What if treatment never helps?

[Moxie]

This is my first time using a support system like this and I'm unsure how to begin, but am feeling very isolated and hope that this alleviates some of this feeling.  I'm hoping for some feedback and advice on two main areas.

My BF of 5 years is very clearly BPD.  When we first began dating, I noticed quickly that something was "off" and encouraged him to get into therapy and psychiatric care.  Surprisingly, he did both and has stuck with it (in his own semi-honest way) for the duration of our relationship.  He has two fantastic therapists, both of whom he has allowed to speak with me at certain points, which he believes shows his commitment to our relationship (but I suspect is also a bid for attention).  His healthcare providers were ambivalent about diagnosing him with Bipolar II, and it was clear that none of them was comfortable with it.  His main therapist, I believe, figured out the BPD first.  It took me three years to figure it out and when I asked her about it, she was unable to verify due to confidentiality, but pointed out that she had changed his treatment modality to DBT.  I took that as confirmation and the more that I have researched the condition, the more it seems to be a slam dunk.  What I don't understand is why she isn't telling him.  He continues to believe that he is Bipolar and reaches great depths of depression periodically when his medication doesn't work for him like it seems to for others.  Because I trust her expertise far more than my own amateur sleuthing, I haven't said anything to him.  But I would really appreciate any feedback from members who might have some insight into why not telling him would be to his benefit.  It's very hard to work out coping strategies with him without being able to share some of the literature available on the subject.

My other issue is with his increasing suicidal ideation.  It has been going on for many years and has been increasing in intensity.  I have reached out to his therapists on occasion when I believed the threat to be a credible one rather than a cry for attention, but that just served to alienate him from them.  I have accepted that if he does follow through, despite the blame he often places on me, that I have done all that I can for him and the choice is ultimately his to make.  And I do feel that there's a good chance that he will eventually follow through - all of his financial affairs are in order, he has several well thought out plans, and he has the means to do so.  I know that he wants help - he looks to me to solve his every dilemma and lashes out when I cannot - but I've run out of resources.  I recognize that I stay with him out of fear that he will use yet another of our breakups as an excuse to follow through and "punish" me for hurting him.  I am almost to the point that I can let go for good, but something is holding me back - and it is likely this threat of suicide.  Anyone who has dealt with this and might have some suggestions would be very, very welcome.

Thank you for listening.

[PLEASE - NO RUN MESSAGES]

PLEASE - NO RUN MESSAGES This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members may appear frustrated but they are here for constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[hergestridge]

From what I know about the US health care system there are insurance reasons for not giving someone a BPD diagnosis. But there is no such thing in the european country where I live, and they still hesitate to change the diagnosis from bipolar II to BPD (which is exactly the route my wife went too).

But it sure is problematic. In my wife's case it left her unable to see her part in any of the conflicts she created through her illness. When she considered herself "manic" she could agree that it was down to the illness, but then all of a sudden she declared herself "well", and then all the fighting was due to other people being ___holes.

True story.

When the therapist eventually broke the news to her that she was BPD, she seemed to have taken a decision never to look that disorder up in a book again. She still doesn't have a clue what it is, even though (I think) she is in DBT now.

I supposed she has a nagging feeling it is the one diagnosis that doesn't let her get away with anything.

[takingandsending]

Hi Moxie.

My uBPDw falls into a similar boat. She is not diagnosed as BPD. She self-diagnosed as PTSD, but our MC advised (to me only) that it is BPD. The MC did tell me that US insurance will not cover it, so she did not recommend pursuing formal diagnosis. Additionally, BPD is pretty stigmatizing, as many counselors will not work with BPD patients. I agree with you, though. It is very frustrating for me not to be able to discuss BPD with my wife. But then, I have no idea how she would react to it. Most of the posters here do not recommend pushing for formal diagnosis with your SO. There are some, though, who really firmly believe it is the best thing to do for a partner who is really discouraged and wondering what's wrong with them. There have been times with my wife when she has asked the "Why me?" type of question when it really wrenched me internally not to tell her. I can see how tough this might be for you, especially as you are worried about suicide.

Your BF has 2 good therapists, which is fantastic, and one has directed him to DBT, which is also fantastic. It seems that he is getting the best help that he can right now, whether he knows it or not. What do you think a diagnosis would do for him, and what would it do for you? Also, can I ask what sort of support you have in this difficult situation? What are the sorts of things that you do to redirect the focus off of him and on to your own needs? That is the hardest work that non-BPD living with pwBPD have ahead of us. I hope that you are able to take some time for yourself, to do some self-care. It is so very hard when you feel responsible (in any way) for your partner's illness. You are not responsible for his illness, and you never were. Knowing that rationally and being able to be free of the thought that you are on a feeling level are two very different things. I hope that you are getting the support that you need. 

I have replied to this in the hopes that some of the more experienced members will also chime in. You sound like you have really been there for your BF. Please keep posting and asking questions. The Lessons on the right of this page do have good information on diagnosis and pros/cons of formal diagnosis.

[ColdEthyl]

Hello, Moxie!

It's a circling-the-wagon sort of issue. At the core, pwBPD fear abandonment and rejection, and any sort of talk about their issues and diagnosis usually ends up in a dysregulation. They can't/won't accept it, or talking about it is just too painful.

My H is diagnosed BPD, and when I first figured out something was up with him, he claimed depression first. When I started doing research, I thought Bipolar at first, until I read about BPD. It was obvious from that point. When I asked him again... .he admitted the diagnosis. That's when I started gathering data and trying to 'help' him.

It did not go well. It was met with "I'm sorry I'm so messed up you need a book to deal with me" (Stop Walking on Eggshells) "I don't know why you're with me, I'm obviously damaged. You should divorce me right now." "I thought you were smart. You obviously are not smart if you are staying with someone like me" etc etc

Eventually, I learned from this site not to discuss it. I do this site at work on my own time, I read the lessons, I apply them, and if and when HE ever brings it up... .I will tread lightly. If he starts to dysregulate, I backoff.

It's a very slow process. I am in one year. I see improvements... .but it's 1 step froward, 2 steps back quite often. That's why people suggest not talking to them about it. It doesn't apply for everyone.

I know it's hard when you see them suffering so, and sometimes the more you try to help, the worse they get.  

[maxsterling]

Well, I can say first off that I am really glad you found us here!  We are a resource for you, to help you sort through this mess.  And believe me, dealing with a suicidal BPD is about the most difficult thing you can ever deal with.  I've been in the same situation, and about the best I can suggest is to read the lessons here over and over, reach out for support from friends and family (not support to help you with him, but support to help you stay centered on you).  The key is to not let his issues dominate your life and drag you down with him.  He is a sinking ship right now, and you are no good to him if you are on the same ship.

As for the effectiveness of therapy - my comment is look for small progress and don't expect miracles.  I can tell you my wife has been in therapy since she was a pre-teen, is now 39, and still displays all 9 criteria of BPD. So what has changed for her?  Well, she has attempted suicide in the past, but hasn't in many years.  She was also a cutter, and hasn't cut in many years.  She also used to use heroin, but has been sober now for 12 years.  So, those are all progress.  The therapy has undoubtedly saved her life.  But her relationships with others are still very rocky.  She claims she used to be more abusive and more out of control, but I have a hard time seeing how she could have been much worse. 

I can tell you that if he is going to therapy, that is a very good thing and much better than what most people on here deal with.  Most people on this board are dealing with a person who has no diagnosis at all and is unwilling to go to any kind of therapy.  You just need to have faith and turn his mental health over to the concern of his therapists and doctors, because you do not have the training to deal with it.

[ColdEthyl]

Moxie I don't know if you read this tool yet, it had an answer for you in there:

https://bpdfamily.com/content/how-to-get-borderline-into-therapy

"Professionals do not recommend that you tell a loved one that you suspect that they have Borderline Personality Disorder. We may think that our loved one will be grateful to have the disorder targeted and will rush into therapy to conquer their demons, but this usually doesn't happen.  Instead, this is difficult advice to receive and more likely to sound critical and shaming (e.g., you are defective) and incite defensiveness, and break down the relationship trust.  It's not like a broken leg where the affliction is tangible, the cure is tangible, and the stigma nonexistent.  While we are grateful to learn about the disorder and the pathways to recovery - for us the information is validating and represents a potential solution to our family problems- to the afflicted, it is shaming (you are defective),  stigmatizing (mental illness in general, Borderline Personality Disorder specifically), and puts all the responsibility for the family problems on the loved one's shoulders."

[Moxie]

Wow!  I am not only grateful for the logical and practical advise you have all provided, but I am surprised by the comfort that I feel at knowing that I'm not alone in this rocky journey.  Although logically that is obvious, until you hear from real people what their experiences are, it's easy to give in to the feeling that there is no world outside of the dysfunctional, rather isolated one that seems to develop in conjunction with this type of relationship.

I feel compelled to ask another question.  Does anyone have any suggestions on how to handle integration of a BPD significant other into a blended family?  As I mentioned in my previous post, my BPDbf and I have been together for over five years and we each have a daughter.  His lives with her mother and is young; mine is with me and is a teenager who very distinctly does not care for him and never has.  It's a source of profound stress in our relationship and for me personally because I try very hard to manage each relationship separately.  By doing this, I feel like I am protecting my daughter from the discord that follows him, but he feels that I am deliberately trying to segregate him.  He's not wrong, although I dance around the subject when it comes up (as it does increasingly often).

As a mother, I don't believe that my daughter should have to navigate the challenging relationship that I have chosen.  I feel strongly that any benefit that he might bring to her would be heavily outweighed by the inevitable confusion when his actions and words become antagonistic or confusing.  I have also been motivated by wanting to shield her from abandonment issues that would result should he elect to end his life.  In doing what I believe is right, I have to be less than honest with him and I have to spend more time away from my daughter than I would like in an effort to placate him.  To "talkingandsending's" point, this does not leave me much time or energy for self-care.  My daughter is a junior in high school and I have broached the obvious solution with him about just waiting until she goes off to college rather than pressuring me to make these significant changes he wants me to make regarding her behavior and attitude towards him.  He strongly disagrees and is currently not speaking to me because of another conflict on this subject.

It is my gut feeling that the decision that I have been making is the right one, but I haven't had anyone to solicit feedback from who may have experienced something similar or who has more experience with BPD partners than I.

[takingandsending]

Hi Moxie. You are definitely not alone. 

I wrestle with what to tell my two children regarding their BPD mom, but they are ages 3 and 9, so I am not even certain the oldest is at a point that he could understand about mental illness. But your daughter is older and maybe it would help her to understand your boyfriend and your relationship with him. If you live in North America, you could look to see if there is a NAMI group in your town or city. The NAMI affiliate where I live offers family support classes and also some peer to peer groups for adults and children that allow families living with mental illness to connect, talk and listen to each other's experiences. It is very helpful. There is also a book that I have heard other members on this site recommend for nonBPD parents helping their children negotiate a BPD parent or significant other. The book is Randi Kreger's Essential Family Guide to BPD, which I think has a chapter(s) specific to how to discuss BPD with your children.

Also, from my own experience, I have observed that the better I am doing myself, i.e. the more self-care and less enrollment in my wife's drama and more just living and enjoying life that I do, the better my kids seem to do with themselves and their mom. When everyone is tense and upset, my sons are the proverbial canary in the coal mine, they act out, they become very needy and in general are confused about their security. Even though your daughter is older, I imagine it is much the same. As I keep being reminded, you have to put the oxygen mask on yourself first before you can help others - I get that when it comes to my wife, but it is much harder to do when it comes to my kids.

[ColdEthyl]

Nope you are soo not alone!

I am married to my dBPDh, and I have two children from my previous marriage, D14 and S10. To answer your question, my H doesn't interact with them much. He's afraid of 'messing up' 'being the bad guy' or them 'not liking him'. I quit trying to push it.

My children know about BPD and it's effects, I have spoken to them about it. It was easier for me to do this than most because my children are already familiar with mental illness. I take care of my brother who lives with us who is paranoid schizophrenic, and my S10 is Asperger's. For him, it's data collection. For my D14, she's been around her uncle her whole life, and there are similarities between him and my H.

[maxsterling]

Explaining things to your child is another animal.  I think most children probably feel a bit apprehensive towards their parent's new partners to begin with, add BPD to the mix, and it's easy to see why your daughter is wary. 

And from the other end, I can also see why your BPD partner may not be comfortable with your daughter.  pwBPD have difficulties with interpersonal relations, so dealing with a partner's family is typically stressful.  My wife has a hard time interacting with my family.  Not only that, but pwBPD tend to be self-centered and envious, and to your partner, your daughter represents a previous relationship - something he may never feel comfortable with.  Interestingly, my wife gated lots of men before me, and to my knowledge only once dated a man who had a child.  She doesn't talk fondly of the child, which I find odd considering how much my wife wants a child of her own.  It's like a double-standard for her.  If she was a single mother, she would chastise any man who would not want to date her.  Yet she seems wary of men who are single dads. 

My advice here is to be honest with your daughter about his mental illness.  Validate your daughter's concerns.  Re-assure her that she comes first.  Make sure she feels like you are not abandoning her for him.  Sometimes pwBPD dominate our lives, and we need to be extra aware to keep our focus broad.