New clinic changed her diagnosis to depression on first visit. I need advice

[Jacq189]

A few months ago we moved from the city to a country town. So we are in the process of getting my BPDgf set up with the local hospital for treatment of her BPD. Today she had her first appointment with the triage team. She always like for me to come with her to the first appointments because she isn't very good at explaining herself and gets very emotional having to talk about her mental health. Unfortunately she was dysregulated today and had me painted black after an incident last night so I wasn't allowed to come with her to the appointment. When she got home she said they told her that she doesn't have BPD because she doesn't fit the criteria and that she has depression instead and they will be contacting her GP advising of the change in diagnosis. This seems like such a massive step backwards and a huge kick in the teeth. I have lived with this woman for over 7 years and have spent the past year and a half studying BPD, Im sure many here can relate that I could basically have a PHD on the subject. There is absolutely no doubt in my mind that she has BPD and the previous hospital she was receiving treatment from agreed. I don't understand how they could make this decision after talking to her for only an hour. She absolutely does fit the criteria for BPD but maybe she wasn't able to explain her symptoms very well to them. My ex had clinical depression and that was an entirely different beast to what my current partner suffers from.  If she does have depression at all it is only mild and is a sideline to her severe BPD. The new clinic said they would put her into group therapy like she was receiving back in the city so that is good. But my fear is that she wont be receiving the appropriate care and that this mix up will derail her. It has been a difficult and painful road for her to accept that she has BPD and for them to suddenly say "oops no, actually we will label you as this now" seems so destructive. I have told her that I think they are completely wrong. I asked her what she thinks but she doesn't really know what to make of it all. I am still painted black and am banished to the spare bedroom for the second night in a row so there hasn't been much communication yet.

Has anyone else had these kind of issues with mental health professionals messing around with diagnosis? Am I overreacting or should I contact the clinic and try to explain my point of view? I really don't want to interfere but I know flat out that they are wrong and I don't want this to jeopardise my partner's mental health.

Any advice is appreciated :-)

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[Ceruleanblue]

I was told a lot to not worry so much about the diagnosis. My worry, like yours, was about his receiving the correct treatment though. In our case his primary diagnosis is Intermittent Explosive Disorder and also traits of BPD. Trust me, I know he has every trait except one, but I no longer care because his psychiatrist did put him in DBT, and put him on meds that seem to be working.

I've had a therapist tell me that the diagnosis does matter, but others will say it doesn't. I'm pretty confused, but I'm just glad things are better. What a battle though. I know just how you feel, because I, and plenty of others here have been there too.

I fail to see how they could diagnose her in such a short time? Don't they take her past diagnosis into consideration?

[Oooohm]

Jacq189,

Just an observation:

It seems to me her diagnoses and treatment is Very important to YOU. She sees this to be the case... .

You where painted "black"... .so what is important to you is no longer "Accepted"... .

She went to her appointment... .  Alone... .  No witnesses... .

And came back and told you... .  she is no longer BPD... .Proving you wrong... . 

Hmmmm ? 

Makes you want to think hard about what the symptoms of BPD are and how they affect the sufferer in situations just like this one.

Maybe give it a little time to see what develops... .Maybe she will come back with a slightly different story when you are "White".  I wouldn't push it in the meantime... .

Possible ?

[maxsterling]

My thoughts:

1)  ALL people with BPD have depression.  ALL.

2)  ALL people with BPD have anxiety issues.  ALL

3)  Most people with BPD could also fit criteria for PTSD.  All the T needs to do is listen to the sob/blame others story that all pwBPD seem to have.  You know, the abusive ex, the abusive parents, the abandonment, neglect, rape, etc.

4)  MANY people with BPD are diagnosed bipolar.  Many criteria overlap, at least on the surface.

5)  All 9 criteria are usually not present, nor are present at the same time.  In fact, most of us probably meet a few of the 9 on any given day.  It takes more than one visit to see the patterns.

My feeling is this:  There are meds available for Bipolar, anxiety, and depression.  Some meds help ease BPD symptoms, but won't really help the underlying problem.   So, it is of my opinion that many doctors will push diagnoses they can treat with meds first, before resorting to more rigorous therapies.   

Let's put it this way.  My wife meets all 9 criteria of BPD on a daily basis.  If you wee to write a book about BPD, it would literlally include her as a case study.  She's been diagnosed over and over and over, by multiple doctors in multiple hospitals.  Yet, they still send her home with treatments for bipolar, depression, anxiety, or PTSD.  I still think that if her T had the guts to say "your problems is BPD, I know how to treat that" and my wife would move forward, there would be real progress.  I was hoping that would happen after the last suicide attempt, but so far, not much. 

[Jacq189]

Thanks for everyone's input It always helps to get another perspective.

I think I will just let things be and see how it plays out. The most important thing is that she is still receiving some kind of treatment. She has another appointment in a couple weeks so if she wants me to come with her I will voice my opinion then.

I have been thinking about why her diagnosis of BPD is so important to me. And I think it is because after years of trying to figure out how on earth to make my relationship with her work, my learning about BPD and how to interact with a pwBPD is the ONLY thing that had made an ounce of difference. Understanding BPD has been paramount to my existence and to my future in my relationship. My partner has not researched her illness and has only done the bare minimum of therapy to keep me from leaving her,  so her understanding of BPD at this point is limited. I feel that the only way she will progress is to understand it better. And so being told she doesn't even have the condition seems like a massive leap backwards to her recovery.

But, like I said, I will see how things go for the moment. No point over stressing because the aim of the game is to make everyone's life easier and stress isn't conducive to that. 

[Ceruleanblue]

I understand how you feel. My BPDh I know has not researched what his psychiatrist said he has, and I just can't fathom that. I remember always feeling I was different, and I watched an Oprah show 20 years ago, and found out it had a name: Obsessive Compulsive Disorder. I couldn't learn more fast enough. It was a relief to me to know I wasn't crazy, and that it was something I could work on, and there was a reason for it.

My BPDh is in DBT, and on meds, but I just can't understand why he doesn't want to read up on it at all. I don't feel he's in denial anymore, per se, but he just seems to have a lack of interest.

I guess we research and read up because we are the ones dealing with so much fallout? It's their "norm" so maybe it's not as troublesome to them? I don't know.

[Notwendy]

I think the denial and projection is part of the condition. If you project your bad feelings outside of yourself by blaming others or assigning them to others, then you aren't aware of it. It is surprising to see people cause havoc with others in their lives, and seem unaware that they had a part in it.

There is an acquaintance who I don't have contact with, but I hear about her from others. From what I hear about her, she seems to fit the criteria for BPD. She doesn't stay in a job- goes from one to the other, and each time she leaves the job it is her bosses' fault or someone else's fault- and reasons why the job is terrible. She's had a few failed marriages, raged at people, broken ties with several of her family members. What strikes me as interesting is that she seems to not have a clue about her role in this- to her, it is someone else's fault.

I think for nons, if something were to go wrong in a relationship at work, or family, we ask ourselves what part we played in this. I think this is hard for someone with BPD to achieve. I think it can be done sometimes by a skilled therapist, but I don't think it is something they do on their own.

Since they are so quick to reject their role in this, I wonder if therapists pick something less threatening like depression so that they can work with them without them running out the door. The label may be less important than what they do in therapy with them. There may also be some issues with insurance- which may approve one condition for treatment better than the other. It isn't being dishonest to list a symptom that will be treated in therapy. Either way, they can treat the depression and other aspects. Perhaps they would not get approval to treat depression if the code is BPD.

If the therapist is way off or it is not effective, then you can get another opinion.

[Panda39]

There can also be insurance payment issues around a BPD diagnosis vs depression so that could be at play.  Maybe during their eval with your gf depression was all she exhibited and more will unfold later. The diagnosis that she has now is not set in stone.  

I would just focus on the treatment she receives.

[Jacq189]

She has now crashed right down from her rage after a few days away from home. She has been very apologetic of her behaviour and how she has been speaking to me while she was raging and whilst I was painted black. No specific apologies for specific things she did though (which I rarely get anyway). She has fully swung back the other way and I am perfect and can do no wrong.

So I was able to re enforce that I don't need apologies, I need her to take action and take control of her own mental health. She agreed that she needs to do more research into what BPD is which she has now started to do. It didn't take long for her to say "how did that therapist not think I have BPD? I told them all of this. I clearly have BPD.". She has downloaded some books and has gotten her file out from her old DBT and wants to go through all of the skills again. Progress yay! :-D

Insurance isn't an issue here as we have been going through the Australian public health system. Same system that diagnosed her over a year ago. All we are doing is changing the hospital who cares for her. The therapist had all of my partners previous notes in front of them all conforming to BPD,  she only spent half an hour with my partner before coming to her conclusion. I think it was a grossly inappropriate thing to do and my partner agrees. Luckily the next appointment will be with a different person who will be my partner's case manager. She wants me to come with her to that appointment and to help get things straightened out. The therapy that they are offering is CBT which I think is out of date even for depression but I am trying to keep my partner enthusiastic about it because it is still better than nothing.

The best thing is that this has opened the lines of communication between us about her mental health. Who knows how long that will last but I am not taking it for granted.

[Thread]

I am also concerned about this.

My pwBPD H will be taking an evaluation soon and his therapist recommended I join so that there is a full view of whats going on... .My pwBPD H often tells stories much opposite than what really has happened, or down plays the behaviors to "I'm joking" or "I was just being dramatic"

My only advice I have is maybe search for a DBT clinic or Institute to get diagnosed. I'm hoping since this is the path we are taking that they will see through his not sincere answers... .I'm worried he won't discuss the suicidal threats, or the rages to the extent that they occur.