Good point.



Another good point you are making here, thanks for sharing. 

Take care.

Chief,


Getting your wife into individual therapy is a great idea.  I do like Dr. Phil's suggested approach, even though I did not have to do this, as it was our first long-term recent therapist that suggested this to my wife, and she followed her suggestion on this.

From what I have read, and discussed with my individual therapist, most therapists do not want to diagnose, as it will more likely they do not want to chase the pwBPD away once they learn the amount of therapy and work that is involved as many T's say BPD is not curable - from what I have learned it can be put into remission, and from what I have seen of my daughter's AN with similar pathology, it can be put into really deep remission to the point where it can be considered cured.  My wife was already a little bit self-aware of her issues, and I was able to have her focus on them by discussing the fallout of what I knew that she knew from actively listening and/or her journals and eventually expand to all of the areas over a period of two years.

Also many of the symptoms of BPD are present in varying degrees with Bipolar, HPD, NPD, MDD, GAD, Substance abuse disorders (C)PTSD and possibly others too - My wife says she is diagnosed for MDD & GAD which is the most common misdiagnosis combination for BPD according to my therapist and the SWOE book too.  When going through the manual, I looked up the symptoms to all of these different mental health conditions and had to discern what is the best fit.  For my wife BPD, was a perfect fit of all 9 (even though 5 or more are needed to be present and must have begun by early adulthood and possibly even adolescence).  I also looked at Bipolar and the other issues too, while there was a bit of overlap, those were not good fits.  I did explain to other PD's, and surprisingly she also matches 8/8 symptoms of OCPD which is a cluster "C" vs the "B" for BPD.

For the sole exception my wife had all of the symptoms of BPD except one - self-mutilation - and all of the "OR" statements could be changed to "AND" for my wife.  It was pretty close to a perfect symptom set and had the best match for my wife.   Since BPD can present in so many different ways, and the pwBPD can suppress their emotional dysregulation with those that they are not intimately involved with, it is easy to hide, and makes the licensed professional's job that much harder to diagnose.  When comorbidities are mixed in, this compounds the difficulty in diagnosing.  While I do fault the first couple's therapist for botching her response to my wife's most suicide attempt to be sent to the hospital for an evaluation that never happened.  Therapists are people too, and can only work with the information that they see in front of them.  They do know there are different perspectives, and it can be impossible to discern which perspective is correct and which one isn't, as both people believe their side. 

If I took a straight forward approach, that often didn't work with the therapist.  I had to use prompting questions, so my wife could tell her side of the story, and then I would ask questions around areas where my wife had a different perspective, and I would offer up clarifying statements non-accusatory "I" statements.  For example, if she accused me of not doing the dishes, I would have to ask her - who loaded the dishes into the dishwasher.  Who filled the pan with water so the water could help dissolve the food prior to washing it.  More often than not these statements were contradictory - the T eventually caught on, but continued to validate how my wife felt about it.

I will share with you how I knew if our couple's T caught on to the "BPD" bit...

The first one, on the last two scheduled sessions, she would ask my wife at the beginning of the sessions, "on a scale of 1 to 10, how are you feeling right now" - she did not ask me that question - it was very one sided.  This  shows she is gauging how triggered my wife was at the moment, and adjusting the session accordingly.

For the most recent one, she would take copious quantities of notes, and was very animated to the point I could not miss it when she did this, whenever a new symptom was exhibited or admitted to.

I would also read up on how to treat these symptoms from articles / books - and if the therapist was doing this, then it is a pretty safe assumption that the therapist has caught on.  However, be mindful that many of the methods can be used for other things.  Take for instance DBT was originally used for BPD; however, today, it can be used in treating many issues. 

So discerning if your T has caught on to BPD, at best it is as I described above, and can be a lot more nebulous.


I had to take it slow (I felt it was too slow, but in reality it was too fast at times).  In my particular situation, my wife had to figure out herself, that others perceived her as a monster by cowering in her presence.  I will share how I prioritized the symptoms, from easiest to recognize to hardest recognize:

1.  Repeated suicidal behavior and/or gestures or threats or self-mutilation
2.  Inappropriately intense anger or problems controlling anger
3.  Impulsivity in ≥ 2 areas that could harm themselves (eg, unsafe sex, binge eating, reckless driving)
4.  Rapid changes in mood, lasting usually only a few hours and rarely more than a few days
5.  Desperate efforts to avoid abandonment (actual or imagined)
6.  Persistent feelings of emptiness  **[just ask, and perhaps use this one to start the Dr. Phil dialog]**
7.  Unstable, intense relationships that alternate between idealizing and devaluing the other person
8.  An unstable self-image or sense of self
9.  Temporary paranoid thoughts or severe dissociative symptoms triggered by stress

After 1 & 2 were addressed, I focused on 3-8, whatever seemed to be the issue of the week is where I focused, I picked an area that my wife could describe as it was recent.  9 I found to be the most difficult to address, as dealing with dissociation, where my wife would genuinely not remember issues makes it difficult to address if the reality is simply not in their mind.

1 & 2 were comparatively easy to address, boundaries were put into place by the therapist as the real life consequences were set by the couple's therapist.  The other ones I had to set the boundaries, and it was difficult and contentious, but it eventually worked itself out with a lot of work on both my side, her side, with good communication.

I am going to wrap this up, for now, focused on 1 & 2 for you.  How does your therapist deal with you and your wife, when she exhibits "Repeated suicidal behavior and/or gestures or threats or self-mutilation"  AND "Inappropriately intense anger or problems controlling anger" since you mentioned that she has all symptoms.  I am very curious on how your wife manifests these two symptoms, and what kind of response is observed from the therapists?

Take care.

KD,

This is a bit dated, but might help.

COMPARISON: PTSD vs BPD

My mom confessed to me in about 2018 that she had been diagnosed with PTSD and had been going to counseling since around 1980. My first thought was, "did it help? If so or not, why my childhood???" She also told me at the time that she thought she had BPD. I'm 52.

Whether CPTSD or BPD (or others), these are deep seated personality issues.

This is delusional thinking, but it telegraphs the deep feelings from a pwBPD who lacks self worth and thinks she (or he) is unworthy of being loved. I'd suggest sex therapy, but that takes two committed partners. What if you suggest it though?

This I think is a form of sexual abuse. Imagine you told a women after sex her vagina felt odd, or was too dry or too moist, or disn't she enjoy it because of how her vagina was. Something she would have little cotrol over. At the minimum its cruel and emotionally abusive and you dont deserve this.

I’ve been reflecting some on events in my relationship with my BPD ex. Not sure if it's helpful or wise, but I decided I’d write about the last half of our relationship. Part of why the breakup felt so painful was because it came at a point of real hope.

Twelve years before the end of our relationship, we briefly broke up (she broke up with me). It was painful, but not nearly as painful as our final breakup.

Not long after that initial breakup, her brother (her only full sibling) committed suicide. He would also have qualified for a diagnosis of BPD. His death was devastating for my ex, and I was extremely supportive. She really appreciated that, and we got back together.

For many years in our relationship, I felt ambivalence about being in the relationship. About every couple weeks, we’d end up in a severe fight, and she’d say she was ending our relationship. That left me anxious about it and interfered with my attachment – I was always kind of ready for it to end. And the difficulties of dealing with all her BPD symptoms also contributed to my ambivalence. But about 5-7 years before the end, I somehow decided to fully trust her, and to allow myself to fully attach to her, at depth. In part, I thought that we’d remained together so long, despite all her threats to end the relationship, and so I could trust that she wouldn’t actually leave me. And she has a lot of wonderful qualities. So I accepted how she was, and essentially came to a place of mature love, and chose that this is the relationship I would be in for the remainder of my life. Not as a default, but as something I actively chose. And my heart opened further to her.

A few years into the relationship, we had tried couples therapy. Then she dropped out, stating that the therapist was blaming her for everything. That wasn’t at all true, but like many people with BPD, she couldn’t tolerate anything that could be interpreted as criticism or rejection. Over the last decade of our relationship, I repeatedly begged her to come to couples therapy with me. There were huge problems in our relationship, and we clearly couldn’t rectify then just by ourselves. But she would always refuse.

And I also brought my own problems to the relationship. It’s not that the only issues were her BPD. I grew up with a lot of trauma in my childhood, and qualify for a diagnosis of complex PTSD. I dealt with pain using “flight” tactics – that included numbing out and dissociating to avoid pain, as well as using avoidant behaviors and detached self-soothing behaviors. One manifestation of all this was that I’d get obsessively involved in different projects. So much of my time was unavailable, and I was often emotionally unavailable. For much of the last decade of our relationship, I was obsessively involved in police reform, after an unarmed neighbor of ours was shot and killed by a police officer in a completely unjustified shooting. But early in the year that our relationship ended, I resigned from the police reform organization that I had helped cofound, and that allowed me much more time and emotional availability.

I also suffer from a physical syndrome that doctors couldn’t diagnose and that left me in a constant state of severe, painful fatigue (and brain fog). I had to drive myself through the fatigue to accomplish anything, and it made me much less fun to be around. My ex would complain that every time I saw her, the first thing I would say is how exhausted I felt (and that’s basically true). The problem had been ongoing for a decade, and kept gradually growing worse. And given the complex PTSD, I would often numb out to cope with the pain of the fatigue (but I did so at the cost of emotional availability). Doctors had tried to figure out what was causing it, running lots of tests, but to no avail. I’m a scientist with biomedical background, and I finally decided that I couldn’t live this way, so I set out to diagnose myself. And I succeeded in doing so – I had a mast cell disease. Subsequent medical tests confirmed that that was the correct diagnosis. And it could be treated with meds – reducing the symptoms by >90%. So I was no longer in constant, painful fatigue.

In addition, early in 2020, my ex and I began to take regular long weekly hikes in beautiful natural areas. We both loved doing this, and it began to restore our relationship, in almost a miraculous way. I began telling friends that this relationship, that I’d often been despondent about, had finally turned around.

My ex is a voracious reader, especially of novels. And we began reading to each other – something that we hadn’t done since the beginning of our relationship, 25 years ago.

We also had long been financially insecure. She didn’t handle financial stuff well, and I was often not working in a paid position (I was just patching together income here and there), so as to have time to carry out volunteer work. But by early 2021, I was in a well-paid job, with ample vacation time, and we finally had the time and financial means to go on vacations (which is something she really wanted, but that we hadn’t done in years).

So, in our relationship, there was such a sense of hope at that point, at least for me.

Then our son (my stepson) became addicted to meth. He rapidly became suicidal and homeless. There were recurrent life-threatening situations. The stress was overwhelming. I did everything I could to help. But given the stress and her BPD, my ex couldn’t cope. One of her responses was to split me black to a degree that she’d never done before. Even now, she doesn’t realize how irrational her thinking around this was. It was 100% undeserved. Then two days later, our beloved cat died. And within a month, my uncle was dying, and I flew to another state to take care of him, so he could die at home with hospice. Meanwhile, the NPD guy showed up and began pursuing and love-bombing my ex, and when she had difficulty finding a therapist, he offered to act as her therapist. And so ended our relationship.

With roommates it would cost at least $1500 a month, just for a room.  And then all the other expenses...  Renting a second place to live in NYC (where we live) is not a possibility.

She hasn't finished HS yet either. She wasn't loving and close to me at 15.  We haven't been close since she was 10.  Even before then she was diagnosed with Oppositional Defiant Disorder.  It isn't as if one didn't try to set boundaries with her.  Except what that meant is her responding as another poster mentioned, punishing us 10x worse.

This is the last push. I WILL be moving overseas and if she's still in this state... well I hate to be callous about it, but that's her problem.  I can bring the horse to water, but I can't make it drink.  If she wants to go around with untreated BPD and abuse me, doing things that if she really took responsibility for them, she knows is wrong, then I have a right to live my own life free of abuse, even if it is my own child.

But I am not there yet. I am desperately trying to hold on until she decides to get treatment. Hoping we can get there. It doesn't help that her father, who has his own anger issues sides with her on almost everything. He draws the line when she hits me, but usually comes at me "Well you must have done something."  Yeah, I did something. I shifted my weight because my feet were hurting.

Sorry - there was more but it didn’t post.

In all seriousness - I’m sorry that you are having to endure this.  It sounds cruel and malicious and you shouldn’t have to experience that. No one should.  It makes me wonder if your wife had some kind traumatic event happen to her sexually. I feel bad about that - but I feel worse for you.

Well - at least you’re having sex.   After reading your post I’m now thankful that I’m not.

Hi SD-
 
I realize that my phrasing it as extreme emotionalism was definitely the wrong thing to do. It was taken as an attack - even though I told her I wasn’t saying it to attack her.  I listened to a pretty good podcast by Dr. Phil on BPD and he recommended taking a different approach that I am going to try.  He said that you should say something like - “I see that you are really depressed (anxious, hurt, etc). I think you owe it to yourself to get into therapy. You don’t deserve to live like this and getting into therapy might help you.”  I liked that and we’ll see how that goes.

We are currently in couples therapy but all we are really working on is communication (which I admit I need to help on). It’s been very helpful to me but weather or not my counselor has picked up on my wife’s BPD yet I don’t know. 

I’m really more focused on her getting individual therapy at this point.  I have a counselor I’ve been seeing for about a year but in all honesty I don’t think she understands BPD and often tells me that since she doesn’t have an official diagnosis I shouldn’t assume she has it.  She sounds much like your counselor.  Well - she meets all the 9 characteristics and I truly believe she has it. I’ve sometimes tried to talk myself out of believing it - and then another episode happens and I’m like - she’d definitely got it.