Reader’s Question

My husband occasionally has an angry outbursts where he screams and jumps up and down, like he is throwing a big hissy fit. Usually, I have been here and not reacted to it. There have been times when it happens when I have just run to the store and the children get the brunt end of it. Today it made my daughters cry. Today it was at our young daughters who were at home with him for about an hour. He is diabetic, and doesn’t always take his medicine. He quit his job suddenly last month. He had only been at it for a month. He is normally a self-employed carpenter. He had a paycheck still coming, so we were fine for awhile. This week he earned $200. I ended up taking him to the ER today because he said he almost fainted. They did a brain scan and didn’t find anything. They said he was dehydrated and had a sudden drop in blood pressure. They suggested something neurological may be happening.

It makes me not want to trust him to watch our children alone at all. Something ticks him off — today, the Strawberry Nesquick got knocked off the countertop and spilled onto the floor, and he loses it. It wasn’t until bedtime that my youngest told me why the Strawberry powder was on the floor. She cried when she told me that he made them cry.

Sometimes I think he is manic-depressive. Could this be Cyclothymia?

–THW

Our Clinical Psychologist’s Reply

This is unlikely to be a Bipolar Disorder or Cyclothymia. From his symptoms and behavior, your husband is most likely suffering from stress and depression. Irritability, poor impulse control, taking everything personally, quitting his job, etc. are common in a stress-produced depressive disorder. As stress and depression continue, he will have multiple yet vague physical/medical symptoms. People in this situation often have several trips to the emergency room before they are told “it’s stress”.

To make sure it’s stress and depression, consider these questions:

• Is the family under a high level of stress such as financial concerns, medical problems, etc? A high level of stress can gradually produce these symptoms and reach a level of intensity that the individual is no longer able to work.
• Stress and depression increase whatever behaviors we normally have so if he has always had “temper tantrums” and hissy fits, those will now be more frequent, less predictable, and more intense. Has there been a sudden increase in the number of temper tantrums?
• Has he moved from hissy fits to physical abuse or physical intimidation? If seriously depressed, the move to being physically aggressive may suggest that he is also having thoughts of self-harm or being self-aggressive.

I’d recommend having a heart-to-heart discussion with him, first focusing on his need to be medically responsible with his diabetic medications. Then move to your concern for his outbursts. Don’t focus on his hissy-fit behaviors, but rather your concern that he must be under a lot of emotional stress to be losing his temper so often. Focus on the bottomlines of depression and stress — not individual temper behaviors. He knows he’s been out of control and a focus on what he physically did will only make him defensive. Recommend talking to a family physician or seeking a mental health referral. Keep in mind that he may feel very shameful about his behaviors so we want to focus on how to identify the causes and make him feel better. Volunteer to go with him to a medical or mental health consultation. He’s most likely going through a very difficult emotional/career time rather than being Bipolar.