My husband has three personalities

[WashedUpDriedOut]

I'd say 80% of the time, dh is a great guy. Fun, generous, loving.

However, once or twice a year, he becomes almost manic in his jollity. He's over the top FunFunFun and it's quite wearing. Lots of loud singing, dancing about, rash spending of money, accelerated sex drive.

It is quite alarming although it sounds like fun. This might last a week or two.

This ott jolly episode might be followed by a couple of weeks of a really nasty personality.

Quick to anger at nothing, utterly irrational and verbally nasty. Or the nasty personality might emerge without having even preceded by the jolly one.

When he is in either of these two alternative modes, I can't get through to him. Nor can the dcs.

Then these episodes subside and it's back to normal again for ages. I've tried diarising them fo establish a pattern and there isn't really apart from sometimes the nasty persona comes immediately after the ultra jolly one.

I think he has some sort of personality disorder. I'd like him (us?) to visit a psychiatrist but he's baulking at the cost of a private one and the waiting list for an NHS one is very long.

It's unnerving for us to witness this switch of personality. He can't really remember how he's behaved and apologises for anything he's said or done.

He does a he thinks he's "mad" and always has been.

It's been a tough year. We've moved house, he lost his job and a parent. He's now employed again and all seems steady for now. And the jolly and nasty persona emerged for longer than usual over the last six months.

Do you think he should see a psychiatrist or should I just leave it?

I'm going to throw ADHD into the mix, DH (NOT diagnosed) has all the symptoms....but what really strikes me is he does the jolly/nasty thing you are talking about. It's really odd - His is a bit shorter, the nasty only lasts 3-4 days but the "jolly" is about 2-3 weeks. Almost identical to how you describe...

They are very distinct changes in personality - all I can say is that over the years we get nasty maybe once a year, if it was any more frequent or long lasting we'd be divorced as he can be very unpleasant.

@WashedUpDriedOut jeezus what website were you on? Lithium is avoided as a first port of call for current day bipolar treatment due to the potential damage to body organs (eg liver) and requiring regular blood tests & check ups to ensure all is ok.

I highly doubt anyone being treated for potential bipolar is being given lithium as a first port of call !

Lower doses of Seroquel / queitiapine popular to use & other new generation antipsychotics and also some anti seizure Medications are popular to try nowadays for bipolar. Lithium is very old school but still used yes. Anyone given lithium as a first try should seek new medical advice IMO

Maybe lithium first call in some kind of inpatient setting if under supervision / monitoring in a mental health ward, etc.

@vikingwife I was put on lithium straight away

@StarScream22 really! How do find it ? Have you been diagnosed long ? Am on seroquel & venlafaxine 150mg XR of each. It’s obviously still used just no longer considered the gold standard I suppose ? Is there a particular reason your psychiatrist used this one first? Are they older gen psych ? Or were you in patient ? Sorry for all the questions It’s probably not relevant to this thread actually. I hope the OP is able to get her BF some treatment....we can’t diagnose only speculate but a flag’s a flag ! 🚩

Because I’m of child bearing age, they said lithium is the least dangerous to a pregnancy if I were to get pregnant. They also said it’s the most effective. I was diagnosed just before Christmas but still not in a full dosage yet. They start you off small then increase it every few weeks after a blood test.

Now dh is saying he feels fine and doesn't feel the need to see a psychiatrist.

He feels his last episode (which lasted two months) was due to the stress of being unemployed and bereavement.

Now what? I can't force him.

He is working away as well at the moment so our only contact is FaceTime because he can't come to us due to there being no flights/isolating etc.

The episode could have been triggered by those things but that doesn't mean it isn't bipolar.
Feeling fine after the episode also doesn't mean it isn't bipolar.
I feel fine today, doesn't make my diagnosis wrong.

Yes. I agree.

But how can I approach this and persuade him to still see a psychiatrist?

Tact and diplomacy.

Tact and diplomacy might be the way forwards.
If he recognises that there is sometimes a problem that's probably the thing to focus on. It's about addressing those moments not the rest of the time.
The prospect of seeing a psychiatrist can be daunting, there's so much misperception bout what that means and involves, so much stigma around MH and on a personal level there may be a fair amount of fear for what the future might hold.
It's not uncommon I think, for people to want to ignore the problem and hope it goes away. That's what I did, for a very long time and it didn't end particularly well for me.

I read lithium is often used to treat bipolar. Isn't this quite heavy duty drug? I get that there are varying doses but can one function at work at on lithium?

There are a fair few meds, not just one. If one thing doesn't suit a person and makes them groggy, they can try a different one. Personally, Lithium did nothing for me at all, I couldn't tell I was taking anything, but everyone's different.

The right med will help him at work of course, as I expect he is snappier or more impatient/at risk of making mistakes at work during these episodes.

Now dh is saying he feels fine and doesn't feel the need to see a psychiatrist. He feels his last episode (which lasted two months) was due to the stress of being unemployed and bereavement.

This is the problem with getting someone to get and maintain treatment for an episodic illness. Yes, his last episode was triggered by stress. So, stressful events will happen again in life and risk triggering him again, that's exactly why he needs to be on medication to try and stop stress or anything triggering an episode.

If I were you, I would say to him something like if he gets on meds he can prevent or lessen the impact of some of these episodes, and please will he do it for the sake of you and the kids if not his own, as when he gets these episodes it's unpleasant for you.

It may be that he doesn't get help until he's next in an episode, and that's fair enough although of course we'd rather he did it now and maybe avoided an episode. You can only try your best to get through to him.

Whatever it is, it sounds like he should be on some sort of meds if he wants to stay at his best. If he doesn't get help and I were his wife I would be a bit annoyed TBH.

He needs some reassurance and cajoling - which might take a couple of steps. Us the “4 Es” process that the police use to manage situations without escalating - Engage, Educate, Encourage, Enforce.

The hope is that the first 3 steps mean you don’t have to do the 4th.

Don’t armchair diagnose him - talk about individual “traits” or behaviours that are off kilter, are noticeable to others (DC) and cause you all distress - and that these traits / symptoms can be alleviated - and you are concerned that they are more frequent and/or intense. Read up on untreated MH issues - job losses, addiction, family breakdown, male suicide.

If you have a log of suspected episodes over the years - write these up so that he can see this v clearly. Ask how he remembers the incidents - but also how it impacted you and your DCs (money etc) - the space between episodes is also v important - as you are all now on the alert - which means this is impacting 24/7 365 to a greater or lesser degree.

You know it is an issue and you just need to be informed and ahead of him to encourage him to seek help.

Most professions are working online - and a lot of MH evaluations are questionnaires so no need to be physically present.

Keep nudging it along.

I have a relative with bipolar, during the manic phase they are very happy, euphoric almost, high sex drive, overspending, lack of sleep. They can become very irritable and nasty as the episode progresses. When they finally come out of it they go the other way, so literally won’t see anyone, and become very depressed. I think it’s possible your husband has Bipolar, and I think each person is unique in the way it manifests. Hope that helps, and good luck.

Just to comment on lithium as it has been mentioned earlier in the thread - my mum has been on this for over 40 years now and it has worked out very well for her. She is very happy, has a great, comfortable and stable life with my dad (married for 44 years now and he had a lot to manage when this started especially with 2 toddlers in the mix). It's very different from the highs and lows she previously endured, and it has had no real side effects for her as far as anyone can tell. She worked at a university for many years and no disruption to cognitive function for her. I work with many people on antipsychotics so I am very aware of the impacts of them on cognitive function, but for my mum at least, lithium did not have any effect (yes am aware this is a study of one, not sure what general findings are but you will be able to research)

She has to go for regular bills tests and occasional urine tests to monitor the impact it has on organs but, at the age of 70, they are still happy with her. She has tried to come off it in the past but her previous symptoms return unfortunately.

Blood tests not bills tests!

Definitely he needs to see a psychiatrist. I know you said you don't want a diagnosis but it really sounds like bi-polar I know two people - both men - with these exact symptoms and in both cases it was hugely damaging for both their relationships and work.

Many people are only actually diagnosed with MH conditions when they seek help for an addiction which they have inadvertently used to numb/mask the stress of the condition.

This is an outline from The Mayo Clinic - and I imagine the complications could be similar for many untreated MH conditions:

Complications:

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use
Suicide or suicide attempts
Legal or financial problems
Damaged relationships
Poor work or school performance
Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders
Eating disorders
Attention-deficit/hyperactivity disorder (ADHD)
Alcohol or drug problems
Physical health problems, such as heart disease, thyroid problems, headaches or obesity”

www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

OP I sympathise with your H. Seeing a psychiatrist is a pretty scary prospect, it makes you feel as if there’s something wrong with you. The other thing is that the bit of that manic high before it all goes twisted up and wrong is amazing. There’s no drug on earth that makes you feel that good, and I’ve tried most of them in the past. You feel invincible and like you can conquer the world. Unfortunately it takes until you’ve experienced the bad bits go really bad often enough that you can really stand to do something about it. If I could have the good bits without the bad I’d be the luckiest person on earth.

Bipolar really is the ultimate blessing and curse. You get to feel utterly amazing sometimes, but boy do you pay for it.

Unfortunately this leaves you in a very difficult position. The only thing you can realistically do is to encourage him to seek help while maintaining your own boundaries. Watching somebody go through a manic episode then crashing down into the most severe depression you can imagine is scary, upsetting beyond belief, worrying, all sorts of turbulent emotions, but ultimately until the person seeks help, then takes their treatment regime seriously, and that includes lifestyle changes, there’s precisely bugger all you can do to stop it. The only thing you can do is be clear where your lines are and try to protect yourself.

I’m sorry, that really is it. I put my ex GF through the absolute ringer when I had episodes and I’m lucky she didn’t dump me. It was only after I’d experienced the bad side enough that Istarted taking it seriously. That’s not even mentioning poor DS, who has been through hell with his Bipolar mother.

I was on lithium, and I was on quetiapine for a long time, plus I tried arapiprazole but it didn’t agree with me. I no longer take any medication because I don’t like taking it but I’m very aware of my mood and sleeping patterns, and will take it easy or seek help if things start to slip. I’m also very strict with sleep hygiene, alcohol and I never touch drugs. Lifestyle is at least as important as the correct medication for Bipolar.

sorry I can’t offer you any better advice or more solace.

Agree that it could be bipolar.
My relative diagnosed would spend huge amounts of money, and give it away when manic and her depressive episodes would come on the back of them.

Diagnosis and finally being on a medication regime that suited changed her quality of life massively ...

Stress triggered it obviously, sounds just like bi polar. I am diagnosed with bi polar as is my sister I reached middle age being ok but then severe trauma triggered it, obviously it was bubbling under the surface for years. Has he always been like this or did something traumatic happen and then he displayed behaviours after this?

If I can persuade him to go to a psychiatrist, would it be wrong of me to want to go too or at least send a letter explaining what he's like?

I just don't think he's going to be able to convey what needs to be said mostly because he doesn't really register his episodes.

I think that would be an excellent idea!

My Mum goes to all of my Dad's appointments with his team as he is a very unreliable narrator. His bipolar is managed with an anti-seizure medication and he has anti-psychotics which he takes when he needs them which can be once a week or once a month. He used to take ADs many years ago before he was diagnosed and they triggered a terrible time and several psychotic episodes and attempts on his own life. Treating bipolar as depression can have the opposite effect to the one desired.

I'm not saying it is bipolar as there are a few things it could be - all needing psychiatric assessment - but as the dd of a father with bipolar, can I reassure you that it can be managed and it can result in a v happy childhood? But this does depend on treatment, management and honesty. I've been the dc of an untreated father and it was terrifying, unpredictable and heartbreaking. If he has something like bipolar, he has a choice. He can allow professionals to assess him so that he can be the best possible partner and father.

Are you sure he’s not using drugs...?