Experiencing "Missing Time"
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Q:  Experiencing "Missing Time"

Dr. Phelps, 

It has been 4 years since my diagnosis of bipolar disorder type I.  Late last year I stopped taking my medications and was able to complete my internship to finish my bachelor's degree.  My memory has never been excellent, so I have to be an avid note-taker.  However, recent events have triggered something I've never experienced before. 

Just after my internship, I discovered that my husband was using methamphetamine and having an affair.  Upon my discovery, he immediately quit the drug, confessed everything, and did everything in his power to tell me how sorry he was.  All of this was a very traumatic experience for me.  We've been married for almost 11 years.  It has been 3 months since I found out about his substance abuse and infidelity.  My problem now is that I have missing time.  What I mean is that I don't remember going places that I went or saying things that I said.  For example, my husband told me that we drove to the nearest city to buy a painting at a particular store and ate at a particular restaurant where I didn't order anything and began to cry.  He said we had to leave the restaurant because I couldn't stop crying.  This trip to the city took place about 3 weeks ago and I don't even remember going.  This missing time has gotten as long as 3 to 4 days, but sometimes it's only a few hours.  My husband has noticed that while I'm "missing time" my pupils become very dilated.  

I was hospitalized about a month ago and I'm now taking Geodon and Lamictal.  I was having these memory problems before the meds and am still having them now.  

What is happening in my brain to cause me to forget?  Is it related to PTSD?  If so, how?  Why do my pupils dilate during the time that I later forget?  Will I ever stay in that state, not being able to come out of it?  Do you know what I can do to keep my mind healthy through all of this?  

Sorry for the length of this.  If you post it, you may shorten it.  Just don't use my name. 

Thank You,


Dear Jen --

This was going to be hard enough to figure out, I was getting ready to offer an apology for not being of much use.  Then came the part about the pupil dilation.  As you probably know, the simple explanation would be to invoke the sympathetic nervous system, the automatic control system of our body that mediates "fight or flight" responses. Activation of this system can cause pupil dilation.

But that really doesn't explain anything.  It might be an indication that your body is doing some sort of fear response. But that leaves open the question, "why?"  And because other medical conditions can cause pupil dilation, we should not necessarily a sound that some sort of PTSD reaction is a basis for that.  Unless some better explanation emerges, this is probably worth seeing your doctor about: first, just to make sure there is nothing else going on with your nervous system; and second, to see if she or he might have some resources to recommend, such as a psychotherapist to target possible PTSD.

Now for the apology: sorry not to have anything more useful here.  Good luck getting that figured out.

Dr. Phelps

Published May, 2009


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