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tonyfar
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Default Jan 24, 2020 at 12:58 PM
  #1
Im not sure if I should be posting here or in BP forums and would appreciate some direction there. I started dating and got involved with a woman who has BP2. I am in my 50's, she is in her 30's. The relationship started in August and it had been an awesome 4 months. We saw each other on average of once a week and a few weekends a month. She is a distance (1.5 hours) from me so spending more time was prohibitive due to the distance and work, etc. With that said, we texted and or talked daily and always had great conversations.

She had indicated to me in the September time frame that she suffered from BP2, was on meds and it was under control. She kind of explained what it was all about and I did basic (Mistake) research on the subject. There were times when she indicated she felt foggy and I noticed some memory lapses along with being able to see that she had difficulty with organization and completing projects. We talked about these things with almost every visit and I basically listened and helped where I could in terms of breaking tasks down, etc. I also had alot going on in my life with respect to my ex wife and things that she was doing and we shared alot of that. Probably shared it too much as I think that we got so caught up in talking about those issues that we should have been looking more at hers, along with continuing to enjoy one another's company. Basically, it was great. Conversation flowed easily, we enjoyed doing anything together, and the sex was awesome.

By late October/November I knew I was falling but managed to keep the relationship casual in my mind. Held her at arms length mostly due to the age difference. One week led to another and on Dec. 29 we got together to plan what we wanted to do on New Years Eve. During the discussion, she went down the path of reviewing our relationship and dropped the "I love you" on me....to which I happily rescinded. Those words just opened me up and we talked about that fact that we had almost said it to one another numerous times from November forward. Like I was hooked. I hadnt opened myself up like that in a long, long time so it was like mainlining a huge syringe of feelings.

Within 2 weeks she indicated that she needed a sabbatical from everyone and was unable to communicate at a deep level. Basically, Ive been getting a breadcrumb or two each day since then. She indicates that she just needs time. She did start a new job, so that was a major change. Anyway, in the meantime I have done the deep dive into researching BP2 that I selfishly didnt do 2 or 3 months ago. I took everything at face value without totally realizing what was going on. Basically, it appears as though she was in hypomania (sorry, but I dont know if we call it an episode or what) during the time we were together. So I am kind of left with, did she mean what she said? Was it all part of the state that I think she was in? Does she really need time or is this the process of moving on for her?

Im just looking for some guidance and opinion. I totally want to be there for her in terms of helping her with this. Frankly, if I had realized what was really going on I would have worked with her to know what meds she was on and if she was taking them. I would have looked for a support group. I just feel terrible that it didnt all soak in and that I hadnt armed myself with the knowledge to understand and help her. It's killing me that I cant have a serious conversation with her about this and just want to indicate to her how much Ive learned in the last few weeks along with being able to tell her how sorry I am that I didnt take more time to do that. Any advice is welcome and thank you for your consideration.
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sarahsweets
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Default Jan 25, 2020 at 05:58 AM
  #2
Hey @tonyfar what makes you think she was hypomanic for 4 months?
Quote:
The duration of hypomania in bipolar-II disorder in private practice: methodology and validation.
Benazzi F1, Akiskal H.
Author information
Abstract
BACKGROUND:
DSM-IV 4-day minimum hypomania duration is not evidence-based. Epidemiologic data suggest that briefer hypomanias are prevalent in the community. We sought to find out the relative prevalence of short (2-3 days) versus long (>/=4 days) hypomanias in private practice.

METHODS:
206 bipolar-II (BP-II) depressed outpatients (group B) and a group of 140 remitted BP-II (group R) were assessed with the DSM-IV Structured Clinical Interview, as modified by the authors. BP-II with short vs. longer hypomania were compared on such bipolar validators as early age at onset, depressive recurrence, atypical feature specifier, depressive mixed state and bipolar family history. In addition, to ascertain the bipolar status of depressed patients with brief hypomanias, we included a comparison group of 178 major depressive disorder (MDD) patients assessed when depressed.

RESULTS:
27-30% of hypomanias (depending on whether assessment occurred when patients were depressed or in remission) had 2-3-day duration; 72% lasted less than 4 weeks. Except for the atypical feature specifier, BP-II with short vs. BP-II with longer hypomania were not significantly different on bipolar validators. Moreover, BP-II with short, like its longer hypomanic counterpart, was significantly different from the comparison MDD group on all bipolar indicators.

LIMITATIONS:
Single interviewer and retrospective evaluation of duration of hypomania.

CONCLUSIONS:
As BP-II patients almost never present clinically in a hypomanic episode, the retrospective assessment of the duration of these episodes is clinically unavoidable. Most hypomanias last from 2 days to a few weeks. BP-II with shorter vs. longer hypomanias had significantly higher rates of females, comorbidity and atypical features, but were otherwise indistinguishable on crucial bipolar validators. Furthermore, such validators, including bipolar family history, robustly distinguished BP-II with short hypomanias from the MDD group. The conservative 4-day threshold would misclassify one out of three BP-II as MDD. Such misclassification has relevant implications for treatment and outcome, as well as clinical research methodology for depressive and bipolar disorders.
Quote:
1.3.1.2 Criteria for a Hypomanic Episode

Here it is more interesting to note the similarities and differences between the hypomanic episode and the manic one, rather than to reproduce the criteria. To start with the similarities, both a hypomanic and a manic episode share the same key diagnostic symptoms (A: elevated-expansive-irritable mood and B: 3 or 4 manic symptoms out of 7 identified). Also, similarly to the manic episode, the causation of the hypomanic episode cannot be due to substance use or a general medical condition.

But what really differentiates the two episodes or states from each other, is the severity, duration, and from a psychological point of view the experience of each patient. The DSM-IV sets four days as the minimum duration for a hypomanic episode and states that the mood has to be “clearly different from the usual non-depressed mood”. But the two most important criteria (D and E) that refer to functional impairment essentially summarise the major difference between a hypomanic and a manic episode. The hypomanic episode is associated with an “unequivocal change in functioning that is uncharacteristic of the person when not symptomatic” (criterion C of hypomanic episode) and “the episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features” (criterion D).

The four-day duration for hypomania has been challenged clinically, and more recently empirically (Benazzi and Akiskal, 2006). More recent criteria proposed by Swiss researchers (“Zurich criteria”, Angst et al., 2003), discuss at least a two-day duration for hypomania. These criteria make the diagnosis of Bipolar disorder easier in cases with brief hypomanias, but also tend to inflate the diagnosis of Bipolar disorder, and the time spent in syndromal states and number of episodes, that are usually reported in prospective naturalist studies on Bipolar symptoms (Bauer, Grof et al. 2006).

Any diagnostic definitions that rely on duration and severity of symptom states, especially in a variable condition such as a Bipolar disorder, require continuous monitoring in order to be accurate, and make prospective designs with multiple measurements a necessity.

Two more episodes that are often present in Bipolar disorder are major depressive and mixed episodes. Their symptoms and diagnostic criteria are given below. According to the DSM-IV, the diagnostic criteria and symptoms of a major depressive episode are the same both in Bipolar and Unipolar disorders. Mixed episodes by definition can only be present in Bipolar disorder as they require the presence of both a depressive and a manic episode.
Quote:
Originally Posted by tonyfar View Post
Im not sure if I should be posting here or in BP forums and would appreciate some direction there. I started dating and got involved with a woman who has BP2. I am in my 50's, she is in her 30's. The relationship started in August and it had been an awesome 4 months. We saw each other on average of once a week and a few weekends a month. She is a distance (1.5 hours) from me so spending more time was prohibitive due to the distance and work, etc. With that said, we texted and or talked daily and always had great conversations.

She had indicated to me in the September time frame that she suffered from BP2, was on meds and it was under control. She kind of explained what it was all about and I did basic (Mistake) research on the subject. There were times when she indicated she felt foggy and I noticed some memory lapses along with being able to see that she had difficulty with organization and completing projects. We talked about these things with almost every visit and I basically listened and helped where I could in terms of breaking tasks down, etc. I also had alot going on in my life with respect to my ex wife and things that she was doing and we shared alot of that. Probably shared it too much as I think that we got so caught up in talking about those issues that we should have been looking more at hers, along with continuing to enjoy one another's company. Basically, it was great. Conversation flowed easily, we enjoyed doing anything together, and the sex was awesome.

By late October/November I knew I was falling but managed to keep the relationship casual in my mind. Held her at arms length mostly due to the age difference. One week led to another and on Dec. 29 we got together to plan what we wanted to do on New Years Eve. During the discussion, she went down the path of reviewing our relationship and dropped the "I love you" on me....to which I happily rescinded. Those words just opened me up and we talked about that fact that we had almost said it to one another numerous times from November forward. Like I was hooked. I hadnt opened myself up like that in a long, long time so it was like mainlining a huge syringe of feelings.

Within 2 weeks she indicated that she needed a sabbatical from everyone and was unable to communicate at a deep level. Basically, Ive been getting a breadcrumb or two each day since then. She indicates that she just needs time. She did start a new job, so that was a major change. Anyway, in the meantime I have done the deep dive into researching BP2 that I selfishly didnt do 2 or 3 months ago. I took everything at face value without totally realizing what was going on. Basically, it appears as though she was in hypomania (sorry, but I dont know if we call it an episode or what) during the time we were together. So I am kind of left with, did she mean what she said? Was it all part of the state that I think she was in? Does she really need time or is this the process of moving on for her?

Im just looking for some guidance and opinion. I totally want to be there for her in terms of helping her with this. Frankly, if I had realized what was really going on I would have worked with her to know what meds she was on and if she was taking them. I would have looked for a support group. I just feel terrible that it didnt all soak in and that I hadnt armed myself with the knowledge to understand and help her. It's killing me that I cant have a serious conversation with her about this and just want to indicate to her how much Ive learned in the last few weeks along with being able to tell her how sorry I am that I didnt take more time to do that. Any advice is welcome and thank you for your consideration.

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Default Jan 25, 2020 at 06:16 AM
  #3
Only time will tell. It might be wise to let her know that you want to be there for her etc (maybe in a written letter---something she can see, hold, return to) and give her space and time to respond. She may feel regrets at letting you get so close, and shame/vulnerability about needing support/help---

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tonyfar
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Default Jan 25, 2020 at 09:35 AM
  #4
Sarahsweets,

Thank you for the clinical information, although I may not completely understand all of it. Again, I am in a learning process. I didnt mean to imply that she was hypomanic for 4 months. I think I was just questioning the validity of the overall relationship and how she actually feels and looking for direction on how to possibly communicate with her at this point. Maybe I didnt define everything that I observed properly that Ive read about via blogs, boards, etc. Early on she lost her job. She constantly indicated to me that she had "foggy" days. She struggled with organization. During the period when she was unemployed, which was most of the 4 months, she started various projects but never finished them for the most part. The projects were craft type items that she was interested in regarding a side business that she wanted to start. We had conversations about the business plan and what she wanted to do, but it was difficult to totally comprehend the core products and how to market as it tended to be a moving target for me. She tended to purchase tooling and organizational products that seemed redundant to what she already had. Multiple workbenches for example. As previously indicated, dishes and laundry tended to pile up. Especially dishes. She we express remorse about being able to just get up and do them. As indicated previously, I should have jumped up every time and said lets get them done but I didnt, mostly due to her expression of needing to be independent. In short, she would express remorse at not being able to do these things.

As indicated in my OP, I had alot of issues going on with my ex....basically siphoning money out of me which I shared with her and that became a topic of discussion probably more than it should have been. That said, she wholeheartedly jumped in and provided support. In other words, being more concerned with my issues than hers. There were some occasions in which she would indicate that her anxiety levels were high, ie., feelings of impending doom and times in which she would just cry. I obviously just held her and let her do so. I was glad to do it. That said, I probably didnt get the full context of what may have been occurring. She broke down one day due to being behind on bills and also issues with her car, car insurance, and legal drivers license. In essence, her license had been suspended, so she couldnt get car insurance and was behind on car payments. I took her to the DMV that day and took care of the tickets, etc. to get the license re-instated in order to start the process. Not looking for applause, just giving context. The point being, she would have good days and bad days. Good days, she seemed to be on top of the world. Bad days were foggy and sad.

I failed to mention....Her libido was like off the charts. Of course, I was good to go with that (a little injection of humor). I am pretty much assuming that she was spending time with others in my absence and was OK with that in terms of the fact that exclusivity was never discussed. Again, I kind of kept it all at arms length as best I could in my mind until the L word got added to the mix.
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