BPDFamily.com

Hello,

Throughout our relationship my wife has demonstrated that she was incredibly empathetic, compassionate, and conscientious. However as our relationship progressed I noticed there were times where she essentially had zero self awareness on how her own actions contributed to some of the painful situations she encountered. This was very, very confusing and I had no clue what was going on. Earlier this year I randomly stumbled upon the wikipedia page for BPD after seeing an article about it.  A big blurry picture snapped into clear focus. My jaw was literally on my desk. I could write a novel about how I saw the symptoms come out over time but wanted to be concise. If you need more info here just ask and I can expand.

Right after I saw that wikipedia page I suggested that she start seeing a therapist trained in DBT to see if there was anything to it. She refused, so I started going myself at the beginning of the year. It has been very helpful for me and I've learned a lot. My therapist has not met my wife, but based on some long texts from my wife she believes that my wife would benefit from DBT.

Unfortunately my wife's symptoms have been deteriorating over the past 12-18 months. She finally agreed to get treatment and had her first pre-DBT session last week. However later that week she got into a blowout argument with both parents that progressed to a physical fight with her dad that resulted in her being involuntarily committed. She was very lucky that law enforcement saw it as a medical issue and not a criminal issue. This is the first time anything like that has happened.

This incident has made her more open to treatment. While she was on her hold she agreed to a residential inpatient. I wanted to coordinate that with the therapist that she had just started seeing, however she had not signed a release so I couldn't speak to her. Her parents wanted her to go immediately. I had two places that marketed themselves as treating BPD, and one was listed on behavioraltech.org. However neither of those places had room for her immediately after her release. The non DBT certified place anticipated an open bed within a day or two. The place with full DBT did not provide any firm timeline, but said it would be relatively soon. 

This delay was unacceptable for her parents. They wanted her to go into treatment ASAP. I told them to wait until she saw her therapist or until space opened up at a place specifically for emotional disregulation. Instead they went ahead and paid for an incredibly expensive drug and alcohol rehab that, to be blunt, does not provide evidence based treatment. And while I do feel that she did not have a healthy relationship with alcohol and that her drinking was getting worse, she is not a full blown alcoholic, though it was clearly going that route and was mere months away. Her dad has been to this facility a handful of times for alcohol detox.

While she was on hold I shared with her parents that I suspect she has BPD for the first time. Both of her parents were not buying it at first. However her mom is active in drug and alcohol recovery communities and reached out to some of her friends. After she spoke to a couple friends with BPD in their families that she appeared to be pretty on board with my suspicions, however she also wanted her to get into treatment ASAP.

What is particularly frustrating for me is that her dad completely railroaded any plans I had and completely negated any input from me because the places I wanted her to go did not have immediate space for her. I wanted her to see her DBT therapist prior to dropping her off at the rehab. He said to both me and her stated that seeing her DBT therapist prior to dropping her off at the drug/alcohol rehab would be a waste of money and was not concerned that it would prevent her from getting treatment after she left inpatient. And this statement was echoed several times by him the 24 hours she was at home. Given the time, money, and effort I have spent, this was incredibly frustrating and (surprise surprise) invalidating. Her own therapist was actually pretty cautious about inpatient treatment in the first place, however I did not share that with her own parents - nor would that have mattered.

Even worse is that because she will miss the rest of her pre-DBT appointments, she will not be able to go back to that therapist or anyone in her group for about two months. There are no exceptions to this rule, which I don't like but I understand. Luckily there are other DBT options in our area, however they are less convenient  and would require about an hour and a half round trip of driving time for her to get to appointments. Given that she is a workaholic (currently her healthiest coping mechanism) this may get in the way of treatment.

And I have more concerns. Her dad believes that she is bipolar. Like me, her dad is not a mental health professional. However I have had several friends with bipolar disorder and have seen them in manic states. I have never seen anything from her that reminded me of my friends with bipolar disorder. That doesn't mean she is not bipolar, but I'm pretty skeptical. My concern is that with the poor boundaries demonstrated by her father already, he is essentially going to tell the rehab that she is bipolar and that they will ignore their own medical judgment in favor of $$$ and give her the diagnosis that he wants - this has happened before with a prior psychiatrist. I told her to not sign a HIPAA release for her father and the rehab facility, but she did it anyway. 

Normally this is something that I'd talk to my therapist about, but unfortunately I can't see her in person for 3 weeks because of mutual scheduling issues, and she is unavailable for phone through this week.

The whole situation starting with the involuntary commitment was tough. But I was coping and was able to be supportive and had relatively normal functioning in terms of focus at work, etc. But the issue or dispute with her parents have really thrown me for a loop. I'm trying to be supportive of her and get an attitude to make the best of the current situation, but it's hard given my skepticism of her current treatment center. She seems to be enjoying her time there, which isn't surprising because it's basically a 5 star hotel with aggressively attentive staff and a couple of therapists wandering around. 

Does anyone have any feedback here? Should I speak to them regarding their expectations for treatment? Should I share that I don't think her "anger issues" will go away once she comes back? 

That sounds like a VERY enmeshed family with few too boundaries.

Her father is stepping all over your role as spouse.

What level of contact and I formation can you provide to her current rehab facility regarding your thoughts on BPD vs. Bi-Polar?

She signed all of the releases that allow the current facility to talk to me. So I could call them right now if I wanted.

I'm not sure if I'm going to tell them though.  If the current facility comes back and tells him that she doesn't have bi polar disorder, I think he may drop it. May be wishful thinking though, which is part of the reason why I'm posting here for feedback.

For what it's worth, after the involuntary hold my wife said something to the effect of "I don't know if I have BPD or not, but I do think some of the stuff you learn in DBT would be really helpful". This was a marked change even from before the hold, and part of why I'm so frustrated. It's been a pretty difficult road to get to this point with her.

edit: The day I got her out, her attitude on treatment was "well I don't have a choice". I told her she has a choice, just not a very good one. After waking up the next day feeling rage towards her parents it was a "ok what do I have to do to stop feeling like this". This is the most willingness that I have ever seen from her.

That is encouraging. She does not seem to be resisting treatment.

Can you speak with someone at the rehab facility and, without discussing any diagnoses, communicate that DBT has been recommended several times?

Howdy,

Welcome to bpdfamily. I was very touched by your description of when you discovered BPD, I refer to it as me discovering the enigma machine but I like your analogy of the blur coming into sharp focus.

In many respects it's great that your partner has been able to get into formalised therapy. It sounds like you handled the 'choice' question superbly. Often therapy is ineffective when an individual feels like they are just going through the motions to placate someone, you reinforced (even if she didn't listen) that she does have choices, it's just that they aren't great ones now.

I'm not experienced at all with residential care and formal therapy, however, from a rational stand point my starting assumption would be that these hospitals and their staff see many many people with a range of disorders. Using their own observations and experience will they not come up with their own assessment of her disorder rather than look to parental diagnosis from armchair psychologists... especially one whom has issues with drinking and has been in the facility before, he hardly makes for the most stable impartial observer.

Look forward to hearing more about your journey.

Enabler