Diagnosed or not?

[Ceruleanblue]

My husband had an appointment with his psychiatrist today, and I asked him if he'd ask what his official diagnosis was. My husband says he was told he has traits of Borderline, but not enough of them to say it's full blown. I really like this psychiatrist, but this sort of upsets me. I mean, he put my husband in DBT for a reason, and he knows my husband has been physical with me, and has severe anger issues. He did say one of his diagnoses is Intermittent Explosive Disorder.

My thing is this: I live with my husband and see and endure all the "traits", and he pretty much has every trait of BPD(expect for suicidal ideation), and lots of Sociopathic traits, and Narcissistic traits as well, but the psychiatrist, who spends a short amount of time with him, does not! I was always sort of like "oh, it's just a label anyway, but recently I spoke with a therapist, and he said it does matter, and I shouldn't write it off as just a label".

Plus, now I feel my husband will feel he isn't "that bad", and not really try in his DBT therapy. He's high functioning BPD, I guess? But he's had issues with almost every boss he's had, threatening to beat one up, and calling another a foul name in front of others. People who work for him have issue with him, and I know why. I live with it. He treats people horribly, it's just selective. He has "targets".

I just wish he'd gotten fully diagnosed so he would feel he really had to work this DBT program. I actually think BPD is a far lesser diagnosis, and he actually seems a lot more APD. I can't change him, I can only learn to cope with his behaviors, and not contribute, but this was sort of a let down... .

Now what? Is his diagnosis likely to ever change? I just know he has more than "traits" of it. I mean, the 15 minutes you spend with the psychiatrist isn't long enough to list all his "traits", and my husband is way less than honest about his behavior anyways... .

So disheartened.

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[Ceruleanblue]

Also, does anyone else feel like their pwBPD may have something much worse than BPD? I've always been hoping it was just BPD(likely comorbid with NPD), but I have serious worries now about antisocial personality disorder. This was suggested to me by one therapist who I was seeing, after I told her about how my husband seems to enjoy hurting me.

Maybe it doesn't matter what the diagnosis is? Will any of the things we do for pwBPD, like JADE, still help if he is APD? And basically, APD is something much worse to deal with, right? I guess I'm just questioning because his DBT doesn't seem to be working, and he seems to lack conscience and empathy.

[Mike-X]

Thank you for your post. I understand your concerns, and I am sorry. This issues has come up many times on the boards for various reasons, and therapists have their reasons for revealing or not revealing official diagnoses.

Here is a thread that you might find informative:

https://bpdfamily.com/message_board/index.php?topic=76633.0

[Mike-X]

Also, does anyone else feel like their pwBPD may have something much worse than BPD? I've always been hoping it was just BPD(likely comorbid with NPD), but I have serious worries now about antisocial personality disorder. This was suggested to me by one therapist who I was seeing, after I told her about how my husband seems to enjoy hurting me.

Maybe it doesn't matter what the diagnosis is? Will any of the things we do for pwBPD, like JADE, still help if he is APD? And basically, APD is something much worse to deal with, right? I guess I'm just questioning because his DBT doesn't seem to be working, and he seems to lack conscience and empathy.

Again, I am sorry that you are struggling with this. Treatment takes time. How long has he been in DBT? Have you seen signs of improvement since he started therapy?

[Mike-X]

Also, does anyone else feel like their pwBPD may have something much worse than BPD? I've always been hoping it was just BPD(likely comorbid with NPD), but I have serious worries now about antisocial personality disorder. This was suggested to me by one therapist who I was seeing, after I told her about how my husband seems to enjoy hurting me.

Maybe it doesn't matter what the diagnosis is? Will any of the things we do for pwBPD, like JADE, still help if he is APD? And basically, APD is something much worse to deal with, right? I guess I'm just questioning because his DBT doesn't seem to be working, and he seems to lack conscience and empathy.

Also recognizing that there is a problem and seeking treatment is a big step in the right direction. Many with BPD do not even recognize that they are suffering:

https://bpdfamily.com/content/how-to-get-borderline-into-therapy

[Ceruleanblue]

My husband has been in DBT for a little over a month, I think, which I realize is not long. He does acknowledge that he has "issues", but what is scary to me, is he doesn't seem to care. He'll become super hateful, and cold, and he gets this evil looking blank face, and he'll say "yeah, I'm an awful person", as if he's bragging. It's scary, and it's almost like he has this other "evil" personality that he is very aware of, and I feel he can control it, it's just like he chooses not to? If that make sense. His therapist of four years(who his psychiatrist advised him to stop seeing... .but he won't, of course), recently told my husband that she feels he can control his anger much more than he lets on, because he obviously controls it when he chooses to. It's like he just feels entitled, and like he enjoys having people fear him?

Thanks for the posted links. I'll be sure to read them.

[Ceruleanblue]

Oh, and to answer your question: Yes, for less than a week, he was trying to stop blaming and judging me, and that felt great, but it was short lived. I think it didn't feel good to HIM, so he stopped doing the DBT things that teach thinking through why, and trying not to blame? At this point, I do not feel he is doing his DBT. He finds time to do other hobbies, but I never see him reading his printouts, and I've seen very little, if any change, other than that brief, less than a week time.

What's funny is that BPDh pointed out that his psychiatrist apparently told him he might get worse before he gets better. I get that, but it feels like BPDh is making sure that is the case, just so he doesn't have to do the work for now... .

[an0ught]

Hello Ceruleanblue,

you are rightly concerned about your H sticking with therapy, it is not a given.

It would be nice if H got a straight label and that would motivate him to change. However keep in mind judgment and labels are terrible motivator for people - just look at the whole discussions around job titles and how lasting their impact is. What motivates people in the long run are ongoing benefits for themselves, getting understood and relationships. A big part of getting started in T and in particular DBT is doing away with too harsh judgment and building a relationship with the T. Healing from BPD means learning to judge less and see the Grey between the Black&White.

Your relationship is right now going through a lot of change and it is natural to be very concerned and focused on your husband and T. These changes are going to be irritating and upsetting and certainly will impact you too. But in the end you only control yourself. You are dealing with a person with narcissistic traits so a lot is about him. Don't play his book. Don't center your life around his drama with T etc... .  Now is the time to focus on improving your position, improving what you get out of life.

You deserve being at the center of your thinking 

[Ceruleanblue]

Thanks! I do think I deserve to be more focused on ME, it's just so hard to do because I'm trying so hard to not "trigger" him, or be saddened by the blame directed at me. I don't accept all this blame, but after four years, I'm getting tired of it. He's been told we can only both work our own issues, but he still wants to project, and not accept much, if any true responsibility. It's funny, but not long ago, after he got sent to DBT therapy, he told me that "I always thought it was my ex wife". I guess by even saying that, he is acknowledging that he is having some sort of a small wake up call? What, he thought it was most boss' he ever had too, and most of the people who work under him?

I am trying to focus on ME, because focusing oh him is like chasing my tail. I do still spend too much time worrying about his arrival home from work, and my tools, like JADE, and such because those are essential right now. I need to get those down, so I can make MY life easier.

[hegrid]

I don't know that I can add much to the great link and advice from Mike-x and An0ught except to say that when I stopped fixating on getting the diagnosis for my pwBPD, life got better for us both. In some respect we need the diagnosis more than they do; it validates the experience we are having dealing with their behavior. If you need that, and I definitely did, I highly recommend getting your own therapist.

[Ceruleanblue]

I really only need the diagnosis in one regard: so he can't keep blaming and projecting on ME. I couldn't care less whatever label they slap on this, but I know it matters as far as his treatment. That part seems to be taken care of, as he's in DBT, and his psychiatrist just upped his dosage of meds.

One good thing did happen yesterday, he did actually "claim" what he has, saying he has two diagnoses, and that's good enough for me. Maybe now, he'll stop trying to claim it's all my fault, or that I "set him off". If that was truly the case, I'm not alone because lots of people in his life have "set him off"... .even strangers. When you pick fights with strangers, you might have an issue.

Things are getting some better, it's just hard to remember that on bad days. Today has been better, and I'm hoping that's a sign of him perhaps using some of his DBT skills. Fingers crossed. If he did half the learning and effort I've done(using the tools here) in regards to his issue, we'll get to a much better place. I'm hopeful we'll get there, and I'm going to keep doing my part, and it's sort of learn as you go, and trial and error.

At least we are in a better place than we were a year ago. His divorce threats have stopped, and that alone has helped immensely.

[hegrid]

Unfortunately, a diagnosis will probably not change the projection or behaviors. It didn't for me. Even if it makes them change a specific behavior (such as moving on from, "I'm not crazy, you're crazy) they will just move on to the next thing. It's about perpetuating the chaos.

And here's the thing - they already know they are the ones to blame. They feel a deep sense of shame at the core of their being. They know something's wrong with them. Focusing on that doesn't change the behavior, it makes it worse. It causes their defense mechanisms to kick into overdrive to cover up all that self hate and shame. That's what projection is all about.

My wife essentially accepted a "diagnosis" three years ago. She has been in and out of DBT, is on classic BPD meds, meets 7 of 9 DSM criteria. On a good day, she'll admit it's not my fault and talk about the things she needs to do to get better. But on a bad day, I'm still the one to blame and I still deal with all the same things I did before the diagnosis.

I really hope you continue to see improvement. DBT is great because it does focus on skills versus diagnosis or blame. She is back in now and for the longest time so far. I'm hopeful and this site has helped. I totally understand where you are at - I posted this same thread around diagnosis 3 years ago. Stop letting his projection bother or trigger you - you know it's not you! It's so hard to let that go, but it helps when you do. I forget it all the time, and that's when things get worse for me. Ironically enough it happened today and that's why I'm here.

[Ceruleanblue]

Hegrid: Sorry for your recent hard time. It does seem to cycle. Better times, and bad times. I do know it's not me, but I think the part that bothers me is that HE believes it, or at least seems to. He does seem to have self loathing at times, but he also has lots of arrogant/superior behaviors(huge narcissistic tendencies). I think during the brief self loathing spells, he might realize it's actually him, but then he seems to forget he ever felt that way. If I ever got a sense that BPDh actually really thought it was him, it would be so much easier to take. I do have compassion on him, and he seems super unhappy and miserable, all unnecessarily. It's almost like he enjoys wallowing it misery, and creating it.

I'm really glad for this site too! I sure wish my husband would find a comparable site for those who actually have BPD, or are in DBT. Things are some better, but the only day he seems to remember or do tasks for the DBT is the day he has to attend. Still, it's better than nothing, and I'm hopeful, and grateful for any change. Plus, I'm working on my skills dealing with this too... .

[enlighten me]

This is something I dont understand or agree with. The fact that people are unwilling to label what is wrong.

I feel it would help me if I knew exactly what was wrong. If you had an STD you would want to know which one so you could understand the treatment and its effects. So why with mental health is there this apprehension to label. It smacks to me as a lack of confidence in their diagnosis. I could understand if they put a caveat in such as "it seems like BPD but without knowing more I cant be sure"

I suppose that until there is a physical test such as a brain scan or genetic mapping then this wishy washy approach will remain.

[an0ught]

hegrid had some good observations 

With therapy and us learning skills the situation will improve. But then there are some things that may not - a person may be intrinsically impulsive and some impulses may get a person into a disassociated state. This is true for pwBPD but can also happen with normal people as a result of an external overwhelming event. Therapy will increase the ability to deal with such situations, will increase the ability to steer away from triggers etc... .but life happens. Frequency of events will decrease, severity will decrease and duration will decrease. But smaller things will still happen... .

... .and that smaller happening may well trigger you! "Judgement" is something akin to b&w thinking that has an in-build amplification we have to be aware of. It is an extremely valuable ability but also one that may sustain us being triggered and may turn against us eroding our self esteem. Balancing judgment with compassion for ourselves and others is very important for our healing.

Keep in mind that the next year will be very confusing as different changes work on different time-lines:

Avoiding invalidation - Immediate reduction of triggering events

Validation - Slow, accumulating

Boundaries - Fast after boundary defending and extinction burst, self sustaining, power shifting, relationship repositioning, think teenager, turbulent change with possible some game play aftermath.

Psychoeducation - Early in therapy, psycho-babel, projection and later better ability to navigate own emotions and condition

Throw in BPD intrinsic impulsivity and splitting and it becomes obvious that progress will be anything else than a smooth process. It is well worth monitoring, but it will be very irritating if you focus on it too closely. There will be smaller and big changes. Some may even look as a step backwards. Writing here will give you some track record on what was happening months back and can help you seeing the bigger picture.

[an0ught]

To enlighten   you (and I'm sure others watching this thread thinking similarly)

This is something I dont understand or agree with. The fact that people are unwilling to label what is wrong.

I feel it would help me if I knew exactly what was wrong. If you had an STD you would want to know which one so you could understand the treatment and its effects. So why with mental health is there this apprehension to label. It smacks to me as a lack of confidence in their diagnosis. I could understand if they put a caveat in such as "it seems like BPD but without knowing more I cant be sure"

your analogy is interesting so let's build on it: What if the bacteria causing your STD are intelligent? What if you getting a lecture on antibiotics will increase their ability to resist the medicine?

The challenge with therapy in general is often to overcome the minds defense mechanisms. Before DBT the treatment of BPD was seen as mostly hopeless. The breakthrough in BPD therapy with DBT was possible as DBT moved away from talk analysis and focused on relationship building and validation of the patient as a first step to skill building. Labels tend to be strongly invalidating and get in the way of laying the groundwork for therapy. This is especially true for BPD which may be described as a condition driven by invalidation (pwBPD invalidates others, others invalidate pwBPD, slowly the whole environment becomes invalidating and boom).

Yes, it is definitely counter intuitive but the track record of DBT in large long term studies is empirical evidence that the approach is effective.

[enlighten me]

So maybe a different approach is needed. You dont tell a cancer patient that theyve got cancer so might as well say goodbye now.

The stigma associated with BPD isnt as great as people make out. I had never heard of it before splitting with my exgf. If you had said psycopath i would have run a mile but boderline wouldnt have even registered. Its only because the majority of us hear have had awful experiences that we paint BPD as black and that theres no hope for them.

[hegrid]

So maybe a different approach is needed. You dont tell a cancer patient that theyve got cancer so might as well say goodbye now.

Where the cancer analogy works with BPD is that it is an illness, not something they choose. They are a victim too. Like cancer, they must be responsible for taking their treatment seriously and even that is no guarantee of recovery.

Where is doesn't work is there isn't a MRI that will pinpoint where the BPD tumor is, how intertwined it is with other conditions, and no blood test that tells you what medications might target those cells. BPD is a spectrum of behaviors that are subjectively classified into a a diagnosis by professionals often relying on self reported data from a non-cooperative person they see one hour a week - or month. That's imperfect. It's also why a BPD "diagnosis" is not equivalent to one for cancer or an STD. We are still effectively in the early 1900s compared to internal medicine.

The stigma associated with BPD isnt as great as people make out. I had never heard of it before splitting with my exgf. If you had said psycopath i would have run a mile but boderline wouldnt have even registered. Its only because the majority of us hear have had awful experiences that we paint BPD as black and that theres no hope for them.

Maybe this is a generational thing. Popular culture, movies like Fatal Attraction didn't help. It's definitely something I wasn't well versed in but knew was bad. It certainly needs a new label. The term "borderline" is quite meaningless in how we understand the spectrum today. I like Emotional Regulation Disorder better. What you call something has a lot of impact on the stigma and how people react to it and there needs to be more of a push to change the term  from BPD. It's just ingrained.

[formflier]

 

I would encourage everyone to focus less on "labels" and more on "behavior".

The thought is reasonable that a label might help focus him more on T.  It's also just as reasonable to think that he can overcome "traits"... .but a full blown diagnosis is hopeless... .so why try. 

There are so many ways to look at it... .I'm sure many more can be listed.

Behaviors to focus on ... .and try to keep momentum going.

Less or no divorce threats!   

He is going to DBT... .and going to a P! 

Recovery is not going to be a straight line... .few steps forward... .couple back... .more forward.

The key is for the emotionally healthy one in the r/s to have the long view... .to stay supportive... .and try to keep redirecting back towards the path to healthy.

Yes... .I realize that a partner getting a diagnosis is a validation of ourselves... .that we are not the issue... .they are.

Let me tell you a different story... .a story that helped me have compassion for my wife and her condition.

So... .I have PTSD (service connected)... .it's a frustrating thing to deal with... .something I will work on (most likely) for rest of my life.  I wish I didn't have it... .but it is... .what it is.  I'm open about it with the appropriate people.

Anyway... .in family T (after my wife got evaluated and diagnosed)... .she started in on me being the problem... .blaming and all that.  Family T shut her down quick... .and said "FF wife... .I thought we settled the question of is anything wrong with you during the evaluations... ." 

In other words... .he was reopening the lecture about two people in a r/s... .each with issues... .each need to work on own issues... .

In that moment... .she looked very sad... .I could see some fear in her face... .

All the thoughts that I had of "yeah!  I knew it was her... ."  had melted away... .

So... .I really encourage people to focus on behavior... .less on diagnosis.

FF

[Ceruleanblue]

Yes, I've told BPDh many times that I'm not concerned with what the label is, that it is the behaviors that I'm worried about. I don't think he did it for me, but he might say that, I think he got help because on some level(only part of the time), he had thoughts that it was his behaviors, and they'd caused a lot of trouble in his life. He had one moment where he acted shameful, and said "I just thought my ex was crazy, I thought it was all HER". Well, what made this more confusing, is his ex is sort of "crazy", because she hit BPDh with a hammer in his sleep, and stabbed him once, and cut him badly another time, among other incidences. He admits now that, the physical stuff went both ways though, but he never went to extremes like she did. I think he was able to discount the things HE did, because she acted so outrageously. When he married me, and I wasn't cutting him with knives, and I was trying so hard to not be codependent, and for us both to be healthy, I think  he came to see some of his behaviors were just not okay.

To me, diagnosis or labels no longer matter. It's the effort toward change, and knowing that we are on a journey together, and we both have things to learn. I do see some progress, and I am just so thankful for that. Today, my BPDh came home for lunch, just to apologize for breaking a promise to me yesterday(he'd agreed 6 months ago to not tell me to "F" off), and for the first time, his apology was well thought out, sincere, and I could tell he meant it. That he actually felt regret, which was something I thought he couldn't feel in regards to me. My BPDh is high functioning, but at home, I feel his BPD behaviors are pretty extreme, and have been since he first started to let me see them. I'm just glad that he's trying, and that I am seeing some progress, no matter how small. It's something to build on.

I'm learning too, and I'm sure I'll continue to have to adjust to things as he goes through this DBT. I wish there was a program for those with BPD family members, sort of like there is for alcoholics. This board is great for that though.

[formflier]

and for the first time, his apology was well thought out, sincere, and I could tell he meant it. 

I got an apology the other day as well... .

Felt good!