Diagnosis interview - how is it not a waste of time?

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

This might sound like a dumb question and I guess this all depends on the patient voluntarily seeking help BUT... .since most pwBPD are allergic to guilt and shame, especially the shame that is associated with them being wrong or broken, what is the likelihood of a pwBPD answering any of the questions in a diagnosis interview at all honestly. My uBPDw for example has no recollection of her self harming from the ages of 15-25 (now 38) and she certainly has no awareness of her extreme passive aggressive behavior... .but she does know what is shameful and what isn't and would sure as hell not be able to be open and honest to any questions that might in any way be interpreted as "I'm bad". She is absolutely desperate to find the fault in our relationship within me not her.

It strikes me as a waste of time in any situation other than one where the patient is so low functioning it was pretty darn obvious and lying would be pointless.

[Enabler]

This might sound like a dumb question and I guess this all depends on the patient voluntarily seeking help BUT... .since most pwBPD are allergic to guilt and shame, especially the shame that is associated with them being wrong or broken, what is the likelihood of a pwBPD answering any of the questions in a diagnosis interview at all honestly. My uBPDw for example has no recollection of her self harming from the ages of 15-25 (now 38) and she certainly has no awareness of her extreme passive aggressive behavior... .but she does know what is shameful and what isn't and would sure as hell not be able to be open and honest to any questions that might in any way be interpreted as "I'm bad". She is absolutely desperate to find the fault in our relationship within me not her.

It strikes me as a waste of time in any situation other than one where the patient is so low functioning it was pretty darn obvious and lying would be pointless.

[Tattered Heart]

Hi Enabler,

Diagnostic tests have built in questions to determine a person's honesty. These questions help the person administering the test determine whether the patient is trying to skew the results. Before a diagnostic test or any type of psychological questionnaires or tools are used, they must pass various accuracy tests. It is quite a detailed process and involves lots of math, statistics, and correlating answers. Then the results have to be repeatable, then published in journals, and then eventually it may be adopted as a diagnostic test.

[Mutt]

Hi enabler,



I'm sorry I don't know your backstory. What's on your mind? Are you assessing the chances that she's going to change to improve the r/s?

[sweetheart]

Hi enabler,

My experience of assessments and diagnoses were v dependent on the skill of the clinician and whether the assessment took place over a period of time.
My h had the ability to be v guarded and paranoid initially, withholding information that he deemed 'none of their business' he has little or no insight around his symptoms and dysfunctional behaviours, but if the clinician held on to him long enough and could validate his moans and groans, rants and complaints, accuracy of assessment has been possible for him.
My h however is someone who has come to rely on the interventions and support of mental health services as he has a long history of psychotic episodes and has been hospitalised many times.
For me every contact with a psychiatrist or psychologist is never wasted, they all have the potential to segue into diagnosis and treatment.
You are new to these boards, what are you looking to improve, in the absence of an accurate assessment for the moment what can we help you with?
What support do you have?

[Enabler]

Hello all, I have been on the board for a month or so having been lurking in the backgrounds reading and learning since a eureka moment back in April. I have written a reasonably lengthy explanation of my position and thinking here
https://bpdfamily.com/message_board/index.php?topic=312557.msg12897864#msg12897864

So with respects to getting a formal diagnosis for my uBPDw it is something of a utopia as a route to her getting the help I believe she needs and in some way a bit irrelevant since what I care about is her wellbeing not a rubber stamp that says uBPDw is ill. There is clearly only so much I can do to help or not make things worse. We're in marital crisis at the moment, not for the first time so for me, halting the crisis and stabilising the situation is of primary importance. She is seeing a therapist but in my mind a therapist is only as good as the information she tells her... .yes, over an extended period of time the therapist will hopefully see inconsistencies with regards to her views and perceptions and will hopefully explore those areas more in-depth to uncover the truth, she's been going for 8m already after we had 3m of couples counselling (disaster). I suppose I'm worried since she has NO recollection at all about self harm when she was 15-25. Not just a bluffing denial of the facts but a complete absence of knowledge. Something she wrote to someone else "Enabler mentioned cutting again today, I feel like I'm missing something here".  This feels like a key to acknowledging that there's something more going on than a bit of PMT. I suppose I don't have an enormous amount of faith in professionals not to be manipulated by her "truth". I see how other people believe her truth so easily since she's so high functioning and externally exhibits no signs of how she is in the home and in an intimate relationship.

I'm intrigued that if many BPD sufferers are similar to this, how do clinicians get through the masks with a bunch of questions.

[sweetheart]

Hi enabler,

What we can definitely support you with here is the marital crisis that you are going through again and help you explore ways to stabilise and improve your current situation.

 I understand why you are focusing on an accurate diagnosis and treatment for your wife and  lots of our members start off looking at their SO's issues, remember though your wife's therapy and what she discloses and explores with her therapist belongs to her. The focus on this board is you and what you can change.

Can you tell us more about what is going on in your relationship and what you would like to improve?

[Enabler]

Thanks Sweetheart, I am involved in a few threads now which are proving very very very helpful and this is a wonderful community of wonderful people. I hear you re her therapy, you just want to be a fly on the wall sometimes!

[sweetheart]

Yes indeed you do 
I'm glad the other threads are helping.
Keep posting though.