How do therapists know they are dealing with a borderline?

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

Beside the criteria listed here, how do therapists know they are treating a borderline client? I've read comments here and even heard my own t, who treated BPD exclusively at one time, say: you can tell right away.  I really wonder how?  What are those initial give aways, the " right away" ones, that t's and more experienced members here could pick up on?  I ask for two reasons.  1) Im shocked I didn't notice anything unusual " right away." In fact, all I thought for quite some time was that I was with the kindest most sensitive and caring person I had ever met.  This was my impression for a very good length of time. I am guessing so many of us had no indications as well or we would not be here  2) Although I realize this is indeed a PD and not all BPDs are the same, I don't want to ignore any initial red flags that indicate this again in a potential r/s. 

[Caredverymuch]

Beside the criteria listed here, how do therapists know they are treating a borderline client? I've read comments here and even heard my own t, who treated BPD exclusively at one time, say: you can tell right away.  I really wonder how?  What are those initial give aways, the " right away" ones, that t's and more experienced members here could pick up on?  I ask for two reasons.  1) Im shocked I didn't notice anything unusual " right away." In fact, all I thought for quite some time was that I was with the kindest most sensitive and caring person I had ever met.  This was my impression for a very good length of time. I am guessing so many of us had no indications as well or we would not be here  2) Although I realize this is indeed a PD and not all BPDs are the same, I don't want to ignore any initial red flags that indicate this again in a potential r/s. 

[Time4me]

I think it is very hard to get a borderline diagnosis... My husband saw a number of therapist and was never diagnosed until he ended up in a hospital outpatient program.  He checked himself in for panic and anxiety, he had hit rock bottom.  This is where is was diagnosed Borderline.  We had been to multiple marriage counselors who never picked up on it.  He had been suffering from panic and anxiety for 10 years.  Funny things now is he blames me and the marriage for his panic and anxiety.  They are never willing to accept any responsibility for anything, even after he received the diagnosis.

[antjs]

Beside the criteria listed here, how do therapists know they are treating a borderline client? I've read comments here and even heard my own t, who treated BPD exclusively at one time, say: you can tell right away.  I really wonder how?  What are those initial give aways, the " right away" ones, that t's and more experienced members here could pick up on?  I ask for two reasons.  1) Im shocked I didn't notice anything unusual " right away." In fact, all I thought for quite some time was that I was with the kindest most sensitive and caring person I had ever met.  This was my impression for a very good length of time. I am guessing so many of us had no indications as well or we would not be here  2) Although I realize this is indeed a PD and not all BPDs are the same, I don't want to ignore any initial red flags that indicate this again in a potential r/s.  

hello. it is not a must that a therapist would tell right away that a patient is a BPD. it might take some time and might not. it is also dependent on the skill and familiarity of a therapist with personality disorders. by the way, my therapist informed me that they do not tell BPDs that they are BPDs cause they will abandon therapy. they can not take any blame. they can not feel that they might be voided or wrong. maybe a therapist would like to keep the diagnosis for himself\herself until he can build more trust with the patient. usually the therapist find the BPD patients to always talk about their miserable lives and how all the people around them are toxic. they basically find BPDs always blaming others in their stories and not taking any credit for any bad thing.


i can really see the aim of writing this post. please do not beat yourself up that you did not have the advantage to "tell right away". were there red flags that you did miss ? sure... .as much as all of us did. you are not a therapist to tell right away. i dont even think that therapists are capable of "telling right away". apart from the therapist's knowledge he is also an objective person so he is not blinded by his emotions to miss the red flags. and guess what there are stories here on this exact website of therapists and psychology major holders who were dating a BPD. be kind to yourself. you have loved and trusted this person and his\her doing during the idealization phase did really make it easier to blindly trust. you are not alone here. if we all could "tell right away" i do not think that this website would have existed.  

i do not think you will ignore red flags in the future if you will do your homework of getting over the pain of this r\s then (this is later not now) when the rumination is over you would ask yourself questions of how did you get there with your ex ? why you were attracted to her\him ? you will discover lots of things about yourself. i think experience speaks louder than being informed. we all knew that we must study to pass a test in school. our parents told us that we need to study in order to pass yet we ignore this and do not study. its very obvious like 1+1 equals 2 yet we tend to do the opposite though we need to pass. what makes us really looking forward to study ? its that we have got bad grades or failed. this is called experience. you have been through an abusive relationship. what if you were informed and knowledgeable about abusive relationships before you met your ex ? i think you would have done the same that you did. cause human beings tend to learn from the personal experience the best.

[iluminati]

FWIW, I think that once you hear about enough cases, you can pick up on certain trends right away.  In my experience on this board, and in real life, there is a very specific fear about people with borderline personality disorder that doesn't pop up in other sorts of mental illness.  Think about your worse phobia and how you react around it, then imagine that level of fear sticking around constantly for everything in life in the background.  I think that's the first tell.  It's not even anxiety, because even anxious people have their comfort zones.

[Lights843]

Our therapist picked up on my exBPDw's childish mannerisms right away. Her arms were folded, sitting as far away from me on the couch as she could, burdened, cold, dry, and had a wall up. She looked as if somebody took her favorite toy away from her. Naturally, I was relaxed and seeking help, answers, anything. I was visibly upset but open minded, I was the one that was seeking help for our marriage and for my ex-wife. Like many of us on the forums here, I assumed I was doing something wrong as a spouse and as a provider.

Our T picked up on it in the first session and kept it quiet until the second session.

[AlbertS]

I have estimated that there was a 99% chance that my exgf was some kind of a liar, but there was still a 1% chance that she was in fact a perfect match, so I have decided to check her out. She also told me early about her feelings of emptiness, and I found it strange that our discussions tended to be about whether she is perfect or worthless, nothing in between. These were not red flags for me back then, but if I knew about BPD before, the situation would be clear for me.

I have met several girls later which appeared to have borderline traits too. Still, since apparently distortion campaigns are so often successful, the professionals are not always able to tell right away.

[Vexed]

FWIW, I think that once you hear about enough cases, you can pick up on certain trends right away.  In my experience on this board, and in real life, there is a very specific fear about people with borderline personality disorder that doesn't pop up in other sorts of mental illness.  Think about your worse phobia and how you react around it, then imagine that level of fear sticking around constantly for everything in life in the background.  I think that's the first tell.  It's not even anxiety, because even anxious people have their comfort zones.

Everyone fears BPDs.  I'm a RN and have worked in psych units occasionally as well as in school.  The first thing I wa taught was to beware of the BPD.  They can turn the whole floor into chaos and then I saw it happen numerous times. 

I believe some experienced therapists may be able to pick up on a severe BPD quickly but I doubt the average therapist can especially not on a high functioning one that is more interested in playing games than getting help.  My ex gf therapist insisted she was bipolar and not BPD.  Besides that I thought she was a pretty good therapist.

[OutOfEgypt]

I think it depends on the kind of therapist and their experience level.  But of course, not all BP's are the same, for sure.

How do you notice red-flags for future relationships?  Well, I'm sure you can think of red flags from your ex, can't you?  I know I can.  Here are some that I saw in mine:

1. Extreme idealization of me.  I was everything she asked God for, and she knew it right away and would TELL me frequently.  Normal people might keep something like that to themselves for a while, even if they believed it.  Just sayin'

2. Moved very quickly, and moved quickly into sex.  I barely knew her, and she was telling me that she knew she was going to marry me someday.  And one day, after only "being" with her for a short time, she started having phone sex to my voice.  I was just having a normal conversation and then... .wow... .what's going on?

3. Obviously hyper-sexual.  She "needed" sex.  Couldn't go long without it.  Would plan how to find or call up certain dudes to get it.

4. Deviant sexual fantasies.  I was so young, I let this one go, but I thought it was sorta weird.  She was having sexual fantasies about my DAD... .someone she had never even met!

5. Constantly seeking attention from others.  From how they carry themselves when they walk into a room to how they always seem to have semi-loserish man-friends who follow them around, whom they "innocently" flirt with, you could tell that she loved the attention.

6. Constantly dysfunctional relationships with family of origin.  Everybody has family issues somewhere, but if they have an up-and-down dysfunctional relationship with their family, and always claim to be the victim of "abuse" from them all, this is a major red flag.  It may be true in some degree, but it is still something to watch out for.

7. Presented herself as a shameful victim one moment but "awesome" the next.

8. Obsessed with her appearance and sexual allure.  Needed to look the best, needed to be the hottest, would tell me about how she could tell that so-and-so at work wanted to "F#@K" her, and she would giggle about it.

9. Always involved in drama... .whether someone at church or someone at work, she was always the "target" of someone else's "mean" or "jealous" behavior.  She could not get along in a work or social setting for too long without something like that blowing it up.

10.  You're wrong.  They never are.  You tell them that you don't like how they always seek attention (sexual especially) from other people, for example, and they reply, "It's purely innocent.  You are just insecure and don't get it."  Umm... .no... . See ya.

11.  Verbal tear-downs of others.  She would despite some people, paint them utterly black.  And then she would verbally tear them down like nothing I've heard.  If they do that to others, it's a matter of time until they do that to you.

12. You're special.  They may not even know you barely, but they treat you like you are special.  This is part of putting you on a pedestal.  Suddenly, they are telling you things they "never told anyone" and they are doing it "because it's you, and you are special."  I can understand how this can be the case if you are married or if you have a long-term committed relationship, but this happened before any of that.


In short, healthy people can hold jobs, have functional long-term relationships with family, friends, and co-workers that are not laden with drama, don't constantly need attention, and can accept others' personal boundaries and take their time in finding and committing to a new partner.  Healthy people also aren't regularly doing behaviors that make you go, "huh?" and then defending those behaviors.  Your gut knows.  Listen to it.

[freshlySane]

My ex was diagnosed with PTSD i dont know how or why but therapy stop she told me to seek therapy many times and threating to leave me if i didnt go to therapy. It wasnt untill she painted me black that i researched PTSD and stumbled on BPD and from what i saw she fit the bill of BPD.

I tried many times to help her ask her questions when she hit rock bottom of the emotional hole she felt everything i asked she answered yes

When i told her she responded so im a psycho after that night she never looked it up or thought other wise she just thinks she has PTSD

Im in the Service and im around people with PTSD

She could have Both or be misdiagnosed but from the 4 year hell i lived through Im blaming myself still even though i know it was never me

So i guess it depends on the T or the methods

[Aussie JJ]

I don't understand the clinic differences between PTSD and BPD however I have one friend who has serious PTSD from his OS service linked to confined spaces.  His main one is environmental a bit like BPD but he has never had it before it came on after events that occurred while OS. 

Essentially he has to have a escape route to get out of a room or area, if their is a door it has to be open so he can get out quickly.  As soon as the door is closed it sets him off.  He can be driven around in a car, drive himself but while I doors has to have a 'exit' available to him. 

He has never told me the events that caused this and they are his to open up if he chooses however I know not to stand in doorways or close doors etc when he is in a room.  Whenever he is around I leave the front door unlocked etc and back door to the house open. 

Actually thanked me for this after 4 years of doing it and told me I could close the door last winter because of the cold.  He knows his symptoms and manages them, a lot less on edge than when it first turned up or I was made aware of it. 

BPD the trigger is intamcy or a relationship from what everyone says.  Their are others but that is the overriding trigger. 

[freshlySane]

I don't understand the clinic differences between PTSD and BPD however I have one friend who has serious PTSD from his OS service linked to confined spaces.  His main one is environmental a bit like BPD but he has never had it before it came on after events that occurred while OS. 

Essentially he has to have a escape route to get out of a room or area, if their is a door it has to be open so he can get out quickly.  As soon as the door is closed it sets him off.  He can be driven around in a car, drive himself but while I doors has to have a 'exit' available to him. 

He has never told me the events that caused this and they are his to open up if he chooses however I know not to stand in doorways or close doors etc when he is in a room.  Whenever he is around I leave the front door unlocked etc and back door to the house open. 

Actually thanked me for this after 4 years of doing it and told me I could close the door last winter because of the cold.  He knows his symptoms and manages them, a lot less on edge than when it first turned up or I was made aware of it. 

BPD the trigger is intamcy or a relationship from what everyone says.  Their are others but that is the overriding trigger. 

Thats what made it confusing why did T misdiagnoses maybe they lie or the T isn't verse in that disorder but i know she is suffering more then PTSD it sucks because when they are seeking help and there not able to get the help they need i feel its wasted time getting to the route of the problem.

I am so glad i dont have it this seems miserable

[Aussie JJ]

My P, when I was trying to convince him I had BPD.  As I was to blame and it was ALL my fault... .

I know we have all been there, he told me that he can spot BPD/NPD/HPD fairly easily by asking them to tell stories and seeing how the stories are told.  Asking what they did to fix the problem and also how the other person always causes the whole problem not them.  From how they relay the stories he said you get to see their perceptions and from that their personality. 

I then got told that he did this with me, told me the example with me cutting the lawn and doing the gardening, she was allergic to grass so it was my fault that the garden wasn't perfect as she couldn't do it and I had to.  He had done it with a few everyday tasks asking me to describe what happened and I took blame for everything, I had assumed responsibility for all of her bad qualities and it was my job to fix them not her fault for being inept. 

I think with the correct questions, showing empathy for their view, no matter how distorted it is, they the person with BPD will open up more and show the P more of themselves, that trusting relationship is established and then you get to see how they view the world and their perceptions that drive their actions. 

For me, everything was my fault and I had accepted the twisted reality as truth.  The fact that I wasn't projecting blame or saying how perfect I was showed my mental filters and how I related etc etc. 

Don't get me wrong I'm not perfect however how many of us have had weird stories told to us by our BPD ex that we didn't understand but in retrospect that little bulb goes off and we look back going... .holly shizen... .why didn't I see it?

If your a P and you get those stories flowing from the BPD you can see the pattern's I suppose and once you have walked through it once when it reoccurs it stands out like a virgin in a whore house. 

We ourselves see those red flags now fairly quickly and they have years of training. 

[hergestridge]

When my wife was assigned a new therapist two years ago the T didn't know what her problem was from (suspected bipolar/depression). From my wife's own description she was clueless when it came to diagnosis.

I was invited to parttake in a T session and was asked to give me a brief history of my wife's illness. It turned out she had left out most of the essential facts about previous treatments, about her problems with mood swings throughout childhood, at school, at various workplaces and the way it had affected us both socially.

She had made it all look like a an issue about her current pet-peeve (a conflict at work) which she was 100% focused on at the time. The T asked my wife why she hadn't mentioned that, and just as I predicted this made my wife give the T (!) a long cold look that said "I tell you what the f**k I want".

Right after that her T sesssions took a different turn. My wife only wanted to talk about what a problem I was becoming in her life (disguised as "Why we are not comminucating", and the conflict at work fell off the radar instantly (she told me this herself!).

Almost directly after my visit at her T the possibility of a BPD diagnosis was discussed. My wife's doctor was reluctant, but tests were planned and eventually a disagnosis was set.

My wife was actually desperate when she sought help. She was having trouble taking care of her daughter and she was suicidal at times. Still, the first thing she did was to manipulate the therapist by leaving out information that she knew was important.

My wife's T is experienced with treating BPD people so she was not surprised at all and i think this behavior was what made her "know" so early.

[enlighten me]

I think it is possible to spot BPD straight away if you know what your looking for and are perceptive enough to see the miniscule changes in character.

They say that a BPD will mirror but there has to be a slight time that the BPD assesses the type of mask to put on.

If a therapist is perceptive enough they may pick up on this. The way that the face will change and the body language a BPD adapts might change in the instant they walk into a room and assess the situation.

I have heard many times of therapist/ mental health workers saying that they can label people in a room so it wouldn't surprise me that they can.

[Aussie JJ]

To add to that enlighten me

A family friend who works as a nurse and has worked in mental health and had met her for all of 2 minutes told my mum she had a PD when our son was born. 

To her, she had a 'parkinsons' look on her face between interactions.  Goes blank and then adapts.  She said it is something all PD's have when stressed. 

[antjs]

If you are afraid to date another person with PD. It is as simple as if you feel that "it is too good to be true" believe it literally and take it slowly with great cautious.

[topknot]

Out of Egypt,  that is perfectly described.  The phone sex thing was so very strange. I'm talking about a topic, and then I said, "you're doing WHAT?" And the never ending seeking attention was the deal breaker. Amazing summation

[OutOfEgypt]

Wow, that happened to you too?  Thats pretty nuts.  I thought I would be relieved to find out someone else experienced that.  But nope.

[.cup.car]

In short, healthy people can hold jobs, have functional long-term relationships with family, friends, and co-workers that are not laden with drama, don't constantly need attention, and can accept others' personal boundaries and take their time in finding and committing to a new partner.  Healthy people also aren't regularly doing behaviors that make you go, "huh?" and then defending those behaviors.  Your gut knows.  Listen to it.

Wow. Absolutely nailed it!