How to get loved one diagnosed?

[Penelope57]

Hi-I have been married to my husband for 42 years.  He had a very dysfunctional childhood; traumatic separation from his mother and siblings by age 14; entered military service and had several career disappointments/setbacks in both his military and civilian employment paths.  We raised seven children through his frequent deployments.  When he finally came home (due to overseas Covid travel restrictions), he had his second (really, fourth or fifth) major breakdown, and was hospitalized by the VA for Suicidality. At the time, he had been told he was "bipolar," and apparently leaned into his diagnosis:  made erratic, unsound investments and lost most of our retirement funds (all without my knowledge or consent.)  Since then, he has been hospitalized for a second course of ECT, which continues with 2 week maintenance ECT administrations. This has been going on for 5 months.  He also had a 5 month course of TMS (between the 2 ECT administrations), which gave him about 4 weeks reprieve from his otherwise chronic depressed state.  About 6 months ago, his psychiatric NP at the VA (he had 3 previous psychiatrists but did not like the last 2, who made his bipolar disorder diagnosis) told him he had "traits of Cluster B" personality disorders.  I  believe he exhibits strong BPD and NPD traits, but wish to have an experienced professional make this diagnosis and recommend the appropriate treatment.  My husband has been suffering from his demons for over 2 1/2 years now, with NO evidence-based therapies offered by the VA.  My own research indicates that IF he has BPD, that should be treated primarily BEFORE his other comorbid conditions.  I've raised this point with his current providers (esp. the ECT doc) but to no avail.  If he "just" had Major Depressive Disorder, I would have thought that would have subsided, or at least given him more than a 4 week reprieve (after multiple changes of medications, TMS and ECT)??  Since the VA is an archaic bureaucracy and does NOT include families in their treatment team discussions (rarely solicit input, even, and when it's given, it's discarded), I am at my wit's end to find the appropriate help for my husband.  He is 70 years old, and suppressed/denied serious trauma from his childhood for 58 or so years before finally seeking help.  Any advice?  Doesn't it start with an accurate diagnosis??

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[Notwendy]

Hi Penelope- your H has been through a lot. From my own experience with a BPD mother (elderly parent)- BPD is not the main diagnosis on her chart as there isn't specific medication for BPD. Her other diagnoses are related to her BPD, or in addition to, but she is being  treated for the symptoms. So for instance, if she's anxious, she is given the same medication as someone who doesn't have BPD. It's treating the anxiety. There isn't another medicine for anxiety and BPD.

BPD as a diagnosis is more useful in terms of her behavior- and if someone is willing to attend therapy and work on their BPD- DBT has helped in that setting. It's useful to the people who are assisting her as they also have to manage her behavior. Her medical team has mentioned her behavior fits with BPD but it isn't specifically on her medical charts as it's not a useful diagnosis to her- as she isn't interested in therapy. Instead- anxiety, depression, - these are on the chart. She, herself, would reject that diagnosis. Sometimes providers use a more acceptable diagnosis- it's not wrong to do that, as treatment for depression, anxiety, bipolar is similar medicines- but it may be all they can do to help their patient if they won't be motivated to work on BPD.

If you don't feel the VA is as helpful, is it possible to get another opinion? Would his Medicare cover non VA  treatment for him, and one that does include family?

[Penelope57]

Thank you, NotWendy, for your thoughtful response.

I have tried to convince my husband to seek help outside this VA.  The problem is, that he has convinced himself his "Care Team" is great. They are delivering the very minimal (I would say, de minimus) treatment he wants, vs. the treatment that he needs.  I'm just wondering if anyone has experience breaking through the brick wall of BPD defenses to help get their loved one into effective treatment, and what treatment that was?  I have suggested to his Care Team (which does not include a psychiatrist, by the way) that CPT, DBT, EMDR or Mentalization Based Therapy might help.  He was approved for a 12 week residential program for PTSD and his Alcohol Use Disorder and his Care Team told him he didn't need it.  Now, he's teetering on going back into hospital, and his maintenance ECT has been moved up from every 2 weeks to every week.  (Maintenance ECT has been going on for almost 6 months now.)  I see no end in sight until I can remove him from the VA system, which requires his consent.

[Notwendy]

I understand. You can't do much without his consent. However, at least his symptoms are being treated somewhat. Sometimes that is the best anyone can do.

My BPD mother wouldn't ever accept a diagnosis of BPD or DBT or other approaches. However she will accept taking medicine for anxiety as it does help her feel better.

It's understandable that you want more.