Reader’s Question

My partner and I are absoulty sure he has Bipolar Disorder. He remembers feeling the way he is since about 9 years old, maybe always. I have done quite a lot of reserach this past week and a few quizzes. It would appear he has rapid cycles, going from one end of hyper happiness to despair and feeling suicidel often every day! From what I have found out he has this disorder quite badly — I know some people don’t suffer as severely as he does. He is now willing to get help; although he is against taking medication, he is willing to get “other” help. So long as I go with him and do most of the talking for him. I have been with him for 12 years and just lately his “condition” seems to be getting worse and worse very fast.

He is becoming verbally abusive which is very hard to deal with; he acts like he hates me. He can go from being the nicest person in the world to the worst. He has problems with alcohol, caffeine and sugar. He can go for months with none then he has to have a bit of one of them and it all starts over again like a tidal wave. Each time his disorder gets worse with the next set of bingeing.

So we are going to get help. Do you know what is the best route? He saw his doctor a few years ago, who put him on antidepressants which did nothing for him. He saw a counseler who made him feel a little better for about half an hour after the appointment. He has had hypnotherapy for his alcohol problems which helped for a short time. He has had homeopathy which did nothing for him. They said you have plenty of energy because you can’t stop moving…he went because he had no energy. He listens to NLP CDs which somethimes helps with his confidence.

Shall we go straight to hospital and see a doctor? Shall we seek out a mental health doctor or shall we just go and see his local doctor which seems to be contstanlty run off his feet and in a rush? His parents deny that he may have a mental illness and think it’s all down to drinking, but even if he doesn’t drink for a year he still acts the same way but not as severely. I know all this may be well out of your depth as this appears to be a counselling website but if you have any ideas of where we can go next I would like to thank you.

Our Clinical Psychologist’s Reply

The first place to go is in the direction of psychiatric consultation. There are several factors that can produce these symptoms — only one of which is Bipolar Disorder. Alcohol abuse or addiction can greatly complicate the clinical picture, as many withdrawal symptoms are similar to depression and anxiety. The presence of a Personality Disorder (see my introduction to personality disorders on this website) can also create the problems with verbal abuse, bad behavior, etc.

Another issue with diagnosis and treatment has to do with the professionals involved. As you mentioned, a family physican can and will often prescribe an antidepressant, typically at a low dose or without proper diagnostic assessment. Other nonmedical or nontraditional treatments will have little or no effect. For this reason, it’s best to use the most sophisticated assessment first rather than spend months chasing lower-level attempts to identify the problem.

I’d obtain a few consultations with the idea of finding the correct diagnosis for his situation. A psychiatrist is your first best option, followed by psychological testing by a psychologist. Combining both results will help you determine the best treatment for the specific conditions identified in the consultations. As you’ve discovered, obtaining treatment for something that may not be present only complicates the problem.