Crying out for help...

I love my husband Gene a lot, but I am losing faith in my marriage, and I always have believed marriage to be the most important thing in the world. I was always looking to get married from as far back as I can remember.

Quick run-down on his past, so you can understand him... he has had a dysfunctional family life, most of the relatives on his mom's side are alcoholics, his dad was a drug dealer/alcoholic who abused his mom and cheated on her, she divorced him when Gene was 14. Gene's friend committed suicide in front of him soon afterward, Gene has tried to kill himself numerous times (he says, but I'm not sure how many). He went off to a treatment center in Texas when he was 17, to get help because his mom couldn't manage him anymore. His dad hasn't been in his life at all since 'abandoning him'. He's had many diagnoses over the years, they change a lot. He's been on many meds, and has had many jobs. He has stolen from several jobs, and got in trouble for money laundering from one of them. It's the only crime on his record to date, a felony charge, that has been 'dropped', due to it being a first offense. Gene has been in several relationships, he says girls have 'run away' from him, due to him being too generous and nice(?) I hear him say. I have heard he has at least one kid, due to negligence when he was a teenager. He said before he met me, he was 'getting ready to turn gay', because he couldn't find a girl to date, and 'guys treat me better, anyway'. He has a problem with pawning things, if he 'needs' the money. He doesn't care whose stuff he pawns, either. He has a heart condition inherited from his dad, superventrical tachycardia, and I've spent many nights with him in the hospital because of it. I believe his mom has a few mental health conditions of her own, although I'm not sure what they are.

When I met Gene, I fell in love with him instantly. I knew he had problems, but I knew that they were minor compared with our relationship and how I felt about him. Soon after meeting him, I went off to boot camp and he was my reason for waking up in the mornings. I would go to church, pray for him and his heart, carry his picture (not authorized) around in my shirt (because we had our pockets inspected). He wrote me so many love letters and poems. I showed them to my friends and even to my chiefs. I would have never made it out of there if it wasn't for him.

Right after I got married, I found almost $300.00 missing from a bank account I had back home. By then I had bills to pay (like rent and for my new car, among other things). I called my bank immediately, sure they had made a mistake. They told me it was for a credit card I had authorized a monthly payment to come from. Now, I know I don't own credit cards because my spending habits can get carried away. This is the point where Gene confessed to signing for a credit card in my name, and spending over $900.00 while I was away at boot camp. The military soon found out about it and were concerned because it was extra debt (that they don't like). I asked what I could do to get the card debt erased, and they told me the only way was to file a police report for fraud. That was like sticking a knife through my already bleeding heart. I couldn't do that to the man I loved.

So, that was the beginning of it all. I had to deal with horrid mood swings where he would throw stuff at the walls, scream, drive my car around town like a maniac, stepping on the gas to scare me as we'd come to red lights. He still helped me spend my money as if it was going out of style. I tried to get him help for those problems, but the military provided very limited, very slow treatment.

During our road-trip to my first duty-station, I bought a dog, and Gene would literally toss it around whenever it went potty on the floor. He would scream at it, and then eventually lock it in the kennel in the car all night long. When we went to California to enjoy Knotts Berry Farm, he left the dog in the car all day, which would have been fine, except he drove, and when he parked, he left the windows completely up. So I lost my beautiful new best friend that day. Seven hundred dollars down the drain.

I loved bringing my husband over to meet my dad's side of the family, who welcomed him into their homes like they'd known him for years. It was wonderful to spend my 22nd birthday with them, as I hadn't done that since I was a kid. During all the hugs, warmth, and enjoyment, I'd gaze over at him, and I knew I had married this man for a reason, because I was in love with his soul. I had forgiven him for his past mistakes, and wanted to get on with our lives together.

After the festivities had ended, my relatives were calling me, saying their stuff had gone missing after we'd left. Now, I was getting this deep feeling of dread in the pit of my stomach, because I knew nothing, and yet felt guilty at the same time. I asked Gene and of course he denied it, stone grave-faced, looking me straight in the eye.

When I got to the state where I was to report for duty and began unpacking our boxes, I found part of what was missing from my relatives. I was absolutely shocked, beyond shocked, rolling the item around in my hands. My aunt had told me that the pictures inside her camera that went missing were more important than the camera itself, so I eagerly turned on the device, praying to God himself that they'd still be intact. But no, the only picture still there was one, of the inside of my car. Now, as I worked up the courage to confront Gene, I was heartbroken. I couldn't believe he'd stolen from my family.

I showed Gene the camera when we were driving in the car the next day. He denied taking it, even though I had it in my hand. It wasn't as bad as the fact that he'd taken it even, it was that he had lied. And continued to lie even though I knew the truth.

After we got to my first duty station, it was full-out hell. He wouldn't get a decent job because of 'our location' the military was located at. When he finally got a job at all, he got the most basic, low-paying one out there, which wasn't doing much for our financial situation. The military wanted to put me on a ship, but couldn't, due to the fact that Gene was so irresponsible with money and also because he had started threatening to hit me in his rages. He held a closed laptop near my head one day, and after that I went to his psychological evaluation with him, and told the therapist that. She got the military involved then, because of the domestic violence she perceived. She ruled out his previous diagnoses of major depressive disorder with psychotic features (he likes to isolate himself often to listen to music, won't let me touch him often times, gets paranoid), and instead diagnosed him with bi-polar disorder with depressive mood I believe it was called. I'm still not entirely sure what he has, it seems to fall into a category of it's own.

I began getting brainwashed into divorce by the military, my friends, and family, who all seemed to believe Gene had more problems that I could handle, nor should I want to. I was feeling very betrayed at the time, and my love was still very strong, but I started to question things. Eventually, in order to save my marriage, I started telling Gene I would send him home to get help. It was the most difficult decision I would ever have to make. I told him it was only temporary, until he got some mental health treatment and whatnot. I told him the military was coercing me, harassing me, and I was starting to believe it wasn't to be a part of my life, after all. I knew, even though I had explained myself to no end, Gene wouldn't understand my reasoning for doing such things, and I was right. He thought I was sending him home and divorcing him. I had the paperwork all drawn up and ready to submit, but then I stepped back and said, what am I doing? I tried to communicate this to Gene, but he'd just get pissed and hang the phone up on me.

I never believed in divorce, no such thing in my vocabulary. But I've been in for a run for my money on this one.

Around the time he went home, my dad filed charges with the bank, because once again, Gene had authorized payment to come out of the account I have always been joint-ownership'd on with my dad, causing it to go over $400.00 into the hole. He'd also taken out a payday loan on another one of my bank accounts, in my name. Unfortunately that account was empty and it plummeted into the hole over $200.00 before I found out about it.

I feigned more serious mental health problems than I already had to get myself discharged, so I could go home to my baby. I didn't care much anymore for anything, I just wanted to see him again. Things had been rough with him, but 10x worse without him. I came home with nowhere to go, and nothing to look forward to except him. I soon found out from his sister whom we were staying with, that he'd been seeing other girls in the short time we'd been apart. Like we were divorced or something. One, they said, he took into his room, and was in there with the lights out. Now, I asked Gene what they had done, and he said just talked, that he had let her sleep in his bed while he slept on the couch. Now, it's a good story, but I've heard entirely too many from Gene, and I know better.

I had asked him for some money from a retirement check I had to power of attorney for him to receive it (because we were married), while I was still back in Washington. Now, he had never sent the money, claimed he never got it, but when I came to see him, now he had a brand-new laptop. He claimed he never expected to see me again, so *shrugs*.

He was still talking with the girl as well, which I took as complete disrespect to me, personally. He'd go and call her whenever we'd have arguments, mostly because of his relationships with other girls. He'd leave the room, and go call her. He said they were just friends, but I know better that you aren't just friends with people you have relations with. Na-uh.

He's on meds now, which are nice and helpful at times, but when he's off of them, he's Dr. Hyde full-out. He threatens divorce at the drop of a hat, left me over at his sisters- packed up all his stuff and moved in with his mom. Told me to go back to my family, whom had pretty much disowned me by this time. I couldn't even talk to my parents regularly which I had pretty much done up to this point, because he told me they were interfering too much in our marriage, and the next time they did that, he'd "leave me for good".

He's resorted to squeezing me at odd times, like he'll smile and then grab and squeeze. Not like in a loving manner at all. He also hits now, like when he's angry. His mom heard through a closed door when we were arguing one day, Gene slapping me on the lower back. He only does it twice each time. She comes in and asked what he did, and he denied everything. My back was bruised for days. Most of the time he hits, he does it on my shoulders or back. The one day he did it and I retaliated, slapping him myself, he came at me and I cowered in fear. That was probably the 2-3rd time I seriously believed he was going to hurt me. He says he is just like his dad, and is never going to change. 'It's just the way I am', 'you married me', get over it'.

I am constantly trying to get us help from a counselor, but he says I can't come with him to his treatments, because I'm not native (he goes to a native people-only hospital) and they wont talk to me. I try and talk to him, but he gets pissed, slaps me, and goes to listen to music for a long time. Then he won't talk about things when he comes back.

Right after I married him, I found myself with weird feminine problems I'd never had before. I went to the doctor and discovered I had HPV, which I had been tested for prior to Gene, and didn't have. The doctor told me I had most likely contracted it from him, and asked if Gene knew he had the disease. I said no, definitely not. Later I discovered through his sister that Gene did know he had it, he'd even been on meds because of it.

A strange girl was writing Gene's cell phone again a few weeks ago. She told him she was thinking about him, wanted to see him again, blah blah blah. I told her to stop writing him. Gene started out with the story that she was just a friend for a long time, then she was his friend's girlfriend, and then she was Gene's ex-girlfriend. I asked him how she got his number, and he said she'd always had it. Gene just got his cell phone and number when he came home for our brief split. She wrote him again the other day, and I told her that I'd report her to the police for harassment, and that she was sad because she couldn't find her own man. Gene listened to me tell him this, then smiled, slapped me, took his phone, and left the room. Later, he told me he was angry at me for doing that, because I was 'so rude'.

Now-a-days, we don't have sex at all anymore, mainly because he says he's now on meds to clear up his fungal infection he blames his doctors for acquiring, due to ablation surgeries. He's not loving at all, unless he's squeezing or hurting me.

I have found porn on his computer that I asked him to please delete, even new stuff. He watches X-Tube, too. When I got my cable bill when I was living in Washington, I found a PPV Porn movie on there for $8.00.

I used to try and look into Gene's archive in his online messengers and email, but he has taken to deleting most of the stuff I had found in the past, and even threatened to lock me out of his computers all together. He will usually delete things that I find, telling me "it's alright, it's gone now", but then he'll turn around and do the same things over again.

My ex-boyfriend has been involved in making sure I'm all right in the middle of the night, when I log into messenger in tears. I have no romantic feelings at all for him anymore, but I talk to him, mainly because most of my family and friends have abandoned me. He told me he was going to get to the bottom of Gene's cheating because I wasn't sure of any specifics. If he had done things, what he had done, and with how many girls.

The other day he wrote me, saying he had found proof that Gene was at least attempting to find somebody to cheat on me with, he liked one of his friends, and she had gone to my ex-boyfriend to tell him about it. He gave me a personals website link, and as far as I can tell, it's worthy evidence. He says he's single, and looking for a woman to share himself with. He also says he doesn't want to be with a cheater? Isn't that a bit ironic and hypocritical?

I am having problems even getting out of bed anymore. My self-esteem is so far down in the toilet, I can't even express it. I feel so alone. I can't seem to figure out how to handle this stuff, because there is so much of it, and because it seems to be increasing in size daily. Gene tells me I'm addicted to the computer, that I'm too lazy to do anything or to get a job. He said "ever since you came back up, you've done nothing".

He tells me I want too much attention when I do get up the nerve to ask for a kiss, a hug, anything at all. I won't let him go out with his friends either, apparently, even though he hardly ever talks about anybody at all, let alone asks if he can hang out with anybody. He tells me I control him too much. He told me I have some serious attachment issues. The list goes on and on.

Any help or anything at all for that matter would be greatly appreciated. I am at a total loss on what to do here, all I know is that I'm exhausted mentally from having to deal with this mess..

Thanks for spending the time to read this, it means a lot to me.

I'm sure there's more I'm forgetting to write, and I'll add to this post as I remember things.

Post edited by: hugabaloou, at: 09/14/2007 17:33

first

IT IS NOT YOUR FAULT

it is not you who has the problem is it

so why should you feel bad

it takes two to make a marraige work and if one is not willing then something as been lost somewhere along the way

you get out of this state and rememeber who you are

you are a person not just a wife you have feelings and we can only allow them to be damaged so many times

there has to be a time when we say

NO MORE CRAP I DESERVE BETTER

let your guilt go and do what you feel you must

you have to save yourself before you can save anyone else

love shell

A few weeks ago I would have ranked my problems closer to yours. My wife has worked hard with me to help make things better. Possibly her manic cycle is going more into depression now as well.

Dose your husband cycle? or is he always this way? If he cycles you can have a better hope of treatment helping.

I really don't know what to suggest... Just know your not crazy for wanting to keep your marriage, I stayed where most would likely leave and it is starting to work out good again.

You do need to get some cooperation or help from your husband though, you can't make it work totally without him.

I offer you a big Hug, I will keep you in my prayers for a time as well.

Most of the time he's just detached and bitter. He doesn't want me to touch him, or my love at all. He seems to be in depressive mode quite a bit, and he talks about how sick he is of life, and then he'll talk about divorcing me, then he'll talk about everything working out fine, I just need to relax.

It's always a rollercoaster, I never know what to expect, I feel like I'm with four different people at any given time. I just wish the lying and cheating would stop. I would never do anything like this, even on my deathbed.

and not aspergers

I just need help.

ASPERGERS

Categorical Definition and Clinical Description

As defined in DSM-IV (the most recent Diagnostic and Statistical Manual of the American Psychiatric Association, 1994), the tentative criteria for AS follow the same format, and in fact overlap to some degree, the criteria for autism. The required symptomatology is clustered in terms of onset, social and emotional, and "restricted interests" criteria, with the addition of two common but not necessary characteristics involving motor deficits and isolated special skills, respectively. A final criterion involves the necessary exclusion of other conditions, most importantly autism or a sub threshold (or "autistic-like") form of autism (Pervasive Developmental Disorder - Not Otherwise Specified). Interestingly, the DSM-IV definition of AS is offered having autism as its point of reference; hence some of the criteria actually involve the absence of abnormalities in some areas of functioning that are affected in autism. The following table summarizes the DSM-IV definition of AS:

Qualitative impairment in social interaction, as manifested by at least two of the following:

Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

Failure to develop peer relationships appropriate to developmental level

A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people

Lack of social or emotional reciprocity

Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

Apparently inflexible adherence to specific, nonfunctional routines or rituals

Stereotyped and repetitive motor mannerisms

Persistent preoccupation with parts of objects

The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood

Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Onset criteria

In DSM-IV, the individual's history must show "a lack of any clinically significant general delay" in language acquisition, cognitive development and adaptive behavior (other than in social interaction). This contrasts with typical developmental accounts of autistic children who show marked deficits and deviance in these areas prior to the age of 3 years.

Although the onset criterion is in agreement with Asperger's account, Wing (1981) noted the presence of deficits in the use of language for communication, if not in more specific language skills, in some of her case studies. It is currently uncertain whether the lack of delays in the prescribed areas is a differential factor between AS and autism or, alternatively, a simple reflection of the higher developmental level associated with the usage of the term AS.

Other common descriptions of the early development of individuals with AS include a certain precociousness in learning to talk ("he talked before he could walk"), a fascination with letters and numbers -- in fact, the young child may even be able to decode words although with little or no understanding ("hyperlexia") -- and the establishment of attachment patterns to family members but inappropriate approaches to peers and other persons, rather than withdrawal or aloofness as in autism (e.g., the child may attempt to initiate contact with other children by hugging them or screaming at them and then puzzle at their responses). Again, these behaviors are not uncommonly described for higher-functioning autistic children as well, albeit much more infrequently.

Qualitative Impairments in Reciprocal Social Interaction

Although the social criteria for AS and autism are identical, the former condition usually involves fewer symptoms and has a generally different presentation than does the latter. Individuals with AS are often socially isolated but are not unaware of the presence of others, even though their approaches may be inappropriate and peculiar. For example, they may engage the interlocutor, usually an adult, in one-sided conversation characterized by long-winded, pedantic speech, about a favorite and often unusual and narrow topic. Also, although individuals with AS are often self-described "loners", they often express a great interest in making friendships and meeting people. These wishes are invariably thwarted by their awkward approaches and insensitivity to other person's feelings, intentions, and nonliteral and implied communications (e.g., signs of boredom, haste to leave, and need for privacy). Chronically frustrated by their repeated failures to engage others and make friendships, some of these individuals develop symptoms of depression that may require treatment, including medication.

In regard to the emotional aspects of social transactions, individuals with AS may react inappropriately to, or fail to interpret the valence of, the context of the affective interaction, often conveying a sense of insensitivity, formality, or disregard to the other person's emotional expressions. That notwithstanding, they may be able to describe correctly, in a cognitive and often formalistic fashion, other people's emotions, expected intentions and social conventions, but are unable to act upon this knowledge in an intuitive and spontaneous fashion, thus losing the tempo of the interaction. Such poor intuition and lack of spontaneous adaptation are accompanied by marked reliance on formalistic rules of behavior and rigid social conventions. This presentation is largely responsible for the impression of social naivete and behavioral rigidity that is so forcefully conveyed by these individuals.

As with the majority of the behavioral aspects used to describe AS, at least some of these characteristics are also exhibited by individuals with higher-functioning autism, though, again, probably to a lesser extent. More typically, autistic persons are withdrawn and may seem to be unaware of, and disinterested in, other persons. Individuals with AS, on the other hand, are often keen, sometimes painfully so, to relate to others, but lack the skills to successfully engage them.

Qualitative Impairments in Communication

In contrast to autism, there are no symptoms in this area of functioning In the definition of AS. Although significant abnormalities of speech are not typical of AS, there are at least three aspects of these individuals' communication skills which are of clinical interest. First, though inflection and intonation may not be as rigid and monotonic as in autism, speech may be marked by poor prosody. For example, there may a constricted range of intonation patterns that is used with little regard to the communicative functioning of the utterance (assertions of fact, humorous remarks, etc.). Second, speech may often be tangential and circumstantial, conveying a sense of looseness of associations and incoherence. Even though in some cases this symptom may be an indicator of a possible thought disorder, it is often the case that the lack of coherence and reciprocity in speech is a result of the one-sided, egocentric conversational style (e.g., unrelenting monologues about the names, codes, and attributes of innumerable TV stations in the country), failure to provide the background for comments and to clearly demarcate changes in topic, and failure to suppress the Vocal output accompanying internal thoughts.

The third aspect typifying the communication patterns of individuals with AS concerns the marked verbosity observed, which some authors see as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often in complete disregard to whether the listener might be interested, engaged, or attempting to interject a comment, or change the subject of conversation. Despite such long-winded monologues, the individual may never come to a point or conclusion. Attempts by the interlocutor to elaborate on issues of content or logic, or to shift the interchange to related topics, are often unsuccessful.

Despite the possibility that all of these symptoms may be accounted for in terms of significant deficits in pragmatics skills and/or lack of insight into, and awareness of, other people's expectations, the challenge remains to understand this phenomenon developmentally as strategies of social adaptation.

Restrictive, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

Although in the DSM-IV definition the criteria for AS and autism are identical, requiring the presence of at least one of the symptoms in the list provided (see table above), it appears that the most commonly observed symptom in this cluster refers to an encompassing preoccupation with restricted patterns of interest. In contrast to autism, where other symptoms in this area may be very pronounced, individuals with AS are not commonly reported to exhibit them with the exception of the all-absorbing preoccupation with an unusual and circumscribed topic, about which vast amounts of factual knowledge are acquired and all too readily demonstrated at the first opportunity in social interaction. although the actual topic may change from time to time (e.g., every year or two years), it may dominate the content of social interchange as well as the activities of individuals with AS, often immersing the whole family in the subject for long periods of time. Even though this symptom may not be easily recognized in childhood (because strong interests in dinosaurs or fashionable fictional characters are so ubiquitous among young children), it may become more salient later on as interests shift to unusual and narrow topics. This behavior is peculiar in the sense that often times extraordinary amounts of factual information are learned about very circumscribed topics (e.g., snakes, names of stars, maps, TV guides, or railway schedules).

Motor Clumsiness

In addition to the required criteria specified above, an additional symptom is given as an associated feature though not a required criterion for the diagnosis of AS, namely delayed motor milestones and presence of "motor clumsiness". Individuals with AS may have a history of delayed acquisition of motor skills such as pedaling a bike, catching a ball, opening jars, climbing "monkey-bars", and so on. They are often visibly awkward, exhibiting rigid gait patterns, odd posture, poor manipulative skills, and significant deficits in visual-motor coordination. Although this presentation contrasts with the pattern of motor development in autistic children, for whom the area of motor skills is often a relative strength, it is similar in some respects to what is observed in older autistic individuals. Nevertheless, the commonality in later life may result from different underlying factors, for example, psychomotor deficits in the case of AS, and poor body image and sense of self in the case of autism. This highlight the importance of describing this symptom in developmental terms.

Assessment

AS, like other pervasive developmental disorders (PDDs), involves delays and deviant patterns of behavior in multiple areas of functioning, that often require the input of professionals with different areas of expertise, particularly overall developmental functioning, neuropsychological features, and behavioral status. Hence the clinical assessment of individuals with this disorder is most effectively conducted by an experienced interdisciplinary team.

A few principles should be made explicit prior to a discussion of the various areas of assessment. First, given the complexity of the condition, importance of developmental history, and common difficulties in securing adequate services for children and individuals with AS, it is very important that parents are encouraged to observe and participate in the evaluation. This guideline helps to demystify assessment procedures, avails the parents of shared observations that can then be clarified by the clinician, and fosters parental understanding of the child's condition. All of these can then help the parents evaluate the programs of intervention offered in their community.

Second, evaluation findings should be translated into a single coherent view of the child: easily understood, detailed, concrete, and realistic recommendations should be provided. When writing their reports, professionals should strive to express the implications of their findings to the patient's day-to-day adaptation, learning, and vocational training.

Third, the lack of awareness of many professionals and officials of the disorder, its features, and associated disabilities often necessitates direct and continuous contact on the part of the evaluators with the various professionals securing and implementing the recommended interventions. This is particularly important in the case of AS, as most of these individuals have average levels of Full Scale IQ, and are often not thought of as in need for special programming. Conversely, as AS becomes a more well-known diagnostic label, there is reason to believe that it is becoming a fashionable concept used in an often unwarranted fashion by practitioners who intend to convey only that their client is currently experiencing difficulties in social interaction and in peer relationships. The disorder is meant as a serious and debilitating developmental syndrome impairing the person's capacity for socialization and not a transient or mild condition. Therefore, parents should be briefed about the present unsatisfactory state of knowledge about AS and the common confusions of use and abuse of the disorder currently prevailing in the mental health community. Ample opportunity should be given to clarify misconceptions and establish a consensus about the patient's abilities and disabilities, which should not be simply assumed under the use of the diagnostic label.

In the majority of cases, a comprehensive assessment will involve the following components: history, psychological assessment, communication and psychiatric assessments, further consultation if needed, parental conferences, and recommendations.

People with Asperger syndrome may display some of the following characteristics:

Difficulty in forming friendships.

A preference for playing alone or with older children and adults.

Ability to talk well, either too much or too little, but difficulty with communication.

Inability to understand that communication involves listening as well as talking.

A very literal understanding of what has been said. For example, when asked to 'get lost', as in go away, a person with Asperger syndrome will be confused and may literally try to 'get lost'.

Inability to understand the rules of social behaviour, the feelings of others and to 'read' body language. For example, a person with Asperger syndrome may not know that someone is showing that they are cross when frowning.

Behaviour varies from mildly unusual to quite aggressive and difficult.

Having rules and rituals that they insist all family members follow.

Anger and aggression when things do not happen as they want.

Sensitivity to criticism.

A narrow field of interests. For example a person with Asperger syndrome may focus on learning all there is to know about cars, trains or computers.

Eccentricity.

ONLINE ASPERGERS TEST

http://www.wired.com/wired/archive/9.12/aqtest.html

Post edited by: spectrummum, at: 09/14/2007 17:12

Bipolar affective disorder is sometimes called manic depression or bipolar illness. In this condition you have periods where your mood ('affect') is in one extreme or another.

One extreme is called depression where you feel 'low' and have other symptoms.

The other extreme is called mania (or hypomania if symptoms are less severe) where you feel 'high' or elated along with other symptoms.

The length of time you spend in each extreme can vary. It is usually for several weeks at a time or longer. Bipolar affective disorder is very different from the mood swings that moody people have which last minutes or hours.

You can have any number of episodes of highs and lows throughout your life. In between episodes of highs or lows there may be gaps of weeks, months or years when your mood is normal. However, some people swing from highs to lows quite quickly without a period of normal mood in between. This is called 'rapid cycling'. (If you have the rapid cycling form of the illness you have at least four mood swings per year.)

Who gets bipolar affective disorder?

About 1 in 100 people develop this condition at some stage in life. It can occur at any age, but most commonly first develops between the ages of 18 and 24. It occurs in the same number of men as women. The rapid cycling form of the illness occurs in about 1 in 6 cases.

(Note: mania or hypomania occur in only a small number of people who develop depression. It is much more common to just have depression without episodes of mania or hypomania.)

What causes bipolar affective disorder?

The cause is not known. Your genetic makeup seems to play a part as your chance of developing this condition is higher than average if other members of your family are affected. Stressful situations may trigger an episode of mania or depression in people prone to this condition. However, stress is not the underlying cause.

What are the symptoms of mania and hypomania?

Mania causes an abnormally 'high' or irritable mood which lasts at least one week - but usually lasts much longer than this. It can develop quite quickly - over a few days or so. When you are 'high' you will usually have at least 3 or 4 of the following:

Grand ideas about yourself and your own self importance.

Increased energy. You also tend to move quickly and need less sleep than usual.

Be more talkative than usual. You tend to talk quickly.

'Flight of ideas'. You tend to quickly change from one idea to another. You may feel as if your thoughts are racing.

Easily distracted. Your attention is easily drawn to unimportant or irrelevant things.

Full of new ideas and plans. Often the plans are grandiose and unrealistic.

Irritation or agitation, particularly with people who do not seem to understand your 'great' ideas and plans.

Wanting to do lots of pleasurable things (but these can often lead to painful consequences). For example, you may:

spend a lot of money (which you often cannot afford).

be less inhibited about your sexual behaviour.

make rash decisions, often on the spur of the moment. These can be about jobs, relationships, money, health, etc, and are often disastrous.

take part in risky 'exciting' adventures.

drink a lot of alcohol, or take illegal drugs.

Severe mania may also cause 'psychotic' symptoms where you lose touch with reality. For example, you may hear voices which are not real (hallucinations), or have false beliefs (delusions). These tend to be delusions of importance (such as believing that you are a famous celebrity).

Usually, you do not realise that you have a problem when you are high. But, as the the illness develops, to others your behaviour can be bizarre. Family and friends tend to be the ones who realise that there is a problem. But, if someone tries to point out that you are behaving oddly, you tend to become irritated as you can feel really good.

If mania is not treated, the bizarre and uninhibited behaviour may cause great damage to your relationships, job, career, and finances. When you recover from an episode of mania you often regret many of the things that you did when you were high.

Hypomania is the term used when you are high, but the symptoms are less severe or extreme as in true mania. You may function quite well if you have hypomania. For example, you may just appear to be full of energy, the 'life and soul' of the party, work too much, but find it difficult to 'switch off' and relax. However, you are still at risk of making rash and dangerous decisions. Family and friends will recognise that you are not your normal self.

What are the symptoms of depression?

The word depressed is a common everyday word. People might say "I'm depressed" when in fact they mean "I'm fed up because I've had a row, or failed an exam, or lost my job" etc. These ups and downs of life are common and normal.

With true depression, you have low mood and other symptoms each day for at least two weeks. Symptoms also become severe enough to interfere with day-to-day functions. The following is a list of common symptoms of depression. You may not have them all, but you usually develop several if you have depression.

Low mood for most of the day, nearly every day. Things always seem 'black'.

Loss of enjoyment and interest in life, even for activities that you normally enjoy.

Abnormal sadness, often with weepiness.

Feeling guilty, worthless, or useless.

Poor motivation. Even simple tasks seem difficult.

Poor concentration. It may be difficult to read, work, etc.

Sleeping problems.

Sometimes difficulty in getting off to sleep.

Sometimes waking early and unable to get back to sleep.

Sleeping too much sometimes occurs.

Lacking in energy, always tired.

Difficulty with affection, including going off sex.

Poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.

Being irritable, agitated, or restless.

Symptoms often seem worse first thing each day.

Physical symptoms such as headaches, palpitations, chest pains, and 'aches and pains'.

Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. Some people get suicidal ideas - "life's not worth living".

Some people do not realise when they develop depression. They may know that they are not right and are not functioning well, but don't know why. Some people think that they have a physical illness, for example, if they lose weight.

What is the usual pattern and outcome of the condition?

Bipolar affective disorder is a lifelong condition. There is no usual pattern. Every case is different. Some general points include the following.

Without treatment:

The average length for an episode of mania is four months. But for some people it can last much longer.

The average length for an episode of depression is 6-9 months. but again, it can be longer.

You cannot predict how often episodes of mania and depression will occur.

After recovering from an episode of mania, a further episode of mania or depression occurs within 1 year in about half of cases, and within 5 years in about 7 in 10 cases.

Some people only ever have one episode of mania for a few weeks or months.

The rapid cycling form of the illness occurs in about 1 in 6 cases.

Some people have 'mixed states' where symptoms of both mania and depression occur at the same time. For example, a low mood, but with racing thoughts.

So, some people have more frequent and severe episodes than others. Because of the nature of the condition, your chance of holding down a job is less than average. Relationships can be strained. Also, you have an increased risk of suicide if depression becomes severe, and an increased risk of death from risky adventures during an episode of mania. The outlook is worse if you take street drugs or drink a lot of alcohol.

With treatment:

The course, pattern and outlook of the condition can be improved. However, there is no once and for all 'cure'.

What is the treatment for bipolar affective disorder?

Treatments include:

Medicines that aim to prevent episodes of mania, hypomania and depression. These are called 'mood stabilisers'. You take these every day, long-term.

Treating episodes of mania, hypomania and depression when they occur.

Lithium

Lithium is the most commonly used medication in the UK for bipolar affective disorder. It comes as a tablet and has been used for many years. However, it is not clear how it works. It is used to treat episodes of mania, hypomania and depression. It is also taken by many people long-term as a 'mood stabiliser' to prevent episodes. Lithium often works well, but does not work in all cases. It tends to prevent episode of mania better than episodes of depression.

One problem with lithium is that the dose for an individual has to be 'just right'. Too low a dose has little effect. Too high a dose, and side-effects can be a problem. So, if you take lithium, you need to have blood tests from time to time to check the dose is just right for you.

Another leaflet called 'Lithium for Bipolar Affective Disorder' gives more details.

Anticonvulsant medicines

Sodium valproate, carbamazepine, and Lamotrigine are also used to treat episodes of mania. They are also used long-term as 'mood stabilisers'. (Anticonvulsant medicines are commonly used to treat epilepsy but have been found to be work in bipolar affective disorder too. However, it is not clear how they work in this condition.) Sometimes one of these medicines is used alone. Some people take an anticonvulsant in addition to lithium if lithium alone does not work so well.

Antipsychotic medicines

One of these may be used to treat an episode of mania or hypomania. Another name for these is 'major tranquillisers'. They include chlorpromazine, haloperidol, risperidone and sulpiride - but there are others. Some are more 'sedating' than others. Once one of these medicines is started, the symptoms of mania often settle within a week or so. These medicines are usually stopped once the symptoms have gone. They are not usually used as long-term 'mood stabilisers'.

Treating episodes of depression

The treatment of depression in people with bipolar affective disorder is similar to that for people who develop depression without episodes of mania.

Antidepressant medicines are commonly prescribed for all types of depression.

Antidepressants work well to relieve symptoms in about 7 in 10 cases.

They do not usually work straight away. It takes 2-4 weeks before their effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. So, do persevere if you are prescribed an antidepressant medicine.

A normal course of antidepressants is for 6 months or more after the symptoms of depression have eased. If you stop them too soon the depression may quickly return.

There are several types of antidepressants, each with various 'pros and cons'. For example, they differ in their possible side-effects. (The leaflet that comes in the medicine packet provides a full list of possible side-effects.)

One uncommon problem with antidepressants is that they can 'trigger' an episode of hypomania in some people.

Lithium is used to treat depression as well as being a mood stabiliser. A combination of lithium and an antidepressant may be used to treat episodes of depression.

Cognitive therapy (if available in your area) is another option which can work well to treat depression. It is a 'talking' treatment.

Regular exercise may also help to ease symptoms of depression.

Compulsory treatment

When you have an episode of mania or hypomania, usually you do not realise that you are ill. It is sometimes necessary to give treatment against your will if you have symptoms which are putting you, or other people, at risk of harm. A short admission to hospital is sometimes needed.

Other treatments and new developments

Research continues to try and find better 'mood stabiliser' medicines. New non-drug treatments such as transcranial magnetic stimulation and vagal nerve stimulation are being studied. Also, there is a large trial currently underway to find out which is the best mood stabiliser - lithium or the anticonvulsant sodium valproate. See www.psychiatry.ox.ac.uk/balance/ for details.

What can I do to help?

Try to avoid stressful situations which may trigger an episode of mania or depression. This is often easier said than done. But, a change in lifestyle may be appropriate for some people. You may find another leaflet useful called 'Stress and Tips on How to Avoid It'.

Try not to drink much alcohol or take any street drugs. These may trigger an episode of mania.

If you are prescribed a mood stabiliser medicine, take it regularly. Sometimes, suddenly stopping a mood stabiliser can trigger an episode of mania. So, if you get any side-effects, tell a doctor. The dose of type of medication can often be changed, but do this with the advice of a doctor.

Consider being quite open to family and friends about your illness. If they understand the condition, they may be able to tell if you are becoming ill, even if you do not realise it yourself. Particularly if you are developing an episode of mania. Rather than thinking of you as 'bizarre' they may think of you as ill and may encourage you to get help.

Learn about your illness. It has been shown that if you are taught to recognise the early stages of mania, you are more likely to seek help and treatment which may prevent a major episode developing. Your doctor or psychiatrist may help to teach you about recognising when to seek help. Also...

Consider joining a self-help or patient group. Details are at the end of this leaflet. They are a great source of advice, information, support and help.

When you are well, consider putting some safeguards on your money so that you cannot overspend if you become high. For example, if you are married, consider putting your bank account solely in the name of your spouse.

If you are the main or only carer of children (for example, if you are a single parent), it is important that someone else who knows you well is aware that you may become ill quite quickly and not be able to care for your children properly.

DSM-II: The term used in this edition is “Manic-depressive illnesses”

or “Manic-depressive psychoses.” They describe these as “disorders

marked by severe mood swings” and being recurring. The disorder is

then subcategorized as being one of the following: manic type (296.1),

depressed type (296.2) or circular type (296.3)

Manic type is characterized by primarily manic episodes, although

brief periods of depression can occur. Symptoms include: “excessive

elation, irritability, talkativeness, flight of ideas, and accelerated

speech and motor activity.”

Depressed type, according to the DSM-II, is characterized exclusively

by depressed episodes. Depressed mood, mental and motor retardation,

stupor, apprehension, agitation are some of the symptoms.

Circular type is characterized by both a depressive and a manic

episode. There are two subclassifications: 296.33 Manic-depressive

illness, circular type, manic and 296.35 Manic-depressive illness,

circular type, depressed.

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:

American Psychiatric Association, 2nd ed., 1968, pp. 36-37.

DSM-III: In this edition, the disorder is now referred to as Bipolar

Disorder.

296.6x refers to Bipolar Disorder, Mixed; 296.4x is Bipolar Disorder,

Manic and 296.5x is Bipolar Disorder, Depressed. There is some change

of language, but the essence is the same. Mixed is the successor of

the DSM-II's "Circular."

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:

American Psychiatric Association, 3rd revised ed., 1987, p. 217.

There is greater detail in terms of describing what goes into a manic

or into a depressed episode.

Major Manic Episode

A. Having had one or more periods with a "predominantly elevated,

expansive, or irritable mood."

B. Duration of at least a week with at least 3 symptoms below (4 if

only irritable):

increase in activity/physical restlessness; highly talkative than

normal; flight of ideas; inflated self-esteem; lower need for sleep;

easily distracted; excessive involvement in activities that are

risky/potentially dangerous.

C. "Neither of the following dominate the clinical picture when an

affective syndrome is not present"

Major Depressive Episode

A. Dysphoric mood

B. At least 4 of the symptoms below present for at least 2 weeks:

poor appetite/weight loss; insomnia or hypersomnia; psychomotor

agitation or retardation; loss of pleasure/interest in

activities/decrease in sex drive; loss of energy; feelings of

worthlessness/inappropriate guilt; "complaints or evidence of

diminished ability to think or concentrate;" recurrent thoughts of

death, suicide, suicide attempt.

C. "Neither of the following dominate the clinical picture when an

affective syndrome is not present"

For both manic and depressive episodes, they cannot be "superimposd on

either Schizophrenia, Schizophreniform Disorder or a Paranoid

Disorder" or due to an Organic Mental Disorder (e.g. alcohol

intoxication).

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:

American Psychiatric Association, 3rd revised ed., 1987, pp. 208-209;

213-214.

DSM-III-R keeps the same terminology and essentially the same criteria

although now, there is mention of "seasonal patterns"

Some of the criteria can be viewed here:

Recognizing Bipolar Disorder

http://216.239.51.100/search?q=cache:4MNBAPjW8QkC: www.pendulum.org/criteria/recognizing_bp.htm+dsm-iii-r+% 22bipolar+disorder%22&hl=en&ie=UTF-8

DSM-IV: Among other changes, the distinction is now between Bipolar I

Disorder and Bipolar II. The criteria are expanded The site below has

the diagnostic criteria online:

Bipolar I Disorder

http://www.psychologynet.org/bipolar1.html

Bipolar II Disorder

http://www.psychologynet.org/bipolar2.html

DSM-IV-R: No changes from DSM-IV

An overall look at some of the changes in diagnosis that may be of

interest

Update on Bipolar Disorder: Epidemiology, Etiology, Diagnosis, and

Prognosis

http://www.angelfire.com/fl5/bipolarnoise/News/ Bipolar1.html

Some of the general changes between the DSM-III-R and the DSM-IV can

be found at this site:

DSM-IV: What's Different - What's Not

http://www.psycheval.com/dsm-iv.htm