Nit-picky husband -- or BPII?

Q: My husband has severe mood swings, gets irritable requently and flies into small rages impatient with people who hesitate in speaking or make small mistakes (the wrong name of someone, etc.) A few years ago I thought he was an extreme "nit picker" and his mother was quite similar....she is now 80 and in the advanced stages of Alzheimers....they are much alike and her disease advanced rapidly in the last year. We've been married 4+ years. He had a partner embezzle from him 3 years ago, then his sister was taking financial advantage of his mother's property  holdings .... and trying to alienate my husband from their remaining family. In the last two years he has difficulty keeping or even finding a job (butwe moved ... to San Diego last year adding to our challenge in careers).....An employer let my husband go because they said he failed to communicate and showed no management potential. My husband is a handsome, well educated 43 year old who usually has a good sense of humor. He still has good moments with me but they are dwindling. Everytime we get into a car to go somewhere he starts looking at everything in the car while he's driving to find something wrong: "What is this rough patch on the leather handbrake, from your rings?" "Why do you put your cell phone there?" It's as though getting into a car or plane and going somewhere together triggers irritability and nit picking for at least a half hour. He also likes to be alone a lot. He dislikes a lot of people and doesn't want to get to know new couples...I have to push him to socialize with others, unless they happen to be his one or two long time friends from 15 or 20 years ago. I urinates frequently and I noticed his hands swelling (not feet or anything else) this week. He had some into he was hiding away about hypothyroidism and he has been putting off a blood test his GP ordered two months ago. He uses too much alcohol (evenings only) but goes through a lot of vodka and wine during the week (I check the liquor supply).....alcohol makes him angry. He has also been working out a lot and adding muscle at the gym, which he rather likes, as he has always been somewhat thin but trim. He loosely follows the Atkins diet principles and limits bread and sweets in his diet. (Although he has always craved desserts). He used to smoke marijuana but quit 3 years ago. I find that he fails to remember things or it seems like he "tunes me out." He asked me if I felt he was "shutting down" a lot, when I called this to his attention. He has always been too trusting of others and not a good judge of character....tends to go toward people who are easy to know or who "need him" and are not good individuls to associate with (somewhat lower than him and those from whom he will not benefit at all). Although his mother's mental health has been failing for some years (who knows how long)......I met her 6 years ago and always felt that she favored her daughter (who lives near her) husband has felt neglected by his mother for at least the past 6 years. He is very one from his family called him on his birthday or even Christmas to wish him a happy holiday (even though he'd been up to visit them two weeks before Xmas!)......What can I do? Our life is dismal and we hate where we live (so expensive in SanDiego)....My husband has a good new job.... and I am afraid he will blow it. Also, my ..... job has lots of pressure to perform and I work long hours never having weekends off......I'm afraid my husband's difficulties will destroy my focus and our much needed income to get back on financial track. I feel like I'm "babysitting" sometimes and I hate it. Thank you.

Dear Ms. C' --
Wow, this sounds mighty rough to live with.  You're wondering if he might have Bipolar II, I take it; or hypothyroidism; or alcohol problems; or some other perhaps genetic reason to be so "nit-picky" (which merits thinking about some obsessive-compulsive variation, too). 

The first question is, will he go along with being evaluated by a mental health professional?  If so, you'll be trying to facilitate that, obviously.  Try the therapists' guide if you need help finding somebody in San Diego.  You happen to have moved to the world capitol of bipolar II :  Dr. Akiskal runs the International Mood Disorders clinic at UCSD and has been the most prominent voice for recognizing this condition.  So if you're pretty sure that's what he has on the basis of your reading, you might call their clinic and see what it takes to get in there. 

However, your description raises some other possibilities, especially thyroid and alcohol.  These commonly accompany bipolar disorder, so they don't mean he hasn't got bipolar disorder too. 

Your passage:  "Everytime we get into a car to go somewhere he starts looking at everything in the car while he's driving to find something wrong: "What is this rough patch on the leather handbrake, from your rings?"   sticks out as the kind of thing I look for to establish that a person is clearly not "acting normally".  Just one such example may not say much, but a whole bunch like that, in detail, helps establish that there really is something wrong.

And if those things occur when there's no alcohol in the picture, that will increase the clarity even further (although it doesn't sound like you'd be able to convince him to try 2 weeks with none, eh?). 

Finally, if you can arrange some basic screening blood tests: blood counts, basic chemistries, and TSH (thyroid stimulating hormone),and the result available when he is seen by a psychiatrist, that will move the process forward more quickly. 

Perhaps he'd agree to take the Mood Disorders Questionniare -- just 10 questions? 

Good luck on this difficult project!

Dr. Phelps

Published January, 2001