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Author Topic: According to psychiatrist he is fine  (Read 414 times)
believer55
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« on: January 29, 2015, 08:42:32 PM »

I have been waiting with baited breath for my uBPDh to see a psychiatrist through public health system (has taken a couple of months). I have learned from the posts you have all shared not to get my hopes up as far as diagnosis goes. According to DSM he ticks more than required for criteria but he was told yesterday he is just having trouble getting over his previous relationship and he is fine. So now he looks at me like I have 2 heads when I try to validate or use SET as he thinks he is fine. The last 2 days have been full of verbal abuse due to me not telling him I paid a bill that I already told him I would pay. I am apparently the worst person on earth and he has started shoving things around the house and trying to trip me if I have to walk past him.

My question is ... .how do you encourage SO to seek help if they have been told they are fine? he is on Prystiq which of course does not help the rages and anger. The dysregulation is happening about every 5 -7 days and seems to escalate faster each time. It takes 4 -6 days for him to come down from these. I am becoming exhausted and was pinning my hopes that someone would recognise his behaviour and start providing him with strategies to cope and he was wanting this. Any advice welcome... .
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SlyQQ
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« Reply #1 on: January 29, 2015, 09:14:25 PM »

 A Dilemma “We can prescribe antipsychotics, but patients with BPD do not have true psychosis. We can prescribe antidepressants, but patients with BPD do not have classic depression. We can prescribe mood stabilizers, but the affective instability of BPD is not the same as the symptoms of bipolar disorder.” -Paris 2008 (p. 113) Psychiatrists are generally not well placed to treat BPD ( the succes an type of succes for psycholigists is modest at best and moot for many symptoms
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MaybeSo
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« Reply #2 on: January 29, 2015, 09:44:52 PM »

I’m sorry it didn’t provide confirmation of BPD.    In my area, county mental health won’t admit a person for treatment unless they have tried to commit suicide more than once and/or have obvious symptoms of frank psychosis.  Sigh. 

Some folks with BPD do respond well to some medications, but that’s another post….

BPD is a spectrum disorder.  A person could have all 9 symptoms, but have them ‘light’ or be high functioning.  Someone else might have only 5 but may be so extreme as to keep them in and out of the hospital for many years….it also tends to be comorbid with other disorders…it also tends to look like other disorders…AND anyone under extreme stress or in a really difficult relationship could look ‘borderline’ for a while, and not be sick.

Anyhoo…

SET is a communication tool.  It could be used at anytime with anyone…it’s not just for ‘pwBPD’. 

When someone feels truly emotionally validated, it usually feels good, whether or not you have BPD.  But not if it feels clinical. 

Sometimes I’ve seen a person on this board who sounds like they actually have a partner with more NPD for whom validation just pissed them off more…even if done well…I think that’s more an NPD thing…but a pwBPD or the like (and most anyone else)  tends to respond very well to well done emotional validation.

I think it is a mistake to approach a person with ‘tools’ that feel clinical or have been positioned as needed just for ‘them’ bc they ‘have a disorder’.  (I am not saying you are doing that…it just sounds like that may be the case, and it’s pretty common.)   Also, we all sound sort of weird and clinical when we start using new communication tools….until we get the hang of it…and that can be really off putting to a partner at first. 

Also, no one likes being THE IDENTIFIED PATIENT…even those who actually have a formal diagnosis.

If you are in a partnership, it is more helpful to keep the focus on yourself, your own side of the street, your own boundaries and goals, your own mental health, improve your own communication skills b/c they are helpful in all walks of life, both giving and receiving, getting better at taking good care of yourself etc., …than to turn the focus on another person and how they need to change or get dx.

Even if he got a diagnosis…it’s not a cure.  You still have a complicated person on your hands, that you are trying to relate to. You both impact each other.

What are your your goals?  How do you take care of yourself when he is acting-out in the way you described?
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SlyQQ
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« Reply #3 on: January 29, 2015, 09:46:57 PM »

Antidepressants Antidepressants z MAOI’s – moderate effectiveness but lethal in overdose z TCA’s – poor efficacy and lethal in OD z SSRI’s/SNRI’s– greater benefit on anger and anxiety than on depressed mood and impulsivity; still a first-line treatment given safety profile and efficacy

this extract (mayo clinic B Palmer i) ndicates pristiq should maybe help with the anger ( this article is well worth looking at )

( it also points out starting point should be psychologist )
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vortex of confusion
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« Reply #4 on: January 30, 2015, 02:40:18 AM »

My question is ... .how do you encourage SO to seek help if they have been told they are fine? he is on Prystiq which of course does not help the rages and anger. The dysregulation is happening about every 5 -7 days and seems to escalate faster each time. It takes 4 -6 days for him to come down from these. I am becoming exhausted and was pinning my hopes that someone would recognise his behaviour and start providing him with strategies to cope and he was wanting this. Any advice welcome... .

Like MaybeSo said, it is a spectrum disorder. Having a diagnosis may or may not even help. Just because somebody gets a diagnosis, that is no guarantee that they will seek treatment. And, I have heard of people seeking treatment but not taking it seriously so it didn't help much. There really isn't much you can do if the person doesn't want help.

You said that he was wanting this? If he wants help, then why can't he talk to a therapist. Even if he doesn't have a diagnosable condition, he could still seek help for his anger.

If a T gave a diagnosis after just one session, I would be a bit concerned about its accuracy. It is really difficult to tell what is going on with somebody in one or two sessions. It is way too easy for the person to be "normal" in a few isolated sessions.
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misuniadziubek
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« Reply #5 on: January 30, 2015, 09:14:27 AM »

Anyhoo…

SET is a communication tool.  It could be used at anytime with anyone…it’s not just for ‘pwBPD’. 

When someone feels truly emotionally validated, it usually feels good, whether or not you have BPD.  But not if it feels clinical. 

Sometimes I’ve seen a person on this board who sounds like they actually have a partner with more NPD for whom validation just pissed them off more…even if done well…I think that’s more an NPD thing…but a pwBPD or the like (and most anyone else)  tends to respond very well to well done emotional validation.

I think it is a mistake to approach a person with ‘tools’ that feel clinical or have been positioned as needed just for ‘them’ bc they ‘have a disorder’.  (I am not saying you are doing that…it just sounds like that may be the case, and it’s pretty common.)   Also, we all sound sort of weird and clinical when we start using new communication tools….until we get the hang of it…and that can be really off putting to a partner at first. 

Also, no one likes being THE IDENTIFIED PATIENT…even those who actually have a formal diagnosis.

If you are in a partnership, it is more helpful to keep the focus on yourself, your own side of the street, your own boundaries and goals, your own mental health, improve your own communication skills b/c they are helpful in all walks of life, both giving and receiving, getting better at taking good care of yourself etc., …than to turn the focus on another person and how they need to change or get dx.

Even if he got a diagnosis…it’s not a cure.  You still have a complicated person on your hands, that you are trying to relate to. You both impact each other.

This is extremely true as well in my relationship. I read a lot of things off here for a while. I tried to implement many things as well with very limited success. The moment things started working. They sort of 'clicked' more often and often is once I worked on myself.

Simply validating my uBPDbf just for the sake of calming him down is probably the most futile effort I can endure. He recognises it right away and it escalates the situation even more. If I blame the BPD for his behaviour, same effect.

It really hit me one day that I'm not here to 'fix' him or diagnose the BPD symptoms in him. I'm here to be his significant other. And that's an extremely taxing role to take on. Which is why I have to take care of myself.

When he is behaving well, and has just enough openness, he admits himself that his emotions are extreme sometimes and he doesn't always treat me well. But if I try to connect a specific situation to that same description, he gets extremely defensive and points out how all of those were my fault anyways. It's a very delicate road to tread on.

So I don't. I focus less on the BPD and more subtle NPD and I focus on really understanding what he's experiencing.

In a way, you have to take on his filter of the world without identifying with it yourself. If you really understand where his anxieties and anger comes from, you have the greatest tool ever. You have empathy for how difficult it is for him and you can deal with it better. Acquiring any of the skills on this forum for dealing with a BPD are skills for dealing with anyone in reality.

To give an example. I used to be late to meet up with him all the time. To me it didn't seem like a big deal. To him it was the end of the world and proof that I was 'useless' and didn't care about him.

Then one day it clicked. When I'm late, he feels like he can't count on me, he feels such extreme disappointment that  he can't handle. He then associates me with all the people in his life that have severely disappointed him. He regresses to a child-like mentality of me being the evil monster that is out there to hurt him. He backs this up in his own head with bulletpoints of 100% certainty evidence that I don't really love him. That I'm liable to leave him. He can't handle that. He becomes void of positive emotion and it all turns into rage.

I could see it. Through every word he uttered. Through his body language.

"I'm sorry. I shouldn't do that. I should not disappoint you like that. It almost seems like I don't really care about you. That everyone/everything else is a priority over you. Whereas you put me at the highest priority."

And I could instantly see him soften up. These weren't magic words.  But they showed that even an ounce of me understood his plight. And that made a difference.

My point isn't that he's right. He perceives things differently and you have to acknowledge those differences even if they don't make any logical sense to you. You have to take them under consideration every time you talk to him.

You won't always be successful, unfortunately. But every time you are it's another opportunity to decrease the toxicity of an exchange. And again. This can be applied to any situation with any person. Understanding their reasoning and discomfort goes a long way in more effective communication.
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Notwendy
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« Reply #6 on: January 30, 2015, 09:24:48 AM »

In my experiences, people with PD's rarely let on what is going on with them, in general, and almost never in front of a T. I found this very invalidating for me, since when we go to a marriage T, H acts calm, cool, collected and I'm the one that opens up to her. So I'm the one with the label ( co-dependent ) and the intervention ( 12 step group), while my H is off the hook. The T even told me to "stop provoking his rages" which was very invalidating to me. I think she's bought into his act, while I'm being honest, but this is the only T he will go to, and not his own- so I don't want to stop or discourage the possibility that it might help.

I once asked my dad why mom didn't see a P. She did, tons of them, and nothing worked. I don't know what information they had back then about PBD. My parents mostly denied their issues, and occasionally I heard TMI. By the time I asked this, I was an adult and it was pretty obvious that I knew things weren't normal. My dad's reply was that he gave up trying to get her to the P, because he said, she lied to them.

If my mom went to a P, the most she would say is that the P said she's fine. I think sometimes she went to the P for "proof" that she was.
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