Separating the Dual Diagnosis From the A$$Hole

Old 10-12-2015, 11:45 PM
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Separating the Dual Diagnosis From the A$$Hole

My RAH (technically boyfriend of 19 years) has been sober for 2 years now. While I respect, admire and understand that huge accomplishment and am grateful for the work he has done to this point, I am struggling with his general attitude and mental illness(es).

RAH has many mental health diagnoses such as Anxiety, borderline personality disorder, OCD and has a mental health timeline that is eerily bipolar. Obviously RAH self medicated until he entered rehab two summers ago.

What I struggle with most, is where does the mental illness end, and the a$$hole begin?

Even sober he is angry, passive-agressive, judgemental, and negative. The continuous complaining and negativity is exhausting. So exhausting. He also verbalizes his cultural misconceptions (or racist views) to the point where he has felt humiliated (even though no one else heard what he said). His absolute inability to give two toots about others is my biggest frustration.

RAH is in a mental downswing right now; he was declared not fit to work due to anxiety issues (high stress job), but has been attending meetings, group therapy, behavioral therapy and seeing his addiction Dr every week. He has been off work 4-5 months now (we live on my part time income, doable but not easy). He recently withdrew from his psych meds (it was an awful thing to watch) and just started brand new ones. He is trying or at least going through the motions on that front.

His crazy is making me feel crazy myself. I need to resolve within myself where my line in the sand is. When do I decide to toss in the towel (so obviously a question only I can answer)?

My biggest concern is that my kids are growing up with a very cranky person in the home who resorts to anger and judgement for the smallest of issues, as opposed to kindness and compassion.
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Old 10-13-2015, 12:53 AM
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Good morning. Still rather the middle of the night. I am really sorry you are dealing with this. He sounds a bit like my brother in law who is a mostly unmedicated bipolar. The thing is without medication and therapy that stuff will always be there.
You might want to look into Al-Anon for yourself and if the kids are old enough Ala-teen for them. Everyone is affected by alcoholism and you could all use some help.
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Old 10-13-2015, 01:46 AM
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LovesVWs......I noted the letter that you wrote when he was in rehab 2yrs. ago....and, it sounds like you have had a pretty m iserable time for about the last 10yrs. You must be exhausted! I don't know how old your kids are....it must be a very tense atmosphere for them to live in, also.....with a momma that is worn out, exhausted and a dad that is off the hinge.
I was told many years ago that one of the signs of mental health was the ability to make a decision and to carry through with it. I have kept that in my mind, ever since. It comes in handy when I have had the tough situations to face....lol!

I feel compassion for how you must be feeling and, how scared you must be.
What support do you have, if any? Support is so crucial for you. You are carrying the concern for several people on your back....who is there for you?

You will get through this...like so many others, before you. You are not alone, in this.....

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Old 10-13-2015, 03:06 AM
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Gee that's a hard one. When abusers give the excuse that they're acting under intolerable stress, the test is to see if they take it out on (say) their boss or friends. If they don't, then to abuse their spouses or children is obviously a choice rather than something they can't control. Maybe you could apply this test to your RAB.

He's working on the meds, and behavioural modification which shows effort, but seems to get lazy or careless when he's at home. You could think about what's acceptable, what's over-the-top and harmful to the kids. Maybe confront him calmly when he acts out? Maybe work on some strategies with him where he will 'time out' rather than poison the atmosphere?

It seems like something you'll need to confront for yours and the children's sake, but it would be better to have a strategy and possibly some training on how to handle situations without escalating, because you'll need to stay in control. It might pay to consult a counsellor about becoming more assertive.

You're focusing on what's reasonable for him, in the sense of whether it's the mental illness and therefore not his fault. If the children and you are suffering, walking on eggshells and unable to relax, it might be more logical to stop thinking about the cause and focus on the effect. In other words, getting them out of there.
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Old 10-13-2015, 03:59 AM
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Hi Loves - I hope I can offer you some answers here. My RAH is also OCD, has anxiety, and is bi-polar 2.

When you say that he has a mental health timeline that is eerily bi-polar could you be a little more detailed about what you mean? Could you also describe his actions as far as borderline personality disorder?

He recently withdrew from his psych meds (it was an awful thing to watch) and just started brand new ones. This is VERY disturbing to me. Mental health medications when being changed or stopped should be tapered, or replaced with a med that bridges the withdrawal. For instance sometimes an SSRI med will be replaced with another which avoids withdrawal, whereas if a patient is switched from an SSRI to a tri-cyclic antidepressant the SSRI will be tapered. Is there a reason why the meds were pulled in this way???

I'm also wondering what meds they are prescribing for the issues they have determined? I would expect something for the anxiety and there are a myriad that can be used which are usually going to be in the benzodiazepam family although some SSRI do target anxiety such as Paxil. I'm unaware of meds that target OCD especially Borderline as there is no med for that.

I am wondering if your RAH has been correctly diagnosed, and is receiving proper medications? Where the mental health ends and the aHole begins is only something you can determine if your RAH has correct diagnosis and is being medicated properly. He has been sober for 2 years and it sounds like he has been very difficult moreso in the past couple of months. With all that he is receiving as far as support, and his participation which appears to be very active, he is headed the wrong way, and that is a huge red flag to me.

My RAH was misdiagnosed for 10 years. Along the way we got Borderline, clinically depressed and a myriad of others that were WRONG until the diagnosis for BP2. When a patient is on the correct meds its almost like the curtains part and the sun shines in. My husband is not perfect by any means, and the BP does pop up here and there in the form or irritability and insomnia. Its manageable and livable for me and him. Your RAH sounds like in his mind its still a jumble.

If your husband really is Borderline I have another opinion as to where the Ahole begins (when they wake up). DBT is an effective therapy for that is that what kind of therapy he is participating in?
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Old 10-13-2015, 05:42 AM
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Originally Posted by redatlanta View Post
When you say that he has a mental health timeline that is eerily bi-polar could you be a little more detailed about what you mean? Could you also describe his actions as far as borderline personality disorder?
His swings happen in 1.5 to two year cycles, hes been clean 2 years and the downswing was inevitable. It fits his lifelong timeline of up and down. As far as describing actions? I actually can not since I am not sure where the man ends and the disease begins any more. If that makes any sense at all.

Mental health medications when being changed or stopped should be tapered, or replaced with a med that bridges the withdrawal. For instance sometimes an SSRI med will be replaced with another which avoids withdrawal, whereas if a patient is switched from an SSRI to a tri-cyclic antidepressant the SSRI will be tapered. Is there a reason why the meds were pulled in this way???
He was tapered, I didn't say he wasn't. Hence the 5 months off work to make that happen. However the ensuing depressive rebound (which he hasn't had depression ever) and the physical withdrawls were worse than detox by miles. His meds were specifically for the anxiety issues and the like, and was one of very few medications we have found that actually worked for him, until now. In the past there has been an attempt to switch to mood stabelizing meds which have led to suicide attempts (granted at that time he was also drinking heavily). Now they are trying Lamictal, which fingers crossed helps with the swings.


I am wondering if your RAH has been correctly diagnosed, and is receiving proper medications? Where the mental health ends and the aHole begins is only something you can determine if your RAH has correct diagnosis and is being medicated properly. He has been sober for 2 years and it sounds like he has been very difficult moreso in the past couple of months. With all that he is receiving as far as support, and his participation which appears to be very active, he is headed the wrong way, and that is a huge red flag to me.
I work in mental health myself, and for the very first time after being through a number of psychiatrists I feel like we have an appropriate diagnoses. I have been saying that the OCD and anxiety alone were not the only things going on for YEARS. Finally we found an amazing Psychiatrist who deals with Dual Diagnoses who was willing to put in an amazing amount of time with RAH and he agrees and feels so awful for everything RAH has been through up to this point. For the first time ever I feel like we are moving forward on the medical front anyways... We have also had misdiagnoses of depression which was a long deep tunnel to crawl out of on all fronts. The only thing keeping us off of a Bipolar 2 diagnoses was that my RAH manic episodes were maybe feeling like the rest of us do when we are normal. No actual up-cycle. I agree his mind is still a jumble.

It is a tough situation for sure. Most the time he is absolutely fine on the surface, then all of a sudden these things pop up (getting really mad at a computer for no reason, racist slurs when driving, riding our 6 year old too hard about practicing piano, berating a son for a poor hockey game etc) where I realize he is a real special kind of AHole.

I know if it was me struggling I wouldn't want him to quit on me (and by now he would have), but at the same time I feel like I am at a crossroads.
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Old 10-13-2015, 05:56 AM
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Originally Posted by dandylion View Post
LovesVWs......I noted the letter that you wrote when he was in rehab 2yrs. ago....and, it sounds like you have had a pretty m iserable time for about the last 10yrs. You must be exhausted! I don't know how old your kids are....it must be a very tense atmosphere for them to live in, also.....with a momma that is worn out, exhausted and a dad that is off the hinge.
It can be very tense, and I see it affecting our 9 year old son more than our 6 year old daughter at this point. My son is a lot like his dad and is a truly sensitive soul. He tells me he tries to ignore it all but finds it difficult - obviously. My 6 year old daughter will outright tell her Dad he is being a tit and needs a time out and to take a minute to prepare an apology. She is so much like me its funny. It is sad that a 6 year old has a higher emotional intellegence than a grown man.

MY RAH grew up in a volitile house of Alcoholics, and often states he wished his mom left his dad, however she is a tit too.

I feel compassion for how you must be feeling and, how scared you must be.
I am not scared at all. It is his illness and disease process, not mine. I can leave or kick him out at any time. Sure there are a few logistics, but nothing I can't work out with time. I think he'd even understand my reasoning. LOL. I am thankful that I am in a position where I can provide for my family without his presence and support.

I do feel lost. I admit that. Waiting for the 'whats next' and deciding where I cut my losses is the only part causing me distress.


What support do you have, if any? Support is so crucial for you. You are carrying the concern for several people on your back....who is there for you?
I have the best Mom ever, and a great core group of friends too, Along with a few with husbands in recovery. I attend the odd AlAnon meeting, because I work nights and sleep during the day I have a hard time prioritizing them with family commitments. I would like to go to more, but truly have only found one I liked that didn't make me feel like the only answer was to leave my husband (oh how they may be right). LOL. My very first group I went to was AWFUL.
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Old 10-13-2015, 07:15 AM
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Well I am sorry you are going through all this and it's really tough. My husband did not get BP2 either because his up cycle was insomnia. It was attributed to depression. Very hard for all these diagnosis when so many can be something else. My husband does take lamictal and the med has worked great. I am sure they are starting your husband out on very low dose which is protocol to see if he has a reaction to it. My husband was started on 25 mg but it was not until we hit around 100 that there was a change in moods. He ended up at 200 where he has been for 3 years. It took one year to get to 200 mg. He was also treated with seroquel since he is BP and that made some difference immediately.

Back to your original question. I think it's all about coping mechanisms and certainly the alcohol can be that for many. I think those with mental issues develop coping issues that can be unacceptable such as the outbursts at the computer and yelling in the car. For my husband he does this still he gets very frustrated much faster than I do he has little patience. I think this is more about the OCD. In my research way back when I found much information tying OCD into the Tourette family and out psychiatrist (a neuro psychiatrist) believes Bi Polar to be a "form" of epilepsy hence the succes of treatment with epilepsy meds. In our household I have learned to accept a little bit more of this than I would if he didn't have the issues. I don't like it when he yells at the computer but there has been some behavioral changes I think on a cognitive level rather than meds. I don't yell at him anymore when he yells at the computer I used to. Instead we calmly discuss things and now it's not in the amount it was before and is accompanied by a quick apology.

Truth is In my head I yell too. My fuse is longet but trust I am screaming in my head sometimes when I get pissed off I just have the self control not to yell. Somehow you two have to be able to discuss things that upset you in regard to his behavior as opposed to you getting upset OR him saying he can't help it he has OCD blah blah blah. That would be my advice is in therapy to be working on how you both handle his issues. If you are doing that already and it's not working, then I understand why you are questioning how long to hang in......
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Old 10-13-2015, 08:01 AM
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LovesVWs........it is great that you have no fear. That puts you miles ahead of many of the people who come to SR.
It does sound like it is wearing on you a bit....as you say that it is making you feel "crazy", yourself.
The effect on the children might be one yardstick to use if you are having a hard time knowing where to "draw the line". Those effects can last a lifetime.
It is said that the concerns fall into the categories of FOG.....fear...obligation....or guilt. I have noticed that many people have a lot of guilt when dealing with someone who has an illness.

Have you all ever considered a stint in one of the dual diagnosis treatment centers?

He is important (of course).....and, so is everybody else in the family.
Do you feel that h e couldn't get better without you..?

I do hope that they can figure out a schedule that helps him.....

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Old 10-13-2015, 01:09 PM
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What I struggle with most, is where does the mental illness end, and the a$$hole begin?
What does it matter? You're with someone who sounds incapable of having a healthy relationship. You're unhappy in the relationship. It's really about you -- stay in a hopeless situation or leave and deal with your own issues. I recommend Alanon because it kept me sane, helped me realize I'm powerless over other people and their problems and let me to a good life I value.
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Old 10-13-2015, 03:04 PM
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It probably doesn't matter. However, I can mentally accept some of the behavior when it's illness related. Harder to accept that he may just be an a$$ too.
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Old 10-13-2015, 03:57 PM
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There is a very fine, thin line. The problem is, if not treated, in many cases, the person will present as difficult, negative, undermining, lying, manipulative, well an a-hole basically. So, it really does not matter. And a mental illness should never be an excuse for certain behavior. And why would you or your kids put up with it? And till when?
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Old 10-13-2015, 04:02 PM
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Originally Posted by healthyagain View Post
There is a very fine, thin line. The problem is, if not treated, in many cases, the person will present as difficult, negative, undermining, lying, manipulative, well an a-hole basically. So, it really does not matter. And a mental illness should never be an excuse for certain behavior. And why would you or your kids put up with it? And till when?
Good point.

I keep trying to find reasons to accept it and make it work. I keep hoping the new medications will level things out. The reality is I just need to understand that I don't have to do this unless I want to. Not sure if I want to.
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Old 10-13-2015, 04:12 PM
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Originally Posted by LovesVWs View Post
Good point.

I keep trying to find reasons to accept it and make it work. I keep hoping the new medications will level things out. The reality is I just need to understand that I don't have to do this unless I want to. Not sure if I want to.
You do NOT have to continue this relationship if you don't want to. You do NOT have an obligation to wait until the meds work or something changes.

Unfortunately mental illness IS the reason behind lots of unacceptable behavior. Some of that behavior can be unlearned or changed with meds.....or not. In my mind its kind of like alcoholism, its a very sad an unfortunate disease. However, unlike alcoholism not everyone can get "sober" so to speak.
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Old 10-13-2015, 05:07 PM
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You do not ever have to answer the question "is it his dual diagnosis, or is it his alcoholism?" You don't ever have to sort out "why" he behaves the way he does.

The real questions, as some articulated above, is "how to you want to live, and what environment do you want your children to grow up in?"

Right now, you have placed the ball in his court, and are waiting on his timetable for his behavior to change so that you feel comfortable with the life he is creating for you and your children. He has all the power; he controls the timeline to get to health or not, while you wait. Your life is frozen until he works out his issues and changes. You are stuck with whatever he does. And he may not want to or be able to change in a way that is acceptable to you.

I know if it was me struggling I wouldn't want him to quit on me (and by now he would have), but at the same time I feel like I am at a crossroads.

I suggest re-framing this idea. In my view, the children in the family deserve top billing. This isn't about your quitting on him; it is about you needing to be the single parent who can create a healthy environment for your children to grow up in. He is accountable for being a good parent as well as a good partner.

From my experience growing up in a severely dysfunctional environment, children easily believe that they are at fault when the problem is that the parents' behavior is flawed. The childrens' emotional health needs to be at the top of the list.

Try turning your thinking around the other way. Think about what you need to have a healthy home life for you and your children. Articulate the different elements; describe to yourself how a happy home life will feel and will be.

Then, tell your husband what you need. If it were me, I would ask him to leave until he can provide the security, serenity, and safety (emotional as well as physical) that you require for yourself and your children. Your children deserve two good parents, or at the least, one good parent and the absence of a disruptive damaging parent.

If your boundary is "I will not live with a man who is "XYZ", then, you can take appropriate action and your life and your childrens' lives can get healthier starting today. The ball that is in his court is whether he wants to - or can - change. You are not trapped in a bad situation while he has the freedom and the to either change or not change, and bear the consequences of his actions. And when - if - his behavior is constructive, he can come back.

He can work hard to get well; he can spend time understanding what it is to be a healthy parent; he can go through the medication trials and tinkering on his own without damaging your children. Or, if he doesn't, he bears the consequences, not you and your kids.

Take what you want of this, and leave the rest. Good luck to you, and I hope you come here as often as you need; you'll find a great support community here and many who have gone through similar difficulties.

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Old 10-13-2015, 05:42 PM
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Shooting Star you've totally hit me over the head with your articulate response.

I am well aware of how much better our home ran when RAH was in rehab and I had the kids alone. There was less stress and nervousness by far.

I have also gone and put myself right out there employment wise (currently my medical specialty has me work nights only, but if I'm to raise my kids alone I'm going to need a day job and childcare) and I've interviewed for a pretty fantastic position within our health ministry that is a minor paycut, but huge potential and workability with families. RAH really wants me to get this position, but he must realize that if I land it (I'm officially in the top three candidates right now) it is much easier for me to move along without him. I have an amazing job now, but I would find it difficult to secure overnight childcare that I'm comfortable with.
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Old 10-14-2015, 09:21 AM
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That was a big realization for me too. My X has a dual diagnosis, but he is basically just an a$$. I thought treatment would help him be less of an a$$, but unfortunately, no.

I say prepare for the worst and hope for the best in every situation in life.

Many hugs to you!
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Old 10-14-2015, 02:57 PM
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I can mentally accept some of the behavior when it's illness related.
It doesn't matter if it's disease related. As a recovering alcoholic (24 years), I learned that each day I make a choice to drink or not. He has made a choice to continue drinking and this is very typical of active alcoholics. Their higher power, God, great love of their life is alcohol. Drunks choose this above all else even the most important people in their lives.
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Old 10-14-2015, 03:17 PM
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It doesn't matter if it's illness related or a$$ related. It just is.

It's as difficult to deal with an a$$ as it is to deal with an active person.
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