.

It was very thoughtful of you to take in your sister when she needed help but it was the correct choice to make to ask her to leave when she began using illegal drugs in your home, around your child. Hopefully in the future she can get the help she needs and then it may be appropriate to allow her back into your home. You can and should support her in her attempts to get help even if they seem half-hearted. Addiction is a very difficult problem to overcome and it usually takes addicts many attempts to finally quit. With your love and support she might someday be able to beat her addiction. Thanks for writing.