Hypomania and marital conflict

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