Therapist changing diagnosis?

[jennaberk]

Curious if people have had therapists vascilate with their child's diagnosis after they'd been given the BPD label, and how this affected things if at all.

My husband's child (14 years old) was diagnosed BPD and we were not surprised--prior therapist had referred us elsewhere stating she felt a PD in that cluster was occurring and outside her scope. My MIL and SIL also have significant symptoms of BPD and we haven't had contact with them in years due to the manipulation and abuse that they weren't wanting to work on. Considering my stepdaughters symptoms and issues, this was very familiar to my husband who grew up with 2 BPD females.

2 months into treatment, we have had some issues (in our opinion) with the therapist knowing how to work with the family. She was sort of encouraging SD victim position, didn't follow up with us to learn family dynamic or what we have seen and experienced. This week she told my husband and his daughter she was unsure about the BPD diagnosis. My husband was frustrated because immediately his daughter was asking what is her diagnosis, does she have one... .accountability and deflecting are huge issues so we are concerned this will be yet another reason for her to not focus on DBT or understanding that her behaviors are causing issues.

Therapist said she's of camp that BPD shouldn't be diagnsoaed before 18. Frustrating since that's not the DSM and we believe great progress could be made if we are up front about what's going on and use the time to work on this. Therapist suggested bi polar is often misdiagnosed as BPD but she has no depressive symptoms, episodes of mania... .I have a clinical background and am struggling because we have explored lots of other things that weren't fitting and until now became my stepdaughters reason for why she should just do things her way ("I have ADHD so I won't pay attention in class and just can't do the work!" Two in depth assessments later,  not even a smidge of ADHD symptoms... .)

I just would like to hear how others have dealt with this and the impact it's had. At 14 she's very concerned with labels. I know BPD can be a struggle to get a proper diagnosis for--just want to hear how its affected the child, treatment and any tips on dealing.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[jellibeans]

Dear Jennaberk

My daughter is going on 20 and I remember searching for a DX for years and having doctors and therapist change it like the weather. I know how frustrating that can be and how desperately we are searching for answers and that must be the key! I feel this was a waste of my energy now looking back. I think it is best to focus on what you are seeing in your child and try to address each one of those issues.

If your child is not responding well to her therapist then don't be afraid to find a new one. At times we stuck with therapist because we didn't want to start over. First and foremost your d has to connect with her therapist. Secondly your therapist needs to understand how to deal with BPD and not become manipulated by her. If you are having doubts then you need to sit with the T and express your concerns.

You have a teen that is going to be difficult regardless of any DX. The keys is trying to find a way to put boundaries in place and still support her emotionally. I think it is so important to try and avoid the power struggles at any cost. I really learned a lot from the articles posted here. Learning how to communicate better was something I needed to do if things were going to get better. A really hard lesson to learn... .I have no control over my D but I do have control over what I can do so that is what I have focused on.

I wish you well... .these teen years a hard... .hang in there

[livednlearned]

This must be so frustrating for you.

What I don't understand is why Ts would not assume BPD and work from there? A BPD dx puts the child into a 360 degree type of therapy like DBT that goes way above and beyond simple CBT or individual talk therapy. And it is perhaps better than most therapies targeting BPD at involving the family.

The tip-off that this T may not be as up-to-date on research is the claim that BPD cannot be dx'd in teens. I think my SO's D19 encountered that same mentality, and as a result I don't see anyone addressing her real issues. Meanwhile, she struggles with suicidal ideation and friendships that last 3 months if she is lucky.

I would be as concerned as you that your SD decides to not be accountable, so in that sense the dx is probably meaningful since she is involved so overtly in the ambiguity of it.

[Portent]

I would say that the sooner they are diagnosed the better. We know that the initial damage occurs very early in development. The sooner we can start therapy and get kids to learn how to control their emotions the better.

I'm personally convinced based on the empirical research that BPD is affect instability. The other 8 traits are merely artifacts of affect instability. The sooner we can teach those who suffer with BPD how to control their emotions the less long term damage will be done.

It is very difficult for me to go through this right now because I'm dyslexic. I see it as a parallel to BPD. Parts of my brain simply do not work correctly. I had to learn how to learn by training my brain. DBT is to BPD as Slingerland is to dyslexia. It took a lot of love and patience from my mother and father and a lot of work on my part but today I have 3 engineering degrees and I am almost done with my masters. I pray that my pwBPD will one day want to get fixed. But that is a long way off.

[Bright Day Mom]

I think it is quite common, particularly with adolescents, for their therapists to tinker with their dx.

After many hospitalizations, IOPs, PHPs etc., about 1-1/2 yrs it took to get the dx BPD, along with bi-polar, anxiety, etc. there is a lot of overlapping with our D who just turned 17.

Since your D seems to be so focused on dx, can everyone agree on BPD traits, since she is still only 14?   This would allow for her team of docs, specialists and yourself to begin targeting her treatment going forward, including DBT. If the family isn't comfortable with any of the team members, they can easily be replaced. It took 4 social workers until my D "clicked" with one and until then it was a very uphill battle.  I agree, the sooner the proper intervention the better the outcome. 

[Portent]

I think it is quite common, particularly with adolescents, for their therapists to tinker with their dx.

After many hospitalizations, IOPs, PHPs etc., about 1-1/2 yrs it took to get the dx BPD, along with bi-polar, anxiety, etc. there is a lot of overlapping with our D who just turned 17.

Since your D seems to be so focused on dx, can everyone agree on BPD traits, since she is still only 14?   This would allow for her team of docs, specialists and yourself to begin targeting her treatment going forward, including DBT. If the family isn't comfortable with any of the team members, they can easily be replaced. It took 4 social workers until my D "clicked" with one and until then it was a very uphill battle.  I agree, the sooner the proper intervention the better the outcome. 

This is the problem with the DSM and psychology as a whole. Its not a science. BPD is a personality disorder that develops overtime in response to affect instability. Someone who never learns how to use the mental pathways to control their emotions will often develop BPD over time. If we can simply recognize that affect instability is the problem we can treat it immediately before a major personality disorder fully develops.

There is a $20,000 piece of equipment that you can hook a patient up to and to a simple test to see if their brain is able to control impulses or not. If they are not you should start DBT or some form of cognitive therapy to teach them how to use the under active parts of their brain.

Imagine if my dyslexia was treated the same way psychology treats BPD. They would have made me wait until my personality was so far gone that much of the damage was irreversible before diagnosing me.

Here is how a psychologist would approach parents of a kid with dyslexia.

'Sure you child shows all the cognitive signs of dyslexia. He has difficulty reading, he transposes words and numbers, he lacks brain dominance to one side or the other. However, that is not enough to diagnose your son as dyslexic.

You see most dyslexics also have a low view of their intelligence. They feel that they cannot succeed is school. They also have a lot of angst and anger due to repeated failure in school. Your child does not yet display these traits of  dyslexic personality disorder so he/she does not clinically qualify as dyslexic per the DSM. That will be $500'

[jennaberk]

Thank you everyone for the additional insights. I agree that the symptoms should be addressed, and we are a bit concerned because this therapist hasn't replied to emailed concerns, starts sessions late, continually meets with my husband but then doesn't prep him at all for "bombshells" or issues she brings up once SD is brought in and he feels really caught off guard. He will be at a session tonigh but I agree it may be worth switching to someone else, especially since this therapist seems to not understand the benefits of an early diagnosis and treatment for the child.

They are re-assessing her now, and like others said, while we understand the diagnosis is mostly a label and the behaviors are the issue, she has latched on to "maybe I don't have this!" And we are back to even more  deflecting, blaming everyone else for natural consequences she encounters and so on as we all know how it goes.

Ultimately I observe that she continues to think we or teachers and everyone else are the issue.  I don't believe that much change can occur when someone thinks they don't need to change and aren't motivated. So my expectations are low but I feel like we have to try or else we'll never know, even though it's frustrating to spend so much time and money on something to see no results. I fear these behaviors will be an ongoing battle for us for years.

[BioAdoptMom3]

It is very frustrating to get a diagnosis especially in a child or teen because of the DSM and its ever changing recommendations. It is common though to have several different/changing diagnoses when they are younger as your child is. Ours was diagnosed with major depressive disorder at 11 and by the time she was 14 they were saying she had borderline traits. She had so many of the symptoms so we bought that. Then she went residential because of 5 hospitalizations in less than a year due to suicidal ideation. On the first day there the pediatric pdoc diagnosed her with bipolar and gave 3 valid reasons. He also suggested we read The Bipolar Child and explained how symptoms in children are different than adults with bipolar. With mania there tends to be more irritability, anger and aggression rather than elation and excitement (and that aggression, etc. can be directed towards themselves). With depression there also seems to be more irritability when they are younger as well as sleeping too much and losing interest in activities they previously enjoyed. I highly recommend the above book because the author does give a great list of PEDIATRIC bipolar symptoms and compares the disorder with other mental illnesses which is very helpful. For us fast forward 3 years and we now have both diagnoses - bipolar AND BPD traits. That is very common too.