Bipolar Depression

[Bunnyme]

My uPD spouse has put me through the wringer.  He has been through rehab several times in the past year due to drug addiction.  His family were convinced he was clean now and I was just not giving him a chance.  Well, I actually caught him using again.  (We are separated and I've filed)  He was suicidal and ended up in psychiatric care.  He has now been diagnosed as bipolar after 2 days there.  I know I'm not an expert, but I disagree...especially because his explosions are situational.  Can anyone with more expertise or experience give me some insight into how the two may be compared or linked? 
I hate to admit it, and I feel pity for him, but it makes me a little mad.  Like, he was finally caught.  Undeniable.  His family couldn't deny it.  But now, there is yet another reason none of his behavior is his responsibility.   Perhaps if i better understood?

[notrightinthehead]

This is a philosophical question for me and I believe we are free to believe what we choose. I choose to believe that adults are responsible for their behaviour unless they are mentally impaired.  There are many people who live with a diagnosis of bipolar and they manage their condition with the help of medication and therapy to the extend that they can have a normal life. From what you tell us, your husband has a good support system, his family jumps at the opportunity to help him.  Yet he seems to choose to behave irresponsibly.
If you choose to believe that he is not responsible for his behaviour because he is so impaired that he cannot understand the consequences of his actions, then there should be arrangements that enable him to live a good quality life with some legal guardianship. 
It seems you have tried your very best to get your husband on a healthy path without success.  You are well justified to now let professionals have a go.

[Cat of the Canals]

First, it's not unusual for people with cluster B personality disorders (NPD, BPD, etc.) to be diagnosed with depressive disorders, anxiety, substance abuse, etc. PDs have a high comorbidity with bipolar disorder (meaning if you have one, you are more likely to have the other) in particular.

I'm assuming that your spouse was referred to some sort of short-term, acute care as a result of being suicidal. Having worked on an acute psychiatric ward, I can tell you that the care is generally focused on the immediate issues, i.e. the fact that he's suicidal.

On top of that, the doctor observing your spouse is operating with fairly limited information: two days of observation, reports of suicidal thoughts, and possibly some history from the family, (which I imagine would be somewhat unreliable, given what you've said about them). The only diagnosis most doctors would make in that scenario is some kind of mood disorder.

The patients I encountered that were diagnosed with PDs had usually either been through the system already (community mental health services or prison) or had been in treatment consistently enough that a doctor could determine there was something more pervasive than (or in addition to) a mood disorder.

My PD grandmother was diagnosed bipolar and went through decades of treatment for it. But as far as I know, her PD was never diagnosed. (Everything gets swept under the rug in my family, though, so it's likely a diagnosis like that would never have been discussed.)

Is there a chance PDs are often misdiagnosed entirely, and the symptoms of the mood disorder are entirely brought on by the PD? It's possible. But I don't know if it's all that relevant.

The fact that your spouse was diagnosed with bipolar disorder doesn't absolve him of responsibility for his behavior now or in the past. If anything, you could say this would require MORE responsibility on his part and his family's part going forward. He has a disease, and it must be managed appropriately to keep him and the people around him safe. Ignoring that or using it as an excuse to enable his behavior would be as irresponsible and unhealthy as allowing a diabetic child to eat a bunch of sugar out of pity.

There's a chance this diagnosis -- accurate or not -- will end up having a silver lining. If his family takes it seriously, it would probably mean enacting some serious boundaries. On the other hand, should they choose to let him off the hook, they will probably come to regret it and be forced to learn some hard lessons.

[GettingOOTF]

My ex was diagnosed with depression and  ADHD for most of his life. After he spent two weeks in a secure psychiatric hospital he came away with a diagnosis of BPD which fit his behaviors much better.

His dr explained to me that BPD is very difficult to diagnose and requires a longer period of observation, not just visits or a day or two.

I have also read in many places that it’s very difficult to diagnose someone in active addition as the behaviors of an addict are quite similar to many mental disorders. Not all addicts have these disorders but all will share behaviors.

When my ex was diagnosed I’d never heard of a PD or a site like this. I was SO relived I cried as I finally had an answer and a game plan. I researched and read all that I could. I honestly doubt that there were medical professionals who knew more than I did about BPD by the time I was done. Learning about it became my full time job, almost at the cost of my actual job. None of this understanding helped him, me or the relationship. Instead it took years more of my life.

Now I see that these diagnosis are really a sign to walk away. There is nothing you can do to influence either way. It’s a proper medical condition that requires proper medical treatment. Much like with addiction, you cannot love or support someone better. If that were possible PDs, depression and addiction wouldn’t exist.

My ex wears his BPD diagnosis like a badge of honor. He uses it to explain away all his poor behavior and to illicit sympathy and support from everyone around him. What he doesn’t use it for is motivation to change, to follow through with treatment. He uses his diagnosis the way he uses everything else in his life - to manipulate others.

My experience was that his family used his diagnosis to guilt and shame me for leaving. The narrative became that I left him when he was sick. Ultimately his diagnosis was freeing for me as I came to see that nothing would ever change, but it costs me many more years of FOGgy living. I consider myself lucky to have walked away with my life at the end of it.

[Bunnyme]

Learning about it became my full time job, almost at the cost of my actual job.

My ex wears his BPD diagnosis like a badge of honor. He uses it to explain away all his poor behavior and to illicit sympathy and support from everyone around him. What he doesn't use it for is motivation to change, to follow through with treatment. He uses his diagnosis the way he uses everything else in his life - to manipulate others.

My experience was that his family used his diagnosis to guilt and shame me

All of this resonates.   I had to limit my googling.  It was hard at first.  I ended up being distracted by it.  I didn't get in trouble, but my work suffered.  Who knew I'd be up at 3am researching how crack is made after something I found (couldn't exactly google that on a work computer      Fast forward a year, and it is much better.  I tend to obsess over things when I am stressed.  (I stayed up literally all night watching youtube review videos before I bought my air fryer    anxiety over making the wrong choice)  I still indulge my desire to learn, but am much better about it.  I come here to vent, and I allow myself to listen to podcasts on the way to work.  If I hear something google worthy, I give myself a few minutes and move on.
That's it. 

I fear mine will wear this as a badge of honor as well.  He was diagnosed adhd in the third rehab.   Who knows.

I also fear the guilt and shame, as I'm sure it is coming (I already get it because "he cant help it that he is an addict," so now that bipolar is thrown in...)  Thankfully, I've put in a lot of work to the point where I know I cant control him nor them or their perception of me.  They want to believe him.  They will.  I no longer share or try to get them to see my side.

Thank you all for your responses.  This is such a rollercoaster.  I have been on many different boards on varying topics over the years, and this is the most well informed, welcoming group.  Truly my lifeline at times.   

[Adria]

Bunnyme,

I'm so sorry for what you are going through.  When you are talking about the two being compared or linked, I assume you are talking about bi-polar and drug addiction? Or maybe I didn't read your post right.

Anyway, in my experience and the hundreds of hours of research I've done, many times the link between something like bi-polar and alcoholism or drug addiction is too much adrenaline.  Dr. Michael Platt has written a book on this subject called "Adrenaline Dominance."  A very interesting read.  He says diseases like bi-polar, ADHD, and many others along with alcoholism and drug addiction are caused by high adrenaline pumping through a person's system. In the case of my son, who has schizophrenia along with bi-polar, it is an easy fix if he will take the few supplements he is supposed to. (That is a big if because he feels better than thinks he doesn't have to take anything anymore and gets back into trouble).  Dr. Platt (and I have spoke with him several times) has proven to me and my son and my husband that if you can stop the adrenaline, you can stop the crazy and addictions.  The reason many people who are alcoholics or drug addicts are so addicted is because they are trying to calm their system and their brain down from too much adrenaline. They are in essence self-medicating because that is all they know how to do.  My husband was addicted to alcohol until we spoke with Dr.Platt and followed his simple protocol.  Got rid of the adrenaline, got rid of the alcohol. You can look Dr. Platt up at plattwellness.com. Very interesting man.  You can email him and talk to him for free. Maybe he can give you some insight on this topic.

I hope this helps and things go better for you. Hugs, Adria