questions about mother's Cluster B Personality Disorder Diagnosis

[Person_Today]

My mom was in a bhu and they diagnosed her with a Cluster B Personality Disorder.

I looked up these disorders, and right away I see that some of the symptoms listed seem descriptive, but others don't, mostly related to Borderline and Histrionic.

The main issue is that my mother isn't rageful or angry, and it seems like when I read different stories of BPD, that seems like a defining characteristic.

Also, a big thing for me is that the articles, etc, talk about the personality disorders being pervasive and long-term.

The thing about my mom is that while she has had at least one episode that lasted 2-3 years about 30 years ago, for twenty years at a time, she does not have symptoms of personality disorder.

The episode she is now basically started in the fall, lasted for a few months, but then she recovered for a few months, but then it started up again at the end of March.

I don't know anything about personality disorders. Because she had so many years where she had a non-disordered life: good relationships with friends and family, steady job, active in the community, etc, I have a hard time swallowing the diagnosis.

The main symptoms she has now is extreme, debilitating anxiety, talking about hurting herself a lot (docs at the bhu and at her local hospital all say that it is attention seeking behavior and "hysterical response), lots of attention seeking behavior in general. Extreme fear of being alone. Excessive concern with physical appearance. Strong opinions about how terrible her life is and about all the terrible mistakes she's made, even though the doctors have said the exact opposite of what she believes. She doesn't talk about anything except her pain and mistakes.

It's hard to describe, and I may need to try to write something up differently.

(My own therapist recommended I call the bhu back to ask more specifically which disorder cluster b disorder, so I plan to do that.)

I've been unheard lately by my own therapist and my gf, who's sister had BPD and other disorders, because anytime I try to mention that I can't quite agree with the PD diagnosis  because of the time issue,and the fact that none of them seem to exaclty fit etc they push on me hard to just swallow it. So I'm seeking some support here and a place to just ask questions about other people's experiences. Has anybody else had a similar experience?

[Harri]

Hi Person_Today and welcome to the board.  It is great that you are searching for your own answers.  It must be very confusing to you since she does not seem to fit any category.  

Honestly, I am not sure what it means that the people in the behavioral health unit did not diagnose her with a specific personality disorder.  I have heard of Personality Disorder not otherwise specified but again I do not want to steer you wrong.  Calling the BHU is a good idea.  You can also try posting on our Library: Psychology questions and answers board.  We have a lot of very sharp minds who may be able to better guide you.  

One thing I do want to mention is that not all people with BPD (pwBPD) exhibit rage as a central behavior.  Some will turn that anger inward and are sometimes referred to as quiet borderlines or inward acting.  I do not know if that fits your mother better or not but I did want to mention it.

Have you talked to your T and your girlfriend about how their response is less than helpful?  In the meantime, I hope you feel free to hang around so we can support you through this as you search for answers and understanding. 

[No-One]

Hi Person_Today:
I'd like to join Harri in welcoming you to the Community.  I'm very sorry about the problems with your mom.

A diagnosis is subjective.  Many members indicate that their person with BPD traits has had various diagnoses over the years.  BPD doesn't stand alone and typically people who get a BPD diagnosis have a combination of mental health issues (i.e. anxiety, depression, bipolar, ADHD, OCD and/or various others).  

I've come to look at BPD in this way.  When someone has mental health issues that aren't successfully managed, they can evolve into exhibiting enough BPD traits to gain a diagnosis of BPD or other Cluster B mental health labels.  Most people will exhibit some degree of various BPD traits during their lifetime (especially people with low emotional intelligence, and a lack of coping skills).  

During stressful life events, people are more apt to display a higher degree of BPD traits.  Some people might be classified as being either a low-functioning or  high-functions BPD.  Some people with BPD are considered a "Waif" subclass and tend to be a quiet version of BPD.

There isn't one pill to treat BPD.  Generally, you need to treat the unique symptoms/behavioral issues that a specific person has.  If they are anxious and depressed, some meds to address those issues is indicated.  Also, DBT or cognative-type therapy can be helpful, with a focus on learning distress tollerance/coping skills and ways to manage anxiety and depression.

My suggestion would be to NOT get hung up on a label, such as BPD or Cluster "B" disorder.  Labels are subjective.  Focus on dealing with managing her behaviors.  Manage the anxiety, manage the depression and whatever other undesirable behaviors she exhibits.

I think it's possible that people who are high-functioning BPD (with the lowest categories of traits) can technically gain and lose the BPD diagnosis during their lifetime.  Stressful life events can push them into the BPD category.  When life is calmer and/or they are using coping skills and their anxiety and/or depression or other mental health issues are well managed, they might technically not have the number of behaviors that qualify for the BPD label.

There are a lot of great communication skills and strategies you can learn about on this website.  You can't change your mother, but you can manage the way you interact with her and react to her. You can set boundaries that can make things better for you (regarding things that you have control over).

If you go to the "Tools" menu, within the large green band at the top of the page, you will find some links to helpful information.

[Harri]

Hi again.  No-One, as usual, makes a whole lot of sense.  She is one of those sharp minds I mentioned earlier.   So yeah, what she said. 

I've come to look at BPD in this way.  When someone has mental health issues that aren't successfully managed, they can evolve into exhibiting enough BPD traits to gain a diagnosis of BPD or other Cluster B mental health labels.  Most people will exhibit some degree of various BPD traits during their lifetime (especially people with low emotional intelligence, and a lack of coping skills).

I have never heard it explained in such a concise way before.  It makes sense.

[Person_Today]

Thank you both for hearing me and for your comments and support. I appreciate your insights. I think this is a good place. I had a long talk with my aunt today and I was able to share with her some of what I read here. I feel like the comments and materials here will help me figure out how to move forward with my relationship with my mom as she struggles along. Thank you again.

[Person_Today]

In the past couple weeks in particular, when I talk to my mom, I have found myself at times giving feedback to her like I would to somebody in my therapy group.

It feels like a healthy distance. Because with people in my group, I don't feel responsible for what they do. I don't feel responsible to fix them. My responsibility as a member of the group is to respond to them honestly. When the group is over, everybody leaves and lives their own life.

Other times, I get triggered.

Sometimes I get angry at her because she refuses to want to get better or she insists on holding onto the most obviously wrong beliefs about herself and her issues.

Sometimes I get angry with her because she doesn't understand why I'm upset about her casually talking about her hurting herself so I won't leave when I'm visiting her.

Or because she's flip flopping on several different medicines every other week for months at a time.

Sometimes I feel guilty for not traveling to her and being with her because I know it would comfort her to have me there.

Or I feel like because we're family I should be sacrificing more than I am to take care of her.

I struggle with knowing how much time I should put into things like making phone calls to help organize more professional in-home support people for her. She has chronic pain issues and with her high level of symptoms she gets balance issues, she doesn't pick stuff up off the floor and she doesn't pay attention to where she's walking and I'm afraid she's going to trip on something and break a bone.

I have gotten calls and texts from a couple of her friends and her neighbors pulled me into a meeting at their house. I am starting to notice that all these people are well meaning, and they all seem to get triggered. I feel like people want to help and so they try to persuade mom to change her beliefs or her attitude or to think more positively, etc. And then mom doesn't do that. And then the people try harder and harder and get more and more frustrated and triggered. And then they reach out to me because they feel bad. Sometimes they give me advice about what I should be doing to fix her.

Anyway, because my mom has had these episodes before and she has recovered from them, I believe she will recover from this one, too. I want to have a relationship with her and have connection, even though she isn't acting like herself. It's extra concerning now because she is older and she has some other health problems. I feel very sad just thinking about it all. I took medical leave from work in the fall to help her when she had broken a rib and got a compression fracture in her back and had bad delirium in the hospital. It was hard and frustrating to help her through that, but it was also more meaningful to me in many ways than my regular job, and even though she was symptomatic, part of me still felt good about reconnecting with her, because I hadn't spent that much time with her since I left home after high school, which was twenty years ago.

My brother and my aunt haven't talked to her in the last week. Their boundary is that they won't talk to her if she's talking about "negative" things. So they don't talk to her at all. I have a different thing. I've accepted that she's going to complain about her chronic pain and regret all of her past decisions and beat herself up and talk about how bad her life is and how non-functional she is, and that's the way it is for now. It's not ideal, but I suppose I do get something out of it. I haven't gotten triggered in the past week. I think she actually heard some of the feedback I gave her. I feel like I'm helping in a way that maybe I help people in my therapy group and I get something out of that for me.

[Person_Today]

I talked to the therapist at the last BHU my mom was in, and she reiterated that the only diagnosis the doc made was Cluster B Personality Disorder. That was what was written in her file.

I think it's important for me to not get hung up on diagnosis. The main traits I observe are this fear of being alone,talking about suicide, occasional periods of dissociation, inability to make decisions, constantly seeking advice, constantly going to ER and Urgent Care for her chronic pain, constantly calling pharmacists to talk about medicines and side effects.

I am partly still hung up on the diagnosis, to be honest. The main thing is that she definitely experiences episodes, and I can't get over the idea that personality disorders aren't usually thought of as episodic.

If anything, I think more of her traits are closer to dependent personality disorder, with a couple from BPD. I think part of the reason that she's fallen apart now have to do with my father's leaving her. This happened a number of years ago, and she has had her difficulties since then, but mostly held it together until this year. I think the main change that happened is a psychiatrist in the hospital abruptly discontinued her benzodiazapines this past fall. I believe the benzos were helping her manage the emotions, and so when they were gone, she became highly disregulated. Her regular psych put her back on the benzos (and a much slower taper plan) and she did have several "good" months over the winter. Plus she had begun an online relationship.

But now she has been tapered down to an extremely low dose of benzo, and in March, the online guy kicked her to the curb. And she is back to being extremely disregulated.

My theory is that the dynamic of my parents relationship helped her maintain a stable life. So if she's dependent personality, my dad (and probably myself to some degree when i was much younger) fulfilled her dependence. But now that he's out of the picture and she's essentially off her anxiety meds, the dependence kicks up into high gear.

One thing I wonder about: I agree with the material that says there's nothing support people can do to "fix" a person's PD. But at the same time, there's material about being an enabler. It seems like these things contradict themselves, because the implication is that if support people stop enabling, that would help "fix" the person. So I'm confused about that. Some in the family won't talk to her when she's "negative" (which is all the time). I will talk to her when she's negative, because I've accepted that's just the way she is while in this episode and trying to get her to be more "positive" is really just getting caught up in trying to "fix" her.

Does anybody have any feedback about that or any feedback in general?

[Harri]

Hi Person_Today.

I have a different thing. I've accepted that she's going to complain about her chronic pain and regret all of her past decisions and beat herself up and talk about how bad her life is and how non-functional she is, and that's the way it is for now. It's not ideal, but I suppose I do get something out of it. I haven't gotten triggered in the past week. I think she actually heard some of the feedback I gave her. I feel like I'm helping in a way that maybe I help people in my therapy group and I get something out of that for me.

It sounds like you can see the difference between fixing things for her and being supportive in this aspect of the situation.  Continue to be mindful of your feelings and your own needs.  Are you familiar with S.E.T.?  It is a method of communicating that works with anyone but especially the more difficult people we encounter.  A lot of people here have had great success in using it to talk with their BPD/PD parent, spouse, etc. 

There are other tools that also help.  The easiest one (IMO) is Don't Jade.  It means do not justify, argue, defend, excuse.  It is often looked at as a way to prevent invalidating the person with BPD/PD but I think it greatest value is in protecting our self-respect.  Regardless, it is a great tool that can help maintain more stable communication.  When we couple that with validation, we can protect ourselves from a lot of stress and often it can prevent conflict from escalating.  These three tools (and we have others as well) can help a great deal but they really only work *before* a person is dysregulated.  Once dysregulation begins, you are best off sticking to your boundaries. 

Okay, sorry.  I went off on a bit of a tangent there.  I hope some of that is helpful to you.

I agree that getting stuck on a label is not good.  It can be helpful to have a general category though.  My T would often catch me on wanting to label my mother for sure.  I found and still find it helpful to have a frame of reference but beyond that I am not all that hung up on labels.
 

If anything, I think more of her traits are closer to dependent personality disorder, with a couple from BPD. I think part of the reason that she's fallen apart now have to do with my father's leaving her. This happened a number of years ago, and she has had her difficulties since then, but mostly held it together until this year. I think the main change that happened is a psychiatrist in the hospital abruptly discontinued her benzodiazapines this past fall. I believe the benzos were helping her manage the emotions, and so when they were gone, she became highly disregulated. Her regular psych put her back on the benzos (and a much slower taper plan) and she did have several "good" months over the winter. Plus she had begun an online relationship.

All of this makes a lot of sense.  Your father providing stability and then leaving, the benzos possibly masking some of her more dependent and dysfunctional traits and then 'losing' her online friend.  It is a lot to deal with and can certainly feel like the floor was pulled out from under...
 

One thing I wonder about: I agree with the material that says there's nothing support people can do to "fix" a person's PD. But at the same time, there's material about being an enabler. It seems like these things contradict themselves, because the implication is that if support people stop enabling, that would help "fix" the person. So I'm confused about that.

Enabling covers up the behaviors rather than fix them.  We make excuses, lie, defend, comply when we enable.  Taking away the 'safety net' we apply when enabling is healthy for us but it can sometimes lead to the person seeing their own behavior when they have to deal with the consequences of that behavior.  If we keep enabling, they will never have to experience consequences.  For help to work, the person has to see the need for it and want it and they won't do what if we keep hiding the truth for them.

Some in the family won't talk to her when she's "negative" (which is all the time). I will talk to her when she's negative, because I've accepted that's just the way she is while in this episode and trying to get her to be more "positive" is really just getting caught up in trying to "fix" her.

Yes.  Plus, trying to get her to see the positive can come off as invalidating to someone with a disorder.  Your other family members have chosen what is right for them.  They have that right.  If their idea of 'helping' is to try to get your mom to see the positive, it may be best they stay away.  Everyone has different strengths and capabilities and it sounds like you have a good way of looking at the situation.

Person_Today, hang in there.