Should BPD individual be told they have BPD?

[Parents! Get help here!]

My 20 year old daughter was diagnosed with BPD last year. Learning this was a total lightbulb moment for me. Everything finally made sense, and knowing the diagnosis at least pointed us in the right direction to get the help she needs. However, a family therapist blasted the psychiatrist for telling my daughter what she "has", claiming my daughter will manipulate and use the diagnosis to her advantage. I'm not sure this will be the case. Frankly, she didn't even seem phased by the diagnosis. In fact, she hasn't even commented on it at all (other than to tell me what the doctor said). What are your thoughts? Are you glad to have the official diagnosis? Do you use it as a crutch or excuse?

[skysidmom]

My 20 year old daughter was diagnosed with BPD last year. Learning this was a total lightbulb moment for me. Everything finally made sense, and knowing the diagnosis at least pointed us in the right direction to get the help she needs. However, a family therapist blasted the psychiatrist for telling my daughter what she "has", claiming my daughter will manipulate and use the diagnosis to her advantage. I'm not sure this will be the case. Frankly, she didn't even seem phased by the diagnosis. In fact, she hasn't even commented on it at all (other than to tell me what the doctor said). What are your thoughts? Are you glad to have the official diagnosis? Do you use it as a crutch or excuse?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[twojaybirds]

It sounds like the therapist and psychiatrist come from two different philosophies, neither is right nor wrong.

My dd was told of her diagnosis when she was 19 while in a psych hospital.  She has never manipulated it to her advantage. In fact it is what has kept her connected with her meds and therapy and is now 26 years old

Although it does not matter now; your daughter knows so you are able to use it to help her understand her when she wants those conversations.

[Juki]

Hi there  

This is a difficult question to answer because there are pro's and con's.  In my opinion BPD can only be diagnosed following an observed pattern of behaviour over a length of time, together with a detailed history and substantial knowledge of all psychosocial factors.  BPD-type behaviour can also be a symptom of PTSD, C-PTSD, bipolar and other mood disorders.  Based on this I believe it takes time to arrive at an accurate diagnosis, after which it is a very individual thing as to whether an individual should be told or not, or how they should be told.  This would be based on many things, including their emotional maturity (especially how self-aware they are), their ability to understand the disorder and cope with such a diagnosis.  For some individuals it is received well, whilst for others it isn't because they feel flawed and labelled.  I can only speak on behalf of my 25 yo BPD daughter and know that being told (after 5 years of psychotherapy) was received well.  In fact, she had already come to the same conclusion and being told merely verified it.  Having received the diagnosis has not altered my daughter's behaviour in any way, but it has given her a very clear direction in terms of treatment (DBT groups and individual therapy).  So in answer to your question my daughter is glad to have an official diagnosis and no she does not use it as an excuse or a tool of manipulation. Additionally, given that your daughter is 20, and an adult in the eyes of the law, she has a right to be told her diagnosis and withholding that would not be right or serve any real purpose.

Now to the family therapist who blasted the psychiatrist for telling your daughter because of fears she will use the diagnosis for manipulation and for her advantage!  I find this a bit out-of-line as it is a subjective & unsubstantiated opinion which should not have been shared. Therapists are required to practice within an ethical framework which should be non-judgemental and here the therapist is fundamentally voicing her opinion and telling you that your daughter is highly manipulative.  There are other ways of arriving at the same place that don't require such frank comments.  Given that a family therapist should be a neutral advisor and mediator in family relationships I think it would have been better to refrain from commenting on this in the name of non-judgemental neutrality.  I have the highest regard for therapists provided that the therapeutic relationship is kept professional and within their ethical guidelines and boundaries. I have a friend whose entire life was thrown into disarray because her counsellor overstepped her boundary and suggested that her father-in-law was a narcissist and potential paedophile!  That has resulted in a full estrangement, not because he did anything to justify such a "diagnosis", but because the counsellor planted the seed and my friend ran with it.  Remember though that this is just my unprofessional, judgemental opinion LOL!

At the end of the day it is what it is.  Your daughter has been told and now only the future will reveal whether or not she uses her diagnosis as a weapon of manipulation.  Most important is that she (and you) receives the appropriate support and therapy, which would not be possible without a diagnosis being put on the table.

Take care
Juki x

[BoyMom]

I often wonder the same thing. I've NEVER used the term BPD with my son, I just picked one thing, his temper, and we've discussed it at length. How can we help you not lose your temper? He will deflect and his answer is usually that everyone in the family needs therapy but him, everyone in the family needs "an intervention" but him, everyone in the family has a problem but him, if only everyone would listen to him we'd all realize that he's right and we're all wrong. In our conversation today, out of the blue he said, "Everyone thinks I'm crazy, I'm not. I'm not a schizophrenic". Well hell, nobody said he was. If he heard the words personality and disorder strung together and God forbid "borderline", he'd hit the roof! I'll leave that to a therapist to say. When I went to California to visit him I'd already set up an appointment with a therapist. I was there to see him for my birthday and I told him that's all I wanted for my birthday, for the 2 of us to go talk to this counselor to help us communicate better. "I don't need a counselor, you do, you're the one with the problem, brotherA needs a counselor and brotherB needs a counselor but there's nothing wrong with me, y'all are all wrong and I"m the only one right". When he was devastated over a breakup with his first love and was going on about how wrong she was and how right he was I told him that sometimes in all relationships it's more important to be happy than to be right and it's important to find a compromise. If I were a betting woman I'd bet my house that the reason they broke up was because she'd had it up to her eyeballs with his raging and insistence on not only being right but forcing her to say he was right and she was wrong. And like I"ve said in previous posts, you can say "you're right, I'm wrong" until you're blue in the face but when he's raging he's not hearing that, he gets stuck like a broken record, he'll just keep going, "...you thought you were right and I was wrong but now you know I was right and you're an idiot..." and the launching of the insults begin.

[formflier]

I have a hard time imagining any medical professional coming up with a diagnosis of an adult and then not sharing it with them.

I'm not even sure that would be ethical.

How did the psychiatrist and the therapist resolve things?   

Best,

FF

[BoyMom]

I honestly don't know if any of the therapists he's spoken to has broached that BPD subject with him, I've said my concerns in the times that I've spoken to the therapist before my son spoke with him. But since he was 18 at the time, that iron curtain went up and I wasn't allowed to know anything that was said between them (except in the event that he threatened to harm himself, but knowing my son he kept it together and portrayed me as a hysterical mom, who knows?) and I honestly can't remember how the few sessions went with us together, it's been so long ago. I do remember the look on that California therapist's face when I expressed my concerns about BPD. He got that look on his face that said, "Oh, she went onto WebMD and thinks she's a doctor now". My son checks every box except the ones about suicidal idealizations or harming himself (thank God). Although there was one time when he had a falling out with a long time friend who he helped get an online business set up - that guy made the fatal mistake of fulfilling an order to DS's exgirlfriend and my son called me up in an angry fit telling me I better never order from him again. I said I didn't need to use his online business, I'd only done so in the first place to help their business but he either wouldn't or couldn't hear me agree with him and just kept going, "You don't understand, if you order from him I will kill myself". 

[livednlearned]

In Buddha and the Borderline the author discovers she was diagnosed with BPD in her teens and no one told her until she discovers it a decade later when she requests her medical records (if I'm remembering correctly). She felt betrayed to discover that the information was withheld from her.

With your daughter, she doesn't seem phased by the diagnosis. Do you wonder if she is not sure what to make of it and what it means for her recovery, if anything?

[twocrazycats]

I believe that having as much information as possible is important in order to deal with it and move forward. A patient has a right to know their diagnosis.

I suspected BPD in my daughter years ago, when she was barely 13. None of the professionals were willing to diagnose it at that time, and I put the thought aside. My daughter got sick with Lyme Disease and then had a concussion, so it seemed there were always other reasons for her behaviors.

Then, last year in high school, she took a psychology class. She read about BPD. She, herself, came to me and said that she thinks she has it, since the description fits how she feels. She started seeing a therapist, and she said the therapist agreed with the diagnosis. My daughter didn't stay with therapy long enough to get in to see the psychiatrist, so we're left with the unofficial diagnosis.

But we know that she has it. She has used that knowledge to help herself, in ways such as reading the workbooks on DBT that I bought. It has helped her understand the extremes in her emotions. It has helped her to understand why she does better with structure. And yes, she has also used it as an excuse, as in "I can't come home tonight; you're triggering my BPD" when she wanted to stay out with the boyfriend.
But overall, I believe the knowledge is a good thing, and will help her to deal with the disorder as she gets older and has to navigate life on her own.

I would have a problem with a therapist who seemed to be advocating keeping secrets.

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