Hypomania and Marital Conflict^*

Abstract

The author treated seven bipolar patients over seven years whose presenting problems were chronic marital conflict. The bipolar diagnosis had previously been made in only one case. Conjoint or family assessment was essential for accurate diagnosis. Lithium was the cornerstone of treatment and the best results were obtained with bipolar patients who were lithium compliant and whose marital conflict was resolved in conjoint therapy. Marital conflict clearly preceded the bipolar disorder and was not prototypical. Neither a family systems model nor a psychopharmacological model alone were sufficient for treatment. The diagnosis of bipolar disorder must be considered with chronic marital conflict.

The Zurich study

“…Brodie and Left 1971;Lesser 1983). This is in line with the finding of the presence of more distressful and conflictual relationships at the age of 20 and 22.…”

Burden and marital and sexual satisfaction in the partners of bipolar patients

“…Several studies have noted high levels of disharmony (e.g. 23) with some authors even suggesting that marital conflict is so ubiquitous as to act as an indicator of the presence of bipolar disorder in one of the partners (24). However there is conflicting evidence on these points with some studies noting little additional marital conflict in the partnerships of bipolar patients compared to well couples (25).…”

Effectiveness of Psychosocial Treatments in Bipolar Disorder: State of the Evidence

“…Specifically, future studies should: (1) employ methods consistent with contemporary standards of psychotherapy research, including randomization of subjects and use of control/comparison groups; (2) use standardized, verifiable, and reproducible therapeutic procedures; (3) test interventions (including those dealing with cognition and behavior or with expressed emotion) likely to be particularly pertinent to individuals with bipolar disorder; (4) enroll enough subjects to assure sufficient statistical power to detect changes related to experimental interventions; and (5) empsychotherapeutic interventions, although reliable assessment of medicine-taking, particularly among outpatients, is difficult. 29,[65][66][67]73,78,88,97 A particularly reassuring finding in all 11 studies that considered the matter was reduced risk of rehospitalization with various psychosocial interventions (see Table 4). 29,[58][59][60][61][67][68][69]76,77,81 Interpretation and generalization of these findings are complicated by major changes in indications for and financing of psychiatric hospitalization in recent years.…”

“…The six controlled studies of family therapy 76 psychoeducation and seven [73][74][75][76][77][78]81 used interpersonal or process therapies, with single families, groups of families, or one or more patient-spouse pairs. The six family therapy studies involving either comparison treatments or quantitative pre-vs. posttreatment comparisons can be summarized as follows: Davenport and colleagues 76 followed 12 patients for an average of 47 months after they entered weekly psychodynamically based couples group therapy during hospitalization.…”