Hi there,

I don't know anyone with both NPD and bipolar.  I do know someone close to me with diagnosed BPD, and someone else with undiagnosed NPD.  Both have self-medicated with illicit/unprescribed substances, and I'm certain that the drugs exacerbated some of their more deleterious behaviors.  There have been times when more "psychotic" episodes from them have coincided with heavier drug use.  The "psychotic" behaviors seemed to go into "remission" when they were hospitalized and cut off from the drug source. 

I'm just mentioning this because, though I'm no expert, I understood that bipolar typically emerges in early adulthood.  That your SIL's bipolar behaviors emerged in her 40s seems unexpected.  I'm not saying it's not true, I'm just wondering if something else is going on, or is a triggering condition, such as a reaction to medications.

Having said that, the pwNPD in my life can exhibit extremely aggressive behaviors.  He has gotten into trouble with police for harassing-type behavior.  There was one incident where the police held him for several hours, and he became increasingly agitated and aggressive, but they couldn't figure out why he was acting so weirdly--he wasn't just drunk or high.  He made threats, but since he didn't actually follow through, the police couldn't book him.  The police called around to try to get someone to take him in, but nobody would.  They ended up taking him to the hospital, where he was treated for a few weeks.  Let's just say this wasn't an isolated incident--the police have a file on him, and that's why they were able to call around to ask someone to take him.  And the reason nobody would take him is that his NPD behavior is too much to handle.  He is in a bad way, and I wouldn't be surprised if he doesn't live much longer, cutting his life short by 30-40 years.  I don't know if he'll get in a fight, a car wreck, OD on drugs/alcohol or succumb to physical system failures (failing kidney, liver, heart attack, stroke?).  It is very sad.  But since he's NPD (in all likelihood), he thinks he's "special" and would never admit to having any sort of problem, whether a physical ailment, mental health issue or otherwise.  Though he loves the attention he gets at the hospital, he doesn't follow doctors' orders and reverts to bad habits when discharged.

My daughter was diagnosed bipolar (unofficially) when she was 16 and BPD at 17.  Then they both made it to her charts when she turned 18.  Now at 26, her therapist is talking about a diagnosis of autism as well.

I mention that because my ex-wife also suffers from what out family doctor said appeared to be textbook BPD, but she also added that BPDs don't experience manic or depressive episodes.  And I was like, she is over the moon happy 24/7...she honestly appeared to be drugged those first few months.  Her diagnosis before this was major depressive disorder, so the manic behavior did not fit by any means and it didn't align with the thinking of BPD either.

So the short answer is yes, people can have multiple diagnosis for mental illness.

Hi DesertDreamer!

How are things going?

Are you doing exercises or some kind of treatment?

Are you digging into information about changing your current treatment?

Hi CC43,

As I just told Pook075, I disagree that therapy will be ineffective. Because pwBPD crave validation and do want to find ways to control their emotions. If you hate cinemas, but you are obligated to watch one because of your schoolwork, it doesn't mean you'll hate the film. Depending on the film, you might like it. And DBT is a good film for pwBPD.

Yet, I'm putting more hope in the pharmacological treatment. Because I think we got the perfect pack for her.

Regarding boundaries, what prevented me from enforcing them was that she kept harassing me (because we lived together). Also, I too quickly left it behind and tried to reapproximate, because I wanted to get rid of that negative climax between us. Is that FOG?

Anyway, now that I'm living apart, I'm finally learning how to use boundaries. Today I failed. After I said she was parroting her mom, she cursed at me, so I said the conversation was over. However, I didn't communicate that well, and she misinterpreted me badly. So she dysregulated and said very bad stuff. After some time I tried to clarify my previous statement about the conversation being over. Yet, since her words had made me angry, I failed to resist the urge to reply. So I kept adding more text to the message, fighting back against what she said. With that, I effectively fell for it and made things much worse. After some time, I prompted AI to help me understand my mistakes, which were obvious, but somehow I couldn't find them by myself.

Now I am leading the relationship, I have peace, and I am not accommodating her. However, that's not enough since I can make mistakes like that. It's worth mentioning, though, that triangulation is happening. Her mother was putting pressure on her, seemingly with the goal of creating conflict between us. Her mother always manipulates her to take control of her and her grandkids, making my wife a real marionette. Yet, I could have dealt with that well.

Hi Pook075 ,


Based on the EOS theory, I believe the distortion you described is made "unconsciously purposeful" so that they can feel rejected and therefore release endorphins. Therefore, you have a good point.

However, this distortion does not always happen. In my case, she didn't react at all when I communicated the four conditions. Because we were together and she was feeling good with my presence. She even asked me to stay for the night in her home. As I denied, she asked why, a bit angry, but as I gave logical reasons, she accepted them. I think it went well simply because she was interested enough in closeness to ignore the opportunities to pick up a fight.


I disagree. Unlike NPD, people with BPD do know that they are mentally ill, even if they deny it to others. And if, for whatever reason, they accept to do DBT with a good therapist, then it is very likely to work, but still it depends on them liking the professional. For instance, my wife does not like male professionals. But once they feel comfortable (which is the goal of DBT), they will begin to like the sessions (because of the validation they get). As a result, they will gradually become more motivated to put up some effort. After all, they are aware of their problems and failures.

My wife never denied being mentally ill, and as soon as she was diagnosed, she shared it with close family the same day.


You correctly pointed out one of the reasons that makes her resistant to treatment. The other reason is that she has never done DBT, and regular therapy (such as CBT) doesn't work for her (makes her feel invalidated). But I am quite sure that this will be overcome once she starts actual DBT and the therapist match is good for her.


I think that only item 1 is the hard one. Because specific phobias (item 2) are considered the most treatable of all anxiety disorders, with a treatment success rate of 86%. Because they only need to treat one specific thing, such as the fear of heights, and do not necessarily need to treat the original trauma when there is one.

Also, I believe that this phobia is a byproduct of her BPD, and she unconsciously cultivates it. I say this because it's clear that she unconsciously took steps to traumatize herself and then always sabotages her treatments. But maybe if medication and DBT are capable of reducing her need for opioids, then any specific phobia treatment will be effective. Many people even cure themselves through gradual exposure, without the support of any professional.


Yeah, I know it seems difficult. However, in my priorities, the peace in my house comes first, and the relationship comes second.

Getting back to the original post, I agree with the general spirit.  I think the spirit your are trying to convey is that you're always loving, but that you won't tolerate (aka "accommodate" or "indulge") abusive behavior from the pwBPD.  Not tolerating abusive behavior, such as throwing hissy fits, destroying property, attempts at sabotage, acts of violence, unsafe driving, stealing money/property/idendity, etc. is important to preserve your own mental health and safety, as well as that of any children in the household.

You state that people with BPD need to be guided and led, and I might agree with that, if "guided and led" is expressed in terms of establishing (and enforcing) boundaries that are both clear and fair.  An example might be, illicit drugs and violence are not tolerated in the home.  Another example might be, adult members of the household must contribute with chores and/or economically.  If she crosses a boundary, there should be certainty around the response--a call to the police, or a request to leave the premises.

Now, my lived experience is that in "enmeshed" relationships, consequence enforcement can be very inconsistent.  The natural inclination is to tolerate a lot of baloney and "walk on eggshells," to do and say almost anything to get her to stop her toxic behavior, in the name of avoiding another meltdown (or worse, suicide attempt).  My experience is that when operating in a FOG of fear, obligation and guilt, there is a ton of FEAR around enforcing consequences, because the pwBPD's emotional reactions always seem so EXTREME.  My experience is that pwBPD often test boundaries, and because of a history of unenforced consequences when boundaries are crossed, they are actually CONFUSED about what is tolerated and what is not.  A typical reaction to a boundary enforcement would be to invent some crazy story to "justify" the boundary violation, such as blaming someone else for provoking her, or twisting the story entirely and saying that YOU assaulted HER, when reality is the other way around.  Alas, because she has "gotten away with" some toxic behavior in the past, she might try to test and re-test the boundaries.  But the way I think of this, she's testing ME and my commitment to keeping the household safe and functioning.  If she sees that I'm always firm, fair and still loving, maybe she'll finally understand that I'm not the enemy, but the ally.  Because just like her, I want a peaceful, respectful, functional and loving home.

I think that if you read this site, you'll see that pwBPD often have to "hit bottom" before they decide to commit to therapy.  Often hitting bottom involves trying to function on their own in the "real world," i.e. not having you around to shield her from the natural consequences of her behavior.  In my opinion, any boundaries you establish in the home should be similar to ones she'd find in the "real world."  Of course she is free to go her own way, and I respect other people's freedom, I truly do.  But I also respect my own freedom to live a healthy adult's life, and that starts with safety in my own home.

I guess I'd disagree with the statement of "pwBPD need to be guided and led" if you mean that you want to compel her to get therapy as a condition for being with you.  I think that sort of "guidance" will probably backfire, especially if she's not "ready" for therapy.  Granted, she might agree to therapy, just "go along with it" in order to get a concession from you.  But I think that therapy won't work until she herself decides she needs it and she's fully committed to the process.  Having said that, once she's on board with getting therapy, then you can support her 100% in that endeavor.

I'm curious if anyone else has seen this combination? 

My NPD sister in law became part of the family when she was in her mid-20s.  As you all can imagine, she was difficult from the start.  Very much straight up NPD behaviors, high conflict, no empathy, attention seeking, bullying others, manipulative.  Then at some point after she turned 40, she was diagnosed as bipolar.  I had cut contact with her a couple years before she had her first bipolar episode.  Now we're limited contact.   I have known other people who have bipolar, but I have never seen someone else when they were in their bipolar mania.  But I'm guessing that it is more complicated when someone already has highly disordered NPD thinking.  The last two years, her manic episodes have been off the charts.  They seem less and less filtered.  And I have concerns that she could get into serious trouble with the police or from "harassing" the wrong people in future manic episodes.  I have always had some hope that she would one day wake up and realize how destructive her behaviors have been and genuinely want to change.  But that isn't going to happen.  It seems likely that she will just have manic episodes every year until she submits to having her meds readjusted.  Or worst case she self-harms during one of her episodes, or gets shot by police or she puts herself in a dangerous position by aggressively harassing the wrong stranger. 

Hi Anonymous22, 

As I sit with what you wrote, two things seem true at the same time.

On one side, it sounds hard. He feels distant, uneven, and not very engaged. Carrying that every day is a lot. 

At the same time, the worst of the storm seems to have eased a bit. Fewer eruptions. A little more room when you pull back. Less second-guessing around childcare. Those shifts are small, but they still matter. 

Sometimes when someone is pressed to look at their behavior, the volume drops before anything healthier appears. It isn't proof of change, but it can hint that the pattern is moving, even if only a little. 

What stands out most to me, though, is you. Your boundaries are clearer. You're protecting your work. You're steady for your kids. You're not getting pulled into arguments. That's real movement on your end. 

It also makes sense that the unevenness wears you down. "Quieter" can still mean you're waiting for the next swing, and that takes a toll. 

With all of that in mind, what would feel manageable right now-not perfect, just doable? Maybe a set time to check in, a basic plan for kid handoffs, or one simple rule you can hold to even on the tough days.

Hi, thanks for checking in.  Its now been about 4 months with my uBPDh being in both DBT therapy and mandated group DV therapy.  Over the last couple of months, his usual cycle has shifted several times and his switches have been more spontaneous than before and probably longer blah periods in between good periods, but the blah periods are pretty much just that, blah, where he ignores me, asks when the kids can stay over at "his" house (one of our rental properties where he is currently living until the DV therapy is finished and the protection order is done, even though he is allowed by the protection order to stay at our house) and makes snide remarks when he doesn't get his way or is in a mood.  There have only been a handful of times where he has gone farther than that in those 4 months, yelling, full on accusation mode, etc, which used to happen every couple of days.   In all honesty, he seems very depressed and checked out on everything to me.  Its like he wants to be a part of his kids life, but can't sustain it even when he is physically present.  For example, he will go to our D5's gymnastics class, but after showing her that he is there, he leaves and goes and walks on the track (in the same building)...but would freak if I took her to gymnastics at a time that he could not be there; he says he wants to be around the kids but chooses going to the gym, walking on the treadmill in our basement, etc over spending time with them when it comes to reality; and its like he has checked out on actual parenting...refuses to take the kids to sports, put the kids to bed, make the kids dinner, etc...told me he doesn't want to be my "errand boy" when the "errand" is taking our S7 to basketball practice! ; and same for house projects, we make a plan when he is in a good mood, I follow what we had decided and he "can't remember" even making that plan.  There are times when the kids will talk to him and he has no idea, its like he is there physically, but not there is no comprehension of what is being said to him.  While he used to mention every once and a while small things about therapy, outside of saying he needs to leave at a certain hour because he has a group session, is all he has said for some time.  I know that he had to have a mental health evaluation, but the results of that were never mentioned to me, and since I don't feel like that is my place, I haven't asked him.  While I would like to be supportive, I feel like sharing his diagnosis would make him feel like a failure.
For me, honestly, I am struggling!  Essentially being a single mom to 4 extremely active (For example this weekend, I have 2 kid birthday parties to go to, 1 soccer game, 5 basketball games, taking my oldest to and from work, celebrating my sister's birthday, a middle school dance and attending a college basketball game as a celebration for one of my kids...on top of regular life) kids, work and my H, I am honestly at my breaking point!  I have set very firm boundaries on making sure that the kids and I continue forward in a positive direction every day despite my H's mood.  It has been very hard, but I try very hard to be happy despite all that I have going on, and while I know it sets him off a lot when he sees that I am happy even when he is freaking out, not getting on his rollercoaster (or getting on for a more limited amount of time) he has slowly started to adjust but I do think that this is his biggest issue right now...but I don't care as my kids deserve a happy mom and I deserve to be happy.  I have finally set up daycare coverage for the kids so that I am able to work and not have to worry and thankfully he is finally being respectful of this...he used to do everything he could to make it so I couldn't work or sabotage the babysitter (but then tell me that I needed to pay for everything!) but he is respecting my boundaries on this recently.  I have also set firm boundaries on the fact that I will not get into an argument with him.  The second he starts in, I tell him that I am sorry he feels this way but that I will not continue forward with this conversation and I remove myself...which he is finally respecting.  So, while things are not great, writing this down has shown me that there has actually been some progress forward, even though it seems so slow! 
I think the hardest part for me is never really knowing what is going to happen each day...and having to plan for it all!  I know that he has lots of stress going on that depending on his mood if he will fill me in on those items or not, so I try to give space, let him know that I love him (even when he has split), try to be there for him and then try to continue forward with the kids.  I assume that he has awhile still in DV therapy and hopefully DBT therapy.     

I'm not very eloquent nor can I get past my inclination to be a logical sort of guy, but knowing my limitations, I appreciate how others can phrase things better than me.  From an email I received:


Do you have a counselor to help center you?  Or friends and family who can share activities and adventures?  My years of traveling and amateur hiking are mostly in my past due to age and health, but for years I enjoyed roaming the great outdoors and magnificent nature.  Most of those close to me like beach vacations but my joy was going into the high rugged mountains and winding roads... well, I did give up quickly on pitching tents and cooking over fires, that wasn't for me.