"Do not try to diagnose BPD -- only a professional can"

[Tim300]

":)o not try to diagnose BPD -- only a professional can"

I have seen variations of this statement on these boards and on other boards.  And I disagree with the statement. 

What exactly is the magic that a "professional" has that allows only him/her to diagnose BPD?  If you Google "Borderline Personality Disorder" and ":)SM" you can find the list of traits written in plain English.  Does getting a medical Ph.D. or other degree give someone a special ability to read English?  Is there some test they perform that is different than simply reading the plain English and observing the patient and her responses to questions?  Personally, I would trust a non-BPD survivor of a BPD relationship to be able to spot pwBPD better than some trained medical professional who hasn't had a firsthand intimate relationship with a pwBPD.   

Perhaps one can argue that a non-BPD survivor might be too subjective in evaluating his own SO.  Yet on the other hand, who else on the planet could better know if the BPD traits exist than the person who spent time (perhaps years) with the SO every day and was potentially subjected to the most intense aspects of BPD?

Furthermore, BPD traits seem so unique and oddly put together as a combination of behaviors, that it seems to me like if you read the traits and your eyes are popping out of your head as you say "WOW, this is it," it's very likely that you've come to the proper conclusion.  Surely, there might be gray cases, where one only sees 3 of the traits in his SO, but if you're clearly seeing all or all but 1 or 2 of the traits, rest assured that you've made a match, with or without having your SO hand you a laminated official diagnosis in rare moment of BPD candor. 

[thatwasthat]

Spot on.

[ogopogodude]

I, too, disagree with this statement.   We here at this site, ... .ALL OF US MEMBERS here, are professionals in BPD. I know that I am.

I live it every day. So do my teenagers who KNOW full well that there mom is ill and they are always walking on eggshells (in terms of being careful of what to say, and what not to say in front of their own mom).

So, ... thus, my kids are professionals as well on the topic of BPD.

We here, are all excellent sources of the behaviour of BPD persons and their effect on those around them.

I actually was/is VERY disappointed on certain physicians that I visited and discussed BPD with them.  Some of them didn't have a f'ing clue what BPD was... .

[Skip]

Let's peal this back a little... .what is your real point here?  What is someone doing that they need to do different?

I could shoot down your argument that Borderline personality disorder is highly unique. The DSM 5 committee wanted to scrap the current criteria in favor one that made more sense. Their reasoning was that 87% of people with "BPD" have it in the comorbidity with something else.  The new criteria is in the appendix of the DSM five pending further study. They'd be happy to just make a personality disorder, with traits based on 4 measures.

Look at the criteria behavior for somebody with ADHD... . 

Also, before anyone diagnoses borderline personality disorder, using the DSM IV multi-axial system, they have to eliminate a large number of other conditions.

That's a lot of technical "stuff" that probably doesn't really matter here. Generally, if we know we're dealing with someone with an impulse disorder, we are going to see a lot of the things that we see on this board. And the tools for borderline personality disorder... .

Tim300, what is someone doing that they need to do different?  

I noticed you were taking some swipes at Marcia Linehan PhD and in another thread, what's up?

[Tim300]

I actually was/is VERY disappointed on certain physicians that I visited and discussed BPD with them.  Some of them didn't have a f'ing clue what BPD was... .

I've experienced this disappointment too.  A close friend of mine is a recent med school grad and as my relationship with my pwBPD was progressing I was coming to her with stories of the crazy behavior -- my friend said something was "off" but I'm surprised now that she wasn't able to give me the label BPD (which would have helped me tremendously).  When I figured out the label she recalled studying it in med school but I had to refresh her about it.  

Also, our MC disappointed me a bit with her lack of understanding about BPD.  First, if the MC had better understood BPD she would have tread much lighter in calling out my ex on her behavior right away (which caused my ex to immediately terminate the counseling).  Second, when I met privately with the MC she asked me to explain when I mentioned basic BPD terms like "splitting"; it's like I am much more of an expert on BPD than the MC is.  You need to go to an MC who specializes in BPD.

I agree with you that we here on these boards are the BPD experts.  Without having been intimately involved with a BPD I think it would just be too difficult to completely get your head around it.  With that being said it would be interesting to talk to medical professionals who have seen a lot of BPD cases come through their offices -- I'm sure they'd have a valuable perspective.        

[Tim300]

Let's peal this back a little... .what is your real point here?  What is someone doing that they need to do different?

I could shoot down your argument that Borderline personality disorder is highly unique. The DSM 5 committee wanted to scrap the current criteria in favor one that made more sense. Their reasoning was that 87% of people with "BPD" have it in the comorbidity with something else.  The new criteria is in the appendix of the DSM five pending further study. They'd be happy to just make a personality disorder, with traits based on 4 measures.

Look at the criteria behavior for somebody with ADHD... . 

Also, before anyone diagnoses borderline personality disorder, using the DSM IV multi-axial system, they have to eliminate a large number of other conditions.

That's a lot of technical "stuff" that probably doesn't really matter here. Generally, if we know we're dealing with someone with an impulse disorder, we are going to see a lot of the things that we see on this board. And the tools for borderline personality disorder... .

Tim300, what is someone doing that they need to do different?  

I noticed you were taking some swipes at Marcia Linehan PhD and in another thread, what's up?

Thanks for this perspective Skip.  I do think it's good to challenge one another to best understand the great complexity that is BPD.  

My main point here is that in many cases a non-professional can label someone with BPD . . . if it walks like a duck, talks like a duck, etc.  And I don't think its constructive to instruct people otherwise.  

First, I wasn't trying to pinpoint any particular member(s).  The perspective that you shouldn't diagnose is one that I've read many times (including many times off of this site).  This perspective is generally shared in response to a thread about another question, so I figured it might warrant having its own thread to discuss the merits.  Nobody needs to do anything differently -- I just didn't agree with the statement and thought it was worthy of discussion.

Second, regarding BPD being unique, I think I understand your point.  And I do find it odd that one only needs to meet 5 of 9 traits.  It seems like there's a lot more to be learned about BPD and I imagine that one day we'll see the current traits split into maybe 2 groups to describe 2 more-uniquely defined disorders.  With that being said, what I mean by unique is that aside from my ex-fiancee, I have never met someone in my life who (1) complained severely about abandonment fears (including imagined abandonment), and (2) idealized and devalued others in a pattern of intense and unstable relationships, and (3) and on down the entire list (including having 4 minor car accidents caused by impulsive driving within a 12-month stretch). . .  I mean, even looking at these each trait individually, these are really not characteristics that I see in people, let alone all in combination with one another.  Seems like a very unique combination to me.  It would be very hard to misdiagnose this in the case of my ex -- she truly meets the criteria to a T (as so many other members have described their exes).  

In contrast, since you brought up ADHD, I looked at the criteria for this and it seems like these traits are quite common and not uniquely lumped together in any surprising way.  I would have a much more difficult time diagnosing ADHD (aside from some very obvious cases which I'm sure exists).  

Third, going off topic from this thread, regarding the Marsha Linehan quote, I wasn't seeking to single her out (and certainly not personally attack her), it just seemed like a good introduction to a topic I thought was worth discussing.  In the New York Times article a lot of the commentators seemed to jump on her for not describing BPD as "dangerous," and I agreed with these commentators and thought it would be a worthwhile discussion on bpdfamily.  I do think it would be a shame if a non caught wind of the term "Borderline Personality Disorder" and looked it up and dismissed it as a trivial personality quirk.  Similar to the Linehan quote, I see a lot of literature about BPD mentioning that pwBPD are more likely to harm themselves than others (period, end of discussion, go home) -- perhaps this would have been a better prompt for a robust discussion than the Linehan quote.  Anyhow, cheers!

[Skip]

Granted, community social workers and MC don't know about rare and complex disorders, just as your child's pediatrician doesn't do cardiac ablation. 

A big difference, in my mind, is that the mental health system does not have the referral culture of MDs.

Have you read this: https://bpdfamily.com/content/treatment-borderline-personality-disorder

For the reasons you mention, it has top position in our editorial.

[Skip]

In the New York Times article a lot of the commentators seemed to jump on her for not describing BPD as "dangerous,"

Link?   

[Tim300]

Have you read this: https://bpdfamily.com/content/treatment-borderline-personality-disorder

Interesting article.  Thanks.  I agree with the part about therapists shying away from even suggesting that a patient has BPD.  I know that there are many likely reasons for this, one of which I can't help but suspect is that it will cause the therapist to lose a potentially great source of revenue (cynical of me, I know, but I can't help but mention it).

[Mutt]

Tim300,

I went to a lot of MC sessions and I felt anger, disappointment, resentment because if anyone had given me a clue, it may of been a chance to save my marriage. Is this what it's about?

[Tim300]

In the New York Times article a lot of the commentators seemed to jump on her for not describing BPD as "dangerous,"

Link?   

www.consults.blogs.nytimes.com/2009/06/19/expert-answers-on-borderline-personality-disorder/

[raisins3142]

I know I found out about BPD and that my ex has the traits by googling "cutting" which she did during a period of her life.  I bet a lot of people find out by looking up something related to self harm.  If they are solidly BPD, it is pretty obvious.

[Tim300]

Tim300,

I went to a lot of MC sessions and I felt anger, disappointment, resentment because if anyone had given me a clue, it may of been a chance to save my marriage. Is this what it's about?

This is frustrating and I had a similar experience with my first MC.  I think we are straying to a different topic than the original subject line of this thread.  This seems like a very worthwhile topic though.  I guess the topic is "Why do some MCs fail to tip off the non about BPD?"    

[Suzn]

Tim I get what you're saying. Therapists have 50 minutes a week or biweekly to get to know a patient. We lived with it, most unknowingly. Till they find these boards.

There are so many variations of the behaviors of this disorder, not to mention the severity scales. I've been on these boards for around 4 years and missed the waif/hermit traits in my own mother. I just recently figured this out. I'm in no position to say she's diagnosable even having known her my entire life. I know she exhibits a bunch of traits but then again I don't know for certain how she thinks.

And to further add more confusion. Codependent traits are very parallel to BPD. Here's just one example of googling those parallels.

www.reignitethefire.net/codependency-serious-problem-relationships/

I've known about these parallel traits for a long time and have no problem sharing that they scared the hell out of me being that I am indeed a recovering Codependent. It scared me because of the stigma. Even on these boards and really if you've read as much as a lot of us have here most people have exhibited traits at some point in their lives.

I'm not a professional by any means but I can identify unhealthy behaviors and whether it be because of codependency or BPD or npd... unhealthy behaviors are just that, unhealthy behaviors.

[Mutt]

May I add the real acting out is usually directed at the SO behind closed doors around family members, usually away from onlookers. There were exceptions with my ex, seldom rare that people saw the other side. Unstable inter-personal relationships.

[Gonzalo]

I know I found out about BPD and that my ex has the traits by googling "cutting" which she did during a period of her life.  I bet a lot of people find out by looking up something related to self harm.  If they are solidly BPD, it is pretty obvious.

I first found out about BPD when I started googling MY symptoms. Things about how I'm feeling crazy, my partner is accusing me of stuff that doesn't make sense, we're talking about things that never happened, and the like. When I kept finding BPD without even looking for information about her, I knew I was onto something.

[SlyQQ]

A lot of proffesionals refuse to diagnose even when they see it the reasons are self evident but actual diagnosis is suppose to be a positive ( though this mainly comes from an increase in hope which for complex reasons I would personally discount ) Also BPD is hard to diagnose correctlly most health proffessionals are on very shaky ground here an often get it wrong ( again personally its an i could do it with my eyes shut scenario but I know if i did not know BPD i would swear blind my NON BPD step daughter would have it having all 9 criteria ( though no actual suicide attempts ) easily falling into dsmV categories an even having said those immortal words to me in the heat of an argument " I HATE YOU" an as i through my hands up an started to turn around ":)ONT LEAVE!" ( my experince with BPD goes more like GET AWAY FROM ME! WHERE ARE YOU _____ GOING !"

Having said all that i believe there is a big difference between BPD an BPD Traits having expierinced it directly and HOW you handle a highly sensitive personaliy with all the traits but probably no genetic disposistion towards BPD an someone who is actually BPD but thats another story

[drummerboy]

What I'd like to know is how a T could diagnose it if all they had to go on we're the words of the pwBPD? My ex had been in T for 10 years with countless Ts and AFAIK none ever suggested BPD, they just kept treating her for severe anxiety and major periodic depression. Unles they were 100% honest it would be impossible to diagnose without talking to family, partners. And of course the vast majority of them probably never even get to T so will go undisgnosed their whole life.

[SlyQQ]

couldnt agree more the main problem a therapist has diagnosing BPD is there main point of reference is the patient with BPD this is a really bad place to start they are normally led quite a merry dance have seen this too an if they get close voila new therapist

[apple2]

":)o not try to diagnose BPD -- only a professional can"

I have seen variations of this statement on these boards and on other boards.  And I disagree with the statement. 

What exactly is the magic that a "professional" has that allows only him/her to diagnose BPD?  If you Google "Borderline Personality Disorder" and ":)SM" you can find the list of traits written in plain English.  Does getting a medical Ph.D. or other degree give someone a special ability to read English?  Is there some test they perform that is different than simply reading the plain English and observing the patient and her responses to questions?  Personally, I would trust a non-BPD survivor of a BPD relationship to be able to spot pwBPD better than some trained medical professional who hasn't had a firsthand intimate relationship with a pwBPD.   

Perhaps one can argue that a non-BPD survivor might be too subjective in evaluating his own SO.  Yet on the other hand, who else on the planet could better know if the BPD traits exist than the person who spent time (perhaps years) with the SO every day and was potentially subjected to the most intense aspects of BPD?

Furthermore, BPD traits seem so unique and oddly put together as a combination of behaviors, that it seems to me like if you read the traits and your eyes are popping out of your head as you say "WOW, this is it," it's very likely that you've come to the proper conclusion.  Surely, there might be gray cases, where one only sees 3 of the traits in his SO, but if you're clearly seeing all or all but 1 or 2 of the traits, rest assured that you've made a match, with or without having your SO hand you a laminated official diagnosis in rare moment of BPD candor. 

Tim,

you are right.

Before I read things about BPD, I felt something was unusual in my relationship that I can not understand or explain. My friends also said to me that they can not understand him. And they thought nobody can understand him.

And then I opened my 1. book about BPD. The feeling was really like, WOW, pwBPD said exactly the same thing. I can suddenly understand why he was angry or felt hurted from time to time.

The sad thing is, although I can understand BPD, but I cannot do anything to change him. Because he does not want.

[enlighten me]

I think part of the problem with the categories is that they are too broad.

There are nine criteria for BPD which only five of are required to diagnose it. This means that there are many variations within the BPD spectrum. (Probably over forty variations. Ive not done the maths on this).

If you then add co-morbid traits then it gets even more complicated. BPD/NPD/ASPD etc.

I feel that rather than having this broad brush approach it should be dealt with by having a tick list of criterias giving a more overall picture. Yes at the end you can come to a conclussion that a person has BPD with many traits from other dissorders but it could be a more fine tuned diagnosis.


As to the arghment of only proffessionals diagnosing I have to agree with tim. I probably understand BPD more than most mental health proffessionals as I have been enmeshed with it. My ex wife had a psyc eval during our divorce and the resultwas that she had situational depression. Its obvious that the psychiatrist wasnt informed about the voices in her head, the self harm, the little but constant lies, the thousands of pounds spent on clothes that were never worn and a lot not even in her size. All the little things that build up a picture that an hour with a so called proffessional will never be picked up on.

[SlyQQ]

9! / 5! gives approx 2700 plus possible combinations of symptoms that could result in a diagnosis

[Maternus]

After I was dumped and replaced by my exgf I had many questions and the first answer I found was BPD. It was not a diagnose, I don't want to treat her disorder, but it helped me to understand what has happened.  But later I found out that many of the things I went through in this relationship are also common to partners of pwNPD, pwASPD and all the other PDs in the Cluster-B-Spectrum. Some traits of my ex are more narcisstic and some things she did were so sadistic - maybe she is a psychopath? The only thing I can say for sure is, that I was in a Cluster-B-Relationship. I know what she did to me, but not why she was doing it. 

[enlighten me]

9! / 5!  gives approx 2700 plus possible combinations

of symptoms that could result in a diagnosis

Thinking about it now that ive woken up its a hell of a lot. My ex wife was easy. She ticks all nine. My exgf definately ticks seven but has other traits from other dissorders rolled into the mix.

For me having a name to put to their behaviour helps. I cant treat it but I can now understand it and deal with them in a more healthy way.

[jhkbuzz]

I'm not a professional by any means but I can identify unhealthy behaviors and whether it be because of codependency or BPD or npd... unhealthy behaviors are just that, unhealthy behaviors.

I like this... .I'm pretty certain that my exgf had BPD but the truth is that I can't be 100%, so I go back and forth about it.  But, in the end, the "back and forth" is unnecessary - I don't need ANY diagnosis to conclude that her dishonesty and infidelity - and her tendency to morph into different "parts of self" (as her therapist termed it) were really unhealthy behaviors.  Is there a name for it?  Maybe.  Does it need to be named for me to recognize that it's impossible to have a healthy relationship with someone who exhibits these unhealthy behaviors?  No.

[Targeted]

I Aswell disagree with the statement, I think most caring loving partners that would go to the links to research this and come to this conclusion based on their SO's traits and behaviours would be correct more often than not, mostly because they would be looking for a answer out of love, A psychiatrist or psychologist or counsellor only gets to meet with the subject for 50 minutes once a week, in these meetings you have to account for denial, projection, and omitting many truths and facts. It would take a professional years to cut through the denial in order to find out what is really going on but a loving partner already knows, there is a lot of information in the DSM and a professional obviously is going to have more knowledge clinically but I believe the loving partner has a much better chance at hitting the bull's-eye for a diagnosis having lived at 24 hours a day even if it is only a one point Bullseye and not the full two point bull's-eye! You are at least walking in the park that you belong in for recovery, you cut out years of useless meetings, A good professional can figure out comorbidity from there!

For example in my case we went to counselling for about a year,this was her counsellor that she had for about five years, Her counsellor knows she has anxiety, and says she is codependent with PTSD due to her rape at a young age,her counsellor knows her four children have four different fathers and this is how he is treating her, at least when she decides to go!

Having gone to counselling with her I know that her counsellor does not know about the extent of number of failed relationships in total as I do, her counsellor does not know her level of impulsivity with promiscuity as I do, her counsellor does not know about her reckless driving as I do,her counsellor does not know about her for spending habits as I do, her counsellor does not know that her anxiety is triggered by the fear of engulfment as well as abandonment as ideal because I experienced firsthand when it happens, her counsellor does not know that The Klonopin she takes for her anxiety severely increases her impulsivity, but I do! Her counsellor does not know the full extent of the relationship between her and her parents, but I do! Her counsellor does not know The severity of how she cannot be alone, but I do! I could go on and on But I am confirmed in my belief that a good professional would say to me good job, you are in the right ballpark kid!

[Gonzalo]

Is there a name for it?  Maybe.  Does it need to be named for me to recognize that it's impossible to have a healthy relationship with someone who exhibits these unhealthy behaviors?  No.

I don't think naming it is needed to say ''this is not for me", but having the name to attach to the behavior helped me a lot. I wouldn't have found some of the resources (like this site) to help me. I wouldn't have understood the projection and why it made me feel so crazy. I would be confused by the completely switching interests and activities. I might tried to push for making the breakup more 'fair' instead of just figuring I was lucky to get out with no police or court involvement.

[jhkbuzz]

Is there a name for it?  Maybe.  :)oes it need to be named for me to recognize that it's impossible to have a healthy relationship with someone who exhibits these unhealthy behaviors?  No.

I don't think naming it is needed to say ''this is not for me", but having the name to attach to the behavior helped me a lot. I wouldn't have found some of the resources (like this site) to help me. I wouldn't have understood the projection and why it made me feel so crazy. I would be confused by the completely switching interests and activities. I might tried to push for making the breakup more 'fair' instead of just figuring I was lucky to get out with no police or court involvement.

I understand what you mean... .it helped me as well.  A LOT.  But I'm 6 months out of the r/s and the truth is that I will never be 100% sure of the diagnosis... .and it doesn't matter.  Whatever Cluster B diagnosis it is, the outcome remains the same: a healthy r/s is impossible with a disordered individual.

[iluminati]

I'm going to be blunt.  I've been on this site 5 years this upcoming Saint Patrick's Day.  Thanks to my ex wife's experience, I have met about a dozen pwBPD in the flesh.  I have counseled hundreds of people thanks to my work in this site.  Heck, one of my closest friends in my post-divorce life is a pwBPD (though I have the sense not to pursue anything romantic with her and the feeling is mutual).  Suffice to say that I'm about as qualified as someone can get with regard to BPD without going for a psych degree. 

And I STILL wouldn't diagnose anyone, even when I can spot the traits at 50 paces.

Diagnosis requires two things: a complete background and objectivity.  The fact that we're here pretty much blows that objectivity to shreds.  Plus so many people aren't honest about backgrounds and such, and we don't have the formal training to get people to give the proper answers with full context.

Now, are the tools and ideas on this site a good idea for everyday relationship use?  Yes.  That's why I don't really go to war over the self-diagnosis crowd.  Still, there are so many mental issues in the world that I wouldn't dare diagnose someone.  Just chill, and leave the diagnosis to the pros.  Got it?

[iluminati]

As to the arghment of only proffessionals diagnosing I have to agree with tim. I probably understand BPD more than most mental health proffessionals as I have been enmeshed with it. My ex wife had a psyc eval during our divorce and the resultwas that she had situational depression. Its obvious that the psychiatrist wasnt informed about the voices in her head, the self harm, the little but constant lies, the thousands of pounds spent on clothes that were never worn and a lot not even in her size. All the little things that build up a picture that an hour with a so called proffessional will never be picked up on.

Based on your language, I'm assuming that you're writing from the UK, where it's more difficult to get a formal evaluation.  (And for the record, the NHS sounds like a crummy system for mental health.  12 therapist appointments unless you're full out seeing Jesus in the walls?  Really man!)  Still, from my American perspective, you should have told your mental health pro the full scoop.  My exBPDw was all lined up for electroshock therapy until she just happened to step out to the bathroom, and I told the psychiatrist the stories about her latest breakdowns, up to an including her father getting out of prison.  Suddenly, she was lined up for another go in the mental hospital.

My point is that you need to be able to speak up as to what's going on as much as possible.