If she admits to all the symptoms, why not the BPD?

[Depression = 72% of members]

My feeling is that my wife would do better in treatment if she would just accept that BPD is behind the range of symptoms she complains of.  But why doesn't she?  I can come on here and describe her behavior, or describe it to my therapist, and all will tell me those are common issues with BPD.  Being "triggered", rages, depression, anxiety, low self worth, addictions, difficulty with relationship - my wife all has them, complains about them, and seeks treatment for them on individual basis.  She's been diagnosed BPD over and over, has BPD books in her collection, but when it comes to an issue she is having, it's not the underlying BPD she looks at - it's the overlying symptom. 

I just feel this is a stumbling block for her finding some real and lasting help.  Is this what has to happen before real progress is made?

An example would be her friendships constantly falling apart usually via the route of a screaming match.  It happens over and over.  She complains about it and wonders why.  She blames her depression, the other person, or PTSD.  Yet BPD is plain as day there, she's aware she has it and what it means, yet won't consider it.  I think if she considered the BPD, she may realize that it's her reactions an interpretations of her feelings getting in the way.  It's like if she has a feeling, the rest of her brain is shut down, and no other explanations are worth thinking about.

[maxsterling]

My feeling is that my wife would do better in treatment if she would just accept that BPD is behind the range of symptoms she complains of.  But why doesn't she?  I can come on here and describe her behavior, or describe it to my therapist, and all will tell me those are common issues with BPD.  Being "triggered", rages, depression, anxiety, low self worth, addictions, difficulty with relationship - my wife all has them, complains about them, and seeks treatment for them on individual basis.  She's been diagnosed BPD over and over, has BPD books in her collection, but when it comes to an issue she is having, it's not the underlying BPD she looks at - it's the overlying symptom. 

I just feel this is a stumbling block for her finding some real and lasting help.  Is this what has to happen before real progress is made?

An example would be her friendships constantly falling apart usually via the route of a screaming match.  It happens over and over.  She complains about it and wonders why.  She blames her depression, the other person, or PTSD.  Yet BPD is plain as day there, she's aware she has it and what it means, yet won't consider it.  I think if she considered the BPD, she may realize that it's her reactions an interpretations of her feelings getting in the way.  It's like if she has a feeling, the rest of her brain is shut down, and no other explanations are worth thinking about.

[RELATIONSHIP PROBLEM SOLVING]

RELATIONSHIP PROBLEM SOLVING This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members are welcomed to express frustration but must seek constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[EaglesJuju]

It is so hard for them to admit anything.  My bf just told me the other day that he thinks he has a PD.  Similar to your wife, he can prattle off all the diagnostic criteria for BPD and even quote Marsha Linehan, but he cannot say that he thinks BPD is the cause for all of his behaviors. 

I think it is the stigma of BPD. Knowing him, most likely he did a web search of BPD and most likely read some unfavorable things. Accepting something that has such a huge stigma attached to it is really difficult. 

[MissyM]

Max, my dBPDh doesn't like to use the word borderline.  I can understand that, he already feels defective and it just seems to add to that feeling.  Since part of the of the focus of therapy is to help him feel more like he belongs, I don't really feel the need to point out BPD.  I am just trying to focus on our interactions and what I need from them.  Your dBPDw seems to have escalated her behavior since she lost her job.  Is she doing anything productive to fill her time?  Boredom is really a dangerous thing for my dBPDh.

[maxsterling]

Last night she was talking about her food addiction. She's been getting involved in a 12-step program that involved food addictions, and last night she talked to a woman about developing an "abstinence program" to help her control her addiction.  Sounds like a good plan to me.  She also remarked on her emotional obsessions and ties to certain foods.  She certainly has those.  And she brought up that she obsessed over food when she was in the hospital last year, and this year after she lost another job.  Yes, that happened.  But, she stated it in a way that her obsession over food led to her depression, and that if she curbed this obsession over food she would be less depressed. 

Considering she has been in nearly every 12 step program out there, and has had obsessions with all kinds of things her whole life (including being obsessed with me), it all just seems like a cart before the horse.  So rather than "I have an addiction to food that is causing all my problems" why not "I tend to get obsessed with things, and that is part of the BPD I have been diagnosed with."  I just feel like treating the food addiction separately won't lead to a solution.

[formflier]

  I just feel like treating the food addiction separately won't lead to a solution.

Max,

I think the challenge for you... .us... .is to be able to express how her "denial"... .or whatever... .of BPD is affecting her treatment negatively. 

So... how would her food addiction treatment look different if she "fessed up" to it being part of BPD?

Once that gets clearer... .I think we can figure out how to approach it.

[maxsterling]

  I just feel like treating the food addiction separately won't lead to a solution.

Max,

I think the challenge for you... .us... .is to be able to express how her "denial"... .or whatever... .of BPD is affecting her treatment negatively. 

So... how would her food addiction treatment look different if she "fessed up" to it being part of BPD?

Once that gets clearer... .I think we can figure out how to approach it.

I'm not sure if this is something worth approaching, or just be patient that she is recognizing a problem and let her find her own path.  I think she's on a better path than before.  Before she obsessed about weight, now at least she has gone a little bit deeper and recognizing the problem is that she is obsessing over food rather than simply eating unhealthy. 

I don't know how her treatment would look different if she would assign her troubles to BPD.  But I assume it would involve constructively examining and dealing with underlying emotions rather than trying to control resulting behaviors.  That's where I see this eventually failing (resulting in more shame), that she will have a hard time sticking to her abstinence program because the underlying emotions will still be there and unaddressed. 

[EaglesJuju]

Hey Max,

I am not familiar with abstinence programs and how the treatment works. In a round about way, her focusing on the food addiction can concurrently address impulsivity issues. Food addictions can stem from issues with impulsivity.  Impulsivity is a key feature with pwBPD.  Just something that I thought of.

[hope2727]

For my ex I think it boiled own to personal responsibility. If his problems were due to BPD or anything else for matter it would have been internal to him. His own 'fault/responsibility". By not admitting then or considering each symptom individually it is not internal. It can be blamed on an external cause. Like us... .we must be the cause.

[maxsterling]

Hey Max,

I am not familiar with abstinence programs and how the treatment works. In a round about way, her focusing on the food addiction can concurrently address impulsivity issues. Food addictions can stem from issues with impulsivity.  Impulsivity is a key feature with pwBPD.  Just something that I thought of.

From what I understand, the idea is to list "trigger foods" as those which you have a tendency to over eat and can't stop from eating.  So if you can't eat just one of something, or eat so much it makes you sick, that's a trigger food and you should abstain from eating it.  I suppose by successfully abstaining from certain foods creates a feeling of control over impulsivity.

[formflier]

  Impulsivity is a key feature with pwBPD.  

Max,

I'm hoping you can find a way to "push this" without mentioning BPD... .as long as not mentioning it does not detract from the treatment.

Impulsivity and "emotional stability" would seem to be great things to focus on ... .without mentioning BPD.

[MissyM]

Max, it sounds like you are talking about cross addictions.  (My dBPDh has this).  If the core issues aren't addressed, then another substance will just be replaced.  So I can absolutely identify with why this is upsetting.  If you just ask her questions about having multiple addictions, what does she say?  Does she understand what is beneath it?

[sweetheart]

Max you have raised what I believe is quite a contentious issue in the world of therapeutic intervention  in relation to people with BPD.

In my long distant before BPD past lets just say my career path was much involved in the therapeutic arena. I know this forum is not someplace to espouse certain types of therapy but in my personal experience therapeutic interventions loosely divide ( and I mean loosely ) into two basic perspectives.

- one is the approach that looks at the layers of emotion underneath a presenting problem and gently strips them away with the aim of exposing and exploring root cause.

- the other approach is the one that takes the presenting problem and works with the presenting problem. this approach acknowledges that there are underlying issues but does not have to look at them. it is very much in the here and now.

In my experience a diagnosis is not necessary for either, or for the therapy to be effective.

Most therapies aimed at pwBPD are here and now focused including addiction models if they are 12 step based and they do not focus on the overall diagnosis but the presenting behaviours and problems as identified by the individual.

Formflier is right saying focus on behaviours like impulsivity and not on diagnosis - your wife is clearly aware of these surface behaviours and many of her core issues and is able to engage in therapy in a way that she finds helpful some of the time.

What difference do you think it would make to your wife if she admitted/acknowledged her diagnosis of BPD ?

[formflier]

What difference do you think it would make to your wife if she admitted/acknowledged her diagnosis of BPD ?

I would modify this question a bit... .to say... .or ask... .what if she was consistent about this?

It sounds like she will occasionally acknowledge this... .

And certainly having her admit to BPD in a dysregulation is not a goal either.

It sounds like a goal is to get her to fess to BPD enough so that therapy can be effective... .(of course I'm assuming that her consistently "fessing" to this will be effective.

[maxsterling]

I think the issue is not for her to admit to and treat the BPD specifically, but to recognize her issues are pervasive and not just the superficial issue she is dealing with.  For example, obsessing over food --->  obsessive thoughts in general.  I'm not really asking how to get her to see things that way, I'm more wondering why she doesn't, or if she doesn't.  And I can't say treatment would be any different or her healing would be any faster or more effective.

I'm asking this question more in a general sense, as a curious person.  I find it interesting that she will talk about obsessing over food as this is a new an unique discovery, when clearly she knows and has articulated she has had obsessions over other things.  My curiosity asks why she is not putting two and two together and saying "I have a problem with obsessing over things, and I need to address that and find was of not obsessing" rather than "I obsess over food, I wonder what foods I eat trigger the obsession."  In that sense, she's still obsessing over why she obsesses over food   And for that, I don't think she will get anywhere in the long run, because then she will obsess over figuring out what her "trigger foods" are.   

[Cole]

Max,

Understand what you are dealing with.

My BPDw has been dx as both BPD and bipolar. She accepts the bipolar dx and takes meds for it. But she refuses to believe or get help for BPD. I almost wish they would change the name of this disease so it does not sound so personal.

She promised to call her P and look for a new T this week. If she does, I am going to call the new T and warn him/her not to use the term BPD because she will paint them black and stop going. Several T's have brought up BPD, and that was the last time she saw them.

[maxsterling]

Cole - I hear ya.  This disorder makes no sense.  To me it's like if my wife was told she was allergic to wheat.   Symptoms include upset stomach, rash, and headaches.  So rather than stop eating wheat, she would take antacids, apply a skin cream, and take advil, yet still wonder what is causing her headaches, rash, and upset stomach.  That's the way it seems right now.  She was describing her food issues with her cousin and her dad, saying things like "now that I am realizing that I am addicted to food... " She's been addicted to nearly everything else in her life, so it just sounds weird to hear her talk of this being some kind of a new thing. 

[formflier]

My curiosity asks why she is not putting two and two together and saying "I have a problem with obsessing over things, and I need to address that and find was of not obsessing" rather than "I obsess over food, I wonder what foods I eat trigger the obsession." 

What does she say when this question is asked?

[maxsterling]

My curiosity asks why she is not putting two and two together and saying "I have a problem with obsessing over things, and I need to address that and find was of not obsessing" rather than "I obsess over food, I wonder what foods I eat trigger the obsession." 

What does she say when this question is asked?

Next time the discussion comes up, I will try to steer it in this direction and see.   My guess is that she would probably agree, yet change nothing.  And that is my basic question here - obviously she's not putting two and two together, and obviously doctors and others have put two and two together when they diagnosed her BPD - so what is preventing her now from carrying that through?

[formflier]

Next time the discussion comes up, I will try to steer it in this direction and see.   My guess is that she would probably agree, yet change nothing.  And that is my basic question here - obviously she's not putting two and two together, and obviously doctors and others have put two and two together when they diagnosed her BPD - so what is preventing her now from carrying that through?

I think this would be a great topic for MC.  A great topic to let her think on and give you a response later.  

This is not a one time discussion... .I think after many discussions... .you may get some TLCs here... .

[Cole]

Cole - I hear ya.  This disorder makes no sense.  To me it's like if my wife was told she was allergic to wheat.   Symptoms include upset stomach, rash, and headaches.  So rather than stop eating wheat, she would take antacids, apply a skin cream, and take advil, yet still wonder what is causing her headaches, rash, and upset stomach.  That's the way it seems right now.  She was describing her food issues with her cousin and her dad, saying things like "now that I am realizing that I am addicted to food... " She's been addicted to nearly everything else in her life, so it just sounds weird to hear her talk of this being some kind of a new thing. 

Max, I once compared BPD to someone trying to interpret Spanish by using a German dictionary. If my wife found out she was allergic to wheat, she would buy a spare tire for her car, plant an apple tree, learn to play the harmonica, and keep eating wheat. It is as if logic just does not compute for pwBPD.

I have been using a sales tool called SPIN (situation, problem, implication, needs pay-off) to help her make more logical choices. It is all about letting the client (in this case the pwBPD) come to their own logical conclusions. Had some good results on small matters, so far.     

[formflier]

I have been using a sales tool called SPIN (situation, problem, implication, needs pay-off) to help her make more logical choices. It is all about letting the client (in this case the pwBPD) come to their own logical conclusions. Had some good results on small matters, so far.     

Very interesting... .any chance you can start a new thread about this?  And lay out some details and word for word on how this goes down... .and how it has worked... .and not worked when you tried it.

I'm intrigued...