Two friends of mine have been a couple for about 40 years now, one of those couples where the two are almost never out of each other's sight, and have had secret languages and all that sort of stuff (but have never been married due to political beliefs). They live together in a motor home and travel a lot.
A couple of years ago, it all started coming unglued with considerable unpleasantness. I witnessed one of the blowups first hand, the one in which Tom struck Peggy for the first time ever.
They visited several therapists without detectable results. Finally, they visited some psychiatrist lady, who listened politely to their story. Then she said, "Tom, you have a thyroid problem, here's a perscription, follow the directions and check back with me in two weeks".
Problem solved.