Why is it that it is better for the pwBPD not to know the diagnosis?

[Krudula]

I was told by my professional, support person that it is best that the dpwBPD is not being told that he or she has the disorder? My son's MIL has never told her dd that she has the condition. After a recent stay in hospital she was again formally diagnosed, but is firmly in denial.

My son is now in the process of dealing with the aftermath of separation, but there isn't a clean break as there is a child involved.

Am soo sick of all this. He's been through a real tough time. Talking with him reveals more and more. Glad that he's found support as well though.

[VeryFree]

Interesting question.

Mine was diagnosed PD, among other things.

She talked about the other things a lot, but never mentioned the PD.

While, imho, from the PD the biggest problems came/come.

[ForeverDad]

This is a good question and one that comes up frequently.  Here is a thread from a few years ago over on the Questions Board:  Why are therapists hesitant to give a BPD diagnosis?  Obviously there are a variety of reasons mentioned, one idea being that some help without a disgnosis is better than no help with a diagnosis.  My own short list, a generic summary, is something like this:

• Most people with BPD are in extreme Denial and will actively Blame others or Shift Blame anywhere else.  (People naturally want to avoid looking bad, and for pwBPD this is a sensitive issue to an unbalanced and extreme degree.)



• Projection and/or Transference are deeply seated behaviors as well.



• If the pwBPD actually does become a patient and rejects or does not accept the therapist or counselor's observations and suggestions, they're like to quit or go elsewhere, telling others the therapist said they're okay now, the T was no good or that the T said other people, the targets, are the problem.  (This can happen because privacy laws such as HIPAA in the USA generally don't give an opportunity for those close to the pwBPD to contribute to or discuss the evaluation or therapy.  If the T doesn't learn what we know and if we can't hear from the T what the T's observations and conclusions are, then that leaves the pwBPD free to tell the T and us whatever he or she wants to claim.)



• pwBPD are prone to be very judgmental, oppositional, have ever changing moods and are unwilling to listen to reasoning from others, especially those close to them.  That is why the professionals will not build an emotional relationship with their patients, too easy for the overtones of emotional baggage to get in the way.



• Courts generally handle people as they are, handling just some of the more extreme behaviors, courts generally avoid trying to fix people by enforcing or getting involved in long term therapy, if any.

[qcarolr]

Forever Dad - your list is right on my experience with BPDDD27. She has been told of the BPD a few times, shrugs it off, or uses it to justify that her acting out behaviors are not in her control because of this label. Feels very manipulative to me. Try to understand she is getting her needs met in the moment in best manner she can. She refuses any treatment of any kind - court ordered or not. She is facing a year in jail, starting in about 2 weeks, because she is unable to give up pot (her self-medication of choice and totally supported by her peer group) and she does not see any benefit to treatment ordered for her DWAI.

I am working to let go of my expectations for the outcomes. Hard to do, but doing better with it.

So in this case, DD knowing the label made little difference in her life. Others have different experiences.

I also have been known to leave a message with DD's T, when she is choosing to go to those first few appts., with my side of the story. They do listen to what I have to say. They just cannot respond with details of therapy. They have offered suggestions for what I can do to manage my side of the r/s. It really has made little difference in the outcome, in my case. DD does accept that she has depression and anxiety disorder and is sometimes willing to take meds for these symptoms. Bringing her true feelings up in talk therapy just leaves her internalizing with suicidal thinking as she leaves the session. She feels safer not going at all and keeping it locked away -- externalizing.

My 2cents - it has to be an individual choice. Any T working with BPD clients has to have excellent training and good supportive supervision - ie. their own therapy to manage staying connected in r/s with BPD client. Takes time to build the trust - maybe even 2-3 months if can keep the pwBPD engage that long.

qcr

[ForeverDad]

Above I focused more on the therapists and courts.  What about us, why can't we just come out and tell what we think, whether or not there is a diagnosis?  Aren't our good intentions enough?

Mentioning something such as BPD can been perceived as an accusation or attack, hitting too close to home either consciously or unconsciously and it can easily trigger retaliation or counter allegations in overreaction.  That's risky for us if we're in a close relationship, exiting the relationship or have to continue contact for many years to come due to sharing children.

For that reason it's best to take the time to ponder the matter, seek advice from trusted family and friends, an experienced therapist or counselor and peer support too such as here.  With education, additional communication skills and techniques and support from various areas of our lives, we can make more informed and more confident decisions.

If we're married to the person or share children with the person, then we probably also need legal advice from an experienced family law attorney so we know how to protect ourselves, how to avoid numerous legal traps and what our options are if the relationship becomes more dysfunctional or even implodes.  Bill Eddy and Randi Kreger have an excellent handbook Splitting: Protecting Yourself While Divorcing Someone with Borderline or Narcissistic Personality Disorder.  (Even if the relationship doesn't come to an end, the advice there is very practical and helpful so that the relationship issues and incidents are less likely to put us at risk of making innocent but serious blunders.)

[HardDaysNight]

I have also heard that insurance companies may not cover treatment for BPD because it is considered incurable.  I've heard a diagnosis of bipolar is the common one given to avoid insurance denials.

[Krudula]

Thanks for all your input.

My reasoning was that if I had, say diabetes, I would want to know, so I could concentrate on getting better, take the right decisions to live healthier, eat the right things, leave out what is damaging to me, etc, etc.

ExDIL-to-be has not only BPD but also Bipolar traits as well suffers from an eating disorder, so we have plenty to deal with, even though the r/s has ended, there still is plenty of contact, due to their child being in the picture.

What I find the hardest is that I have to hand over the child almost every day to the mother and he absolutely freaks out. He cries, avoids her doesn't want to go with her. When I pick him up he is eager to go with me again. Custody wise nothing has been finalised as yet. We may still have a long way to go.

ForeverDad thanks for the thread, I will have a look at it.

[qcarolr]

krudu

It sounds like you are a daily caregiver for your youngest gs. So this transistion back to DIL happens everyday? Where is your DS as the caregiver for his kids, esp. this youngest one.  I understand that things with custody are still being worked out. Is there any way to discuss a less frequent transistion for gs? How old his he again? Is there a child T involved with the family that could advise about tools to help with this seperation axiety?

My gd7 has always lived with us. Her mom, BPDDD27, has been in and out of her life. Sometimes living in our home, sometimes living with bf, sometimes living homeless. The daddy left when she was very young so there was not much attachment with him. When gd was 18 months a baby brother came onto the scene. DD was living with bf/spouse. They married after gs born, moved with our support into apt. then gs was placed in foster care at 5 mos. followed by 12 months of weekly visits with each parent and monthly with gd. There were also weekly visits with DD in the apt. [gs was adopted by the foster parents and is a happy, healthy 5 year old now. He too struggled with seperation anxiety for a couple years as he attached with his new family.]  Gd still has issues with seperation, but things are getting better as we work to provide a more stable, loving environment for her. And she has learned many good coping strategies. It gets better as she is able to verbalize her feelings, thoughts, concerns. We have been working with a T for gd since she was 4 and DD became homeless.

Often kids are resilient. You are a great stablizer in your DS family. I hope you and your DS can find ways to reassure gs during this very very difficult transition time. Hopeful at least a temporary custody arrangement with the child's best interests can be worked out.

qcr

[Krudula]

Hi qcr

Just a bit of background details; I'm always a bit reluctant to write, just incase exBPDdil is browsing this website.

My son broke off his r/s at the beginning of the year. When she sensed that he meant it she admitted herself to the psychiatric ward of the local hospital. She was already known to them for peri- and postnatal mental health. The psychiatrist had several meetings with our son to support his decision and gain insight what daily life was for him and our gs who was 14 months at the time. Ex was already formally diagnosed with BPD several years ago and again at the beginning of this year. You may ask why twice a diagnosis: moved states. As mentioned in one of my previous posts she also has bipolar traits and anorexia. The latter she has admitted to and accepts, the former she is in complete denial of. Suicidal threats have been plentiful. Before the r/s breakup we looked after gs so often, because she either couldn't cope at the time but also because it suited her, gs has bonded strongly with his dad. They are both living with us while the while legal aftermath is being played.

Our nonBPDson has been caring for his son and when he is at work gs stays with me.

Lately the transitions have become more regularly, as she demands to have him more and more, aiming for full-time caregiving. Luckily I have been documenting the days/weeks that gs has been staying with us before the breakup. Mediation on working out 50/50 has not produced any constructive results.

My biggest concern is what is it doing to this small person, who is happy and feels secure when is is with his dad and with us, and gets upset, cries, avoids his mum every time. We try to make the transition a bit easier by putting him in the carseat and distract him a bit. I think cracks are appearing with exDIL becoming impatient and perhaps jealous as he rejects her. When he comes back, after staying with her for the day, or overnight, he is unsettled, has started to bite, is unsettled at night.

This wears off a bit when there is less contact, but I'm greatly concerned what it does to him. We as adults are already finding it hard to witness his crying and reaching out with his arms, or clinging to us when she comes, let alone what he feels, but can not verbally express.

She, with her own emotional dysregulation can't zoom in to his needs. There has never been a strong attachment to her, I'm afraid. She is not the nurturing type, too needy herself.

Up till now there is no T involved with the now 18month old gs. He has his own L.

I'm so worried at times.

[qcarolr]

She, with her own emotional dysregulation can't zoom in to his needs. There has never been a strong attachment to her, I'm afraid. She is not the nurturing type, too needy herself.

This is also true with my DD27. In her mind she sees herself as a 'good' mom. yet so often her r/s with gd7 is about filling her own needs. and she has often used my concerns about gd to manipulate me to give her things I have said no about - money mostly or a bf living in our home with her.

For your gs safety and developmental health, I am hoping that your S can get custody and the mom gets some type of visitation. Keep on doing the diary. This is a hard one to get across to the courts sometimes -- that they are to be looking at the best interests of the child and not the legal rights of the dysregulated parent. 18 mos is too young for direct T, the therapy would work best for caregivers - so good there is strong attachment with your DS.

qcr