bipolar disorder, Dr. Paul Markovitz  Q. My brother has recently been diagnosed with BP disorder. He is telling his family that he is under a psychiatrist's care, but I know for a fact that he is not. Besides manic-depression, he is a drug addict/alcoholic and sex addict. I also believe he has a basic personality disorder. If he were not my brother, I would never choose to be around him. My husband and I, my other brother, and my father are involved with my sick brother because we work together in a family business. My brother with BP has recently been put on a medical leave because his behavior has become so bizarre. My family has enabled his illness for years, but that is another discussion. My sick brother is lying incessantly, engaging in extramarital affairs, jetting off to foreign countries to meet women from the internet, selling drugs while in out-patient drug treatment, taking synthetic testosterone to enhance sexual performance (his wife found this supplement), displays a constant "victim complex," and has an intense hatred towards his family and wife. I do not know the extent of his present drug use.

I am afraid that my brother is dangerous to his wife, his son, and to members of his extended family. Is it common for males with BP to become homicidal? I don't think he is suicidal because he is so narcissistic, but I am not a professional. My husband and I are afraid. Are we over-reacting? All the information I have seen on BP stresses the suicidal nature of the disease, but can these individuals become homicidal ?

  A. It is difficult to assess what the real diagnosis is for your brother. Regardless, if he does not see that there is any problem with his behaviors, there is little chance of him changing. Homicidality as you describe it can occur with bipolar disorder, but in light of his other behaviors, he may have more personality disorder than bipolar disorder. The treatments usually are different.

You have a legitimate worry if he is bipolar or personality disordered, unwilling to change, not seeking any treatment, and abusing substances. He clearly will be more at risk to harm family members based on how you portray him. Everyone involved may want to seek legal advice on how to protect the family and their own assets.