Advice for those with experience with PW. COMPLEX BPD ADHD diagnosis

[MBXTR]

Hi folks,

I created my first post last weekend when deep diving for support resources on how to deal with pwBPD during an exceptionally bad few weeks post officially diagnosis where I can understand he was fighting acceptance of the label because he had a false understanding of BPD thinking it was incurable. This means he spiraled to a non stop cycle spanning a few weeks where he no longer was taking any accountability to his actions and currently in an elevated and defeated level of hurt because he was given a diagnosis without next steps and the reassurance from his diagnosis that it is most definitely a treatable condition if he puts the work I . I think because he was diagnosis on the first visit the psychiatrist had no history of understanding he would spiral and not easily take to reading a book on awareness of the condition “don’t hate me, I love you”. Since then, I have joined a support group that has echoed the statements echoed from replies in my first post about setting boundaries when it’s escalated to a level of emotional abuse. Since last week, I’ve also learned that the disassociation and emotional disregulation symptoms can be even more intense with those with certain “complex BPD “ disorders for example BPD +ptsd and BPD + adhd. I am looking to see if there are any tips from those with personal experience with partners with a dual diagnosis of BPD AND ADHD where the ADHD has only recently started being treated. The reason I am asking is because there is a repeat pattern of not invalidating and setting boindaries that seems to be making things worse under the impression that the partner can be talked to in a calm state. I am in a situation where since the diagnosis 3 weekends ago, he has since escalated the episodes to virtually daily PLUS now no longer feels like apologizing. It was turned into ultimatum central where his attempt to fix things is not acknowledge that he has zero’d in on me as the “FP” more than ever and blames me for making things worse when he walks around with new heightened and uncommunicated expectations and refusing to acknowledge even let alone apologize for the emotional torment. For example: today he wanted to pretend he hasn’t put me through the ringer for weeks, is in his version of reality where he now permanently thinks I am the problem. I am wondering if there are any very specific tips for those who have partners with the dual diagnosis which I have learned can have even more intense emotional regulation stages especially when given the bomb of BPD without the comfort of knowing it is a) treatable and b) currently having a hard time accepting it. I haven’t had an open window of being able to communicate a positive outlook because I am not given the chance and having a harder time trying to “get there” on a worse realization than he needs to. I don’t know how to guide my husband with positivity when he won’t hear that he is trying to come to terms with a worse “reality” than he needs to. He thinks he is stuck this way, has had it forever, and that there is no hope for him all because he wasn’t given that reassurance he probably needed to hear leaving the first psychiatrist visit. Where he thought he was on an upward trajectory with finally treating his adhd he was been taking out his frustrations on what feels like a devastating diagnosis with the BPD. The problem is he doesn’t have a follow up for another month and because it is more intense than normal for me, I don’t know how to alleviate his suffering when he is trying to come to terms with something significantly harder than he needs to. All he was given was a book that tells him what it is whithoit a plan which has made things intensely worse especially since that adhd straights makes it all the more harder to think things through when “calm”. He has cope his whole life with avoidance and I don’t know how to tell him that it is treatable with dbt and doesn’t have accept a permanent diagnosis. How do I help someone without the executive function skills to research uncomfortable topics and has used avoidance his whole life to get by? Thoughts?

I feel like if he only knew what I found out he wouldn’t be so emotionally abusive and can get to the start of his healing journey sooner. I know this sounds selfish but it is hard when it is beyond his normal “episodes” as they are relentless due to floundering.

I welcome any advice  from those who understand the mind of someone who has more than just the singular diagnosis as some advise without context has exceptionally backfired this week.

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[kells76]

Hi MBXTR;

While I don't have experience with the pwBPD in my life having complex or comorbid diagnoses, I did notice this part of your post:

I feel like if he only knew what I found out he wouldn’t be so emotionally abusive and can get to the start of his healing journey sooner. I know this sounds selfish but it is hard when it is beyond his normal “episodes” as they are relentless due to floundering.

To me, it does not sound selfish to wish for healing for your husband. At some level I think all of us here wish for true and permanent healing for the pwBPD in our lives. There would be so much less hurt and trauma for everyone if that were the case, so to me, it sounds like a loving thing to want.

When you mention that you feel like if he could only know what you learned maybe that would help, that reminded me of a book that really opened my eyes to how mental illness impacts the person's basic thoughts/processing/rationality:

I am Not Sick I Don't Need Help!, by Xavier Amador, PhD

Dr. Amador wrote this book from his perspectives of being a MH professional, and also of having a loved one with mental illness (he had a brother with schizophrenia). He was in a very similar position: he loved his brother but his brother would not take or stay on his schizophrenia meds. How could he convince his brother with the info he had that he should stay on his meds?

One anecdote in the book really drove home for me how differently we need to approach those conversations, if we're going to be effective and achieve goals:

(I can't remember if the doctor was Dr Amador or someone else, but) A doctor was seeing a patient who had something like schizophrenia, dementia, or a related mental illness. The doctor asked the patient to draw an analog clock with the hour and minute hands. The patient drew something kind of like a clock, but the hands and numbers were all wrong. The doctor pointed that out to the patient: "can't you see that the ten and two aren't in the right place, and the hands are outside the clock face?" (or something like that). The patient insisted the clock was fine. After some more back and forth, the patient angrily said "Someone else drew that!"

Even in the face of overwhelmingly objective evidence -- the patient literally just drew the clock! -- mental illness will impair the individual's ability to have rational thought processes about information.

The other key takeaway for me was that people get help for problems they see themselves as having, not problems we see them as having. The issue isn't that something they do is a problem for me, or that I think that something they do is hurting them. The key factor in if someone will get more help is if they experience themselves having a problem they don't like, and that problem can be worlds away from what we think the problem is.

There is still hope, though. We may need to give up on our dreams that "if we just explain the information clearly enough, he'll finally see the light!" or "If I can just show him that he's hurting me/hurting himself, then he'll want to change".

Change in these relationship comes less from providing information or telling them something.

Change can come when we listen to them (hear their perspective), empathize with them (put ourselves in their shoes), find some area where we can agree (sometimes the problem they see themselves as having is one we can agree is problematic), and partner with them to find a solution.

Not easy, not intuitive -- maybe something in there that's helpful?

[Outdorenthusiast]

I am looking to see if there are any tips from those with personal experience with partners with a dual diagnosis of BPD AND ADHD where the ADHD has only recently started being treated.

MBXTR,
This can be a frustrating, hurtful, gut wrenching and explosive time.  I wish I could tell you it isn’t - but it is.  Buckle up and put your oxygen mask on before you fix anyone else.  My W has comorbidities of high functioning quiet BPD, CPTSD, ADHD, Depression, Restless Legs, Insomnia, and Anxiety.  We are three years into the journey of healing within a very difficult 27 years of marriage.  ADHD is the most recent diagnosis for us in the alphabet soup of stuff.

While I can’t give you direct advice, I can explain some thoughts.  I never have labeled her. I don’t care what the “name” of what she has is. (I know - because I want the education, but I don’t push it in conversations with her).  I push the behaviors I do/don’t like and how it affects me, her, and our family.

Our path:
1) Me getting counseling support first.  Breaking bad codependent habits that had built up over years from a very powerful emotional manipulator. (Codependent no more - Beaty) is a great book.  Improving myself second.  Enhancing my social support network (not asking permission to hang out with friends - but being respectful), better eating habits (cook my own separate meals if necessary), sleep (moved into a separate bedroom - a boundary due to emotional abuse), and physical fitness (running club).
2) Learning the techniques from here (Grey Rock, SET, JADE, FOG, etc) and educating myself (Stop Walking On Eggshells/I Hate You Don’t Leave Me/ Loving Someone With Borderline Personality Disorder) and creating healthy boundaries for me, her, and our family.  [Many extinction bursts]
3) Her getting into weekly therapy as HER CHOICE due to my healthy boundaries (unwilling to continue under the status quo)
-> Her Dealing with the Emotional Abuse and dangerous life threatening BPD traits first with her counselor (via CBT)
->Getting appropriate antidepressant meds adjusted through her GP Dr. to deal with the depression and debilitating anxiety.
-> Second tackling the CPTSD via CBT and EMDR to bring the anxiety lower and take that noise off the table. (The Wounded Heart) is a good book I read to educate myself.
-> Third tackling the ADHD via techniques and meds (The ADHD effect on Marriage) is a good book I read to educate myself.
-> Getting appropriate ADHD meds added through her GP Dr. to manage ADHD.

…setting boindaries that seems to be making things worse under the impression that the partner can be talked to in a calm state.

In my experience I can only validate and have a boundary for what I am willing to tolerate.  She has to regulate herself - I can’t make her.

… refusing to acknowledge even let alone apologize for the emotional torment.

ADHD people don’t remember.  But the emotional abuse indicates a strong boundary opportunity for you.

…when given the bomb of BPD without the comfort of knowing it is a) treatable and b) currently having a hard time accepting it.

Symptoms can go into remission - but in my experience - they don’t disappear.  SET technique, Grey Rock, and kindness/Patience will be needed in my experience.

I don’t know how to tell him that it is treatable with dbt and doesn’t have accept a permanent diagnosis.

You can’t in my experience.  They won’t listen, or won’t remember..  They have to figure it out themselves.

I feel like if he only knew what I found out he wouldn’t be so emotionally abusive and can get to the start of his healing journey sooner.

Diagnosis names don’t matter in my experience.  Actions/inactions do.  Focus more on the behavior and less on the name since it seems to be a trigger.   My W was totally triggered by the label, but both her therapist and I focus on not mentioning the label and focus on the actions and issues instead.

Fast forward three years and things are much less toxic, and she has many CPTSD and BPD traits in remission.  ADHD she is working on that now.  Meds are helping.

Hope that helps a little,
Outdoorenthusiast