title: Burden and marital and sexual satisfaction in the partners of bipolar patients.
abstract: OBJECTIVE
  Bipolar disorder can be traumatic for both patients and patients' partners. Hence, partners' stress, burden, marital and sexual satisfactions are important areas to investigate. However, there have been problems with past attempts to identify the determinants of marital satisfaction in bipolar patients and their partners. The present study aimed to address these issues and provide an accurate description of relationship functioning in these couples.
  
  
  METHODS
  The sample involved 37 partners of bipolar patients. A semi-structured interview assessed the impact of bipolar disorder on aspects of everyday functioning and partners' attributions for patients' disturbing behaviour. Standardized instruments assessed partners' sexual and marital satisfaction across the different affective states.
  
  
  RESULTS
  Despite couples staying together, significant numbers of partners reported strain as a result of socioeconomic and household changes. More male partners reported premature ejaculation and female partners reported sexual infrequency when patients were depressed. Overall, partners were less sexually satisfied when the patient was ill. Marital disharmony was greater when patients were ill and worse during manic than depressed phases. Marital disharmony was also more likely when partners believed the patient could control their illness; they had increased domestic responsibilities; or were sexually dissatisfied.
  
  
  CONCLUSIONS
  Reductions in sexual satisfaction during affective episodes may be the result of illness-related changes in sexual interest, responsiveness and affection. Partners who attribute control for the illness to the patient may use strategies to influence behaviour that disrupt marital harmony. Interventions involving education, problem-solving strategies and sex therapy components may help to reduce marital dissatisfaction.
authors.affiliation: Department of Clinical Psychology, Institute of Psychiatry, London, UK. spjtdh@iop.kcl.ac.uk
authors.forename: Dominic
authors.initials: D
authors.lastname: Lam
authors.forename: Catherine
authors.initials: C
authors.lastname: Donaldson
authors.forename: Yael
authors.initials: Y
authors.lastname: Brown
authors.forename: Yanni
authors.initials: Y
authors.lastname: Malliaris
mesh_terms: D000223:Adaptation, Psychological; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D017281:Cost of Illness; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008393:Marriage / Q000523:psychology*; D008875:Middle Aged; D010549:Personal Satisfaction; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires