How does somebody even get diagnosed with BPD?

[Slartibartfast]

My wife sees a few therapists, and has since I've known her, I have this to be grateful for. She does bring up her sessions with me occasionally, but I've never heard the actual BPD diagnosis come up. What I have read is that some therapists won't share a BPD diagnosis with their patient because it can undermine therapy. How much of this is true? Where do BPD diagnoses come from when they do come?

Make no mistake, everything on this group resonates like a thunderclap with me, and I'm glad I'm here. I'm just so crispy around the edges, burned out, bullied and wasted, and sometimes I really feel resentful, because "for Christ's sake I didn't do anything!" and then we go right in to the danger zone when I speak up. I need to stop doing that.  But I read a lot about acceptance. But what's the trick of accepting and not sabotaging your entire self esteem and how do you do it without looking like a total and complete robot?

Also, how do I avoid accepting blame for how she feels? It just happens that I'll stupidly take responsibility for XYZ because I think she'll back down because she gets her way and I validate her feelings by saying "Yes you're right I'm a terrible husband" but...I just feel it's a trap that gets set for me and I walk in to it hoping to get a half hour of peace.  I'm not good at this. I need help, I need coaching.

I have two little girls, 4 and 7 and she's starting to get nasty with the 7 year old, on top of statements like "I just don't like that kid." "She's just not that smart." "I think she had a hypoxic brain injury."  The 7 year old will say a 7 year old thing like "You never get me any toys" or whatever, to which Mom will begin the attack and won't stop until the kid feels horrible. It's just started in the past few months, I hope it passes, but if it doesn't...oh boy...  I don't even want to think about separating, the kids would get eaten alive I fear. They're both good kids, although the little one has a temper that's really something else.  I'm just all bald tires and another 100,000 miles to go.

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[khibomsis]

  slartibartifast, and welcome to the family! Hold on to your towel, and grab some peanuts, it may be a rough ride but you will get there  
I think for starters, have a look at the Lessons section above these messages. Radical acceptance means if it looks like a duck and quacks like a duck, accept that it is a duck and will always behave like one. Whether you feel good about it or bad about it, it is still a duck. Its essential duckly nature is not about you, it just is. RA is about you not driving yourself crazy thinking that you are married to an eagle. I found it extremely liberating.  Here's the official lesson to get you started: https://bpdfamily.com/message_board/index.php?topic=89910.0
Let us know if you feel better applying this tool?

It is not a politically correct thing to say, but I am convinced that many pwBPD get triggered by their own children. Have seen no research to this effect but it seems to me from reading these boards that the birth of a child is often the trigger to worse deregulation. I suspect that some of them begin to relive their own traumatic childhood and want to be re-mothered and so they get excessively needy. Certainly my own uNBPD mother was jealous of my relationship with my father and I learnt very young it was something that must be suppressed in her presence. In her 60's she grew more accepting, or were we more assertive maybe?
What I would suggest is to get your daughters and yourself into therapy. They will cope better if they have that support from an early age, and this could be a pathway to inviting your wife also to therapy sessions, saying that you need it for your own sanity and you would greatly appreciate her support. My therapist diagnosed my mom based on my stories, and that is the way many people get diagnosed here.

[khibomsis]

Meant to add that some therapists are not skilled at BPD and many people go through years of misdiagnosis and incorrect treatment. It is like chronic fatigue syndrome in that sense.
Others know it is BPD but prefer to diagnose PTSD for insurance purposes. Why? Because many are the therapists who have been sued for malpractice when their BPD client splits them black. Back in the bad old days, many would refuse to treat BPD clients for this reason. Hopefully that is happening less and less!
That is why I would suggest family therapy for you and your daughters is a better option. There is no point in worrying about your wife's therapy because there is almost nothing you can do about it, and the downside risk is huge. At the moment it is her safe space and tampering with that, as in possibly enquiring about the therapist's qualifications to treat BPD, might cause worse problems than it solves.

[maxsterling]

I can certainly relate to where you are coming from.  My W gets mad at the kids, and that boils over to me.  She blames me for her getting mad at the kids.  That absolutely destroys me.

And like you, I have often accepted blame for things or validated the invalid as an attempt to end the rage, for my sake and the kids' sake.  Not healthy at all, but it's a natural defensive reflex that is sometimes difficult to stop.  Example from my case:  W will complain about having to clean off "that shelf" for 10 minutes that I have ZERO control over, passive aggressively blaming me for the shelf being messy.  I don't even know what shelf she is talking about.  When I ask her what shelf she is talking about, she rages and curses at me for arguing.  After I *finally* get out of her what shelf she is talking about, I realize that the mess on the shelf is not mine.  What to do now?  I say, "I'm sorry you have to clean up my messes, I will do better at cleaning up messes next time."  I try to make it general so that technically I am not talking about *that* mess so that I feel a little better about my reply, but if I don't acknowledge that I made a mess (even though I didn't in this case), W will likely become violent.

As to your Diagnosis question - I described my therapist for 20 minutes and she immediately said it sounded like my W has BPD.  That tells me that any competent T will quickly recognize symptoms, although pwBPD are great at deception.  In the USA, people are often given diagnoses in order to get insurance to pick up costs.  Bipolar, Depression, or PTSD diagnoses tend to get insurance to pay for more.  For example, with a BPD code, insurance won't pay for Ws TMS therapy, but a Major Depressive Disorder diagnosis will. 

My W was originally diagnosed Bipolar as a teenager after she was hospitalized for self-harm, suicide, and drug abuse issues.  This would have been early 1990s.  She was treated as Bipolar for about the next 10 years while her life continued to spiral out of control.  My understanding is that the BPD diagnosis came after another suicide attempt and months-long hospitalization in her mid 20s.  She went through intensive DBT therapy and managed to scrape together a relatively (by her standard) stable life for the next 10 years.  After I met her, she was hospitalized again for suicide ideation, in which she was re-diagnosed Bipolar and was given meds.  Thinking back, I think that diagnosis was to satisfy an insurance requirement and allow insurance to cover certain meds.  She has also been given a PTSD diagnosis - but my feeling is that is not an either/or with BPD.  W clearly has PTSD issues, but the BPD is quite apparent (she easily meets all the DSM criteria).