Should I try to get my wife evaluated for BPD?

[Purplelutris]

Hello!

I'm writing to see if anyone has any help or advice. After much strife and struggle, my wife is in treatment for major depressive disorder and PTSD. She was severely abused by her mother throughout her childhood, and the abuse got much worse once she came out at 17. One therapist (she has been to several in the past four years) told her that her mother likely had BPD, and that she would get that diagnosis too if she didn't proceed with treatment.

Recently, after being very frustrated and hurt by my wife's constant lying, I started doing research. When I stated reading "Stop Walking on Eggshells," it was the first time I read anything that I felt described what I go through with my wife. She's very high functioning, with a job and a master's degree, and she doesn't lash out at anyone but me and a few of her closest friends. I've had more than one therapist tell me that I'm overreacting when I get upset at her behavior. Reading the book, I felt like "finally, someone gets what I'm going through." Looking at the DSM criteria, she has everyone but one.

My question now is, should I let her therapist know that I strongly suspect she has BPD? I know I have a tendency to be a rescuer and try to fix her, and I've worked hard not to intervene in unhelpful ways. On the other hand, I know she has a strong history of lying to her therapists. It took her three and a half years of therapy to admit that she was dissociating and having PTSD flashbacks, and she has frequently told her therapists she's doing great as she's deep in the depths of a major depressive episode. I have never found the advice in books about being supportive to a partner with depression or PTSD to be helpful. When I try out the advice in those books, it tends to just make the lying, disassociation, and lashing out worse.

When I tried out the advice in "Walking on Eggshells," it immediately changed the tone of our conversation, and we had one of the most productive conversations we've ever had.

So my question is, should I tell her therapist that I think she may be a high-functioning person with BPD? The only reason I would do this is so that she can get the treatment she needs, but I worry about interfering with her treatment. I'm also nervous about confronting her directly because of her history of lashing out at any perceived slight or criticism.

Help!

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[pearlsw]

Hi Purpleurtis,



This is an interesting and important question and I feel like I see this kind of topic discussed here a lot, but I am really not sure what the best approach might be.

Do any other members have experience with talking with their partner’s therapist?

Short of any direct advice for now, I suppose you could explore this yourself and contact the therapist and see if they are willing to listen to you. If they say that it is not allowed than you’ll have your answer. How would your wife feel about you making such a contact?

Which of the traits of BPD have you recognize in your wife and how are you currently handling things? What kinds of things does she tend to lie about may I ask?

with compassion, pearl.

[Purplelutris]

Thanks! It's good to be here!

The reason I thought of it is that I have spoken to one of her previous therapists. I did this on the advice of a therapist friend of mine, because I was worried that her disassociation episodes were so severe that they were putting her in danger (ie while driving, she once got into a car accident during which she killed a bicyclist, during what she now admits was probably a disassociative episode). In that instance, my wife was fine with it. My only concern is that this time will feel more personal, because she identifies the BPD diagnosis with her abusive mother, and has expressed how terrified she is that she will have it too.

As for the traits I've recognized:

+She frequently talks about how she doesn't know who she is or what it real

+She dissociates regularly, at least 1-2 times per week, and those are just the times I notice it. It could be happening more often when I'm not around.

+She is extremely self critical. She has admitted that anytime anyone says anything even mildly critical to her, she feels worthless and bad.

+She is extremely critical of others. Most of our conversations revolve around who has wronged her and why nothing in her life is her fault.

+She lashes out in unprovoked rage, or makes off-handedly cruel comments. For example, she'll tell me that a piece of clothing I love and wear often is ugly, or she'll use some personal information I shared with her to ridicule me to our close friends, or she'll randomly say she hates someone that she knows I care about.

+ She lies reflexively, about everything from how she's doing, to whether or not she's dissociating, to whether or not she likes something I've cooked, to whether or not she's had potato salad (literally, I received 5 different answers to this question in the space of a three minute conversation). While we're out in public with friends, I'll say something like, "I love our beautiful home," and she'll say, "Except the floors always look dirty. It just impossible for those floors to look clean. It disgusts me."
Later, when we're alone I'll remind her that actually, the floors look dirty because they haven't been washed in over a year. This is one of the domestic tasks we agreed was her job and she doesn't do it. I don't usually bring it up, because I'm not a neat freak and honestly, clean floors are not at the top of the list of things I need from my marriage. When I catch her in the lie she will argue with me, and that will eventually give way to sobbing and self-flagellation.

+When I ask her to do something (everything from "please don't lie to me" to "do you mind filling the Britta when you empty it" she will sob for hours and tell me how sorry she is and how terrible she feels. She will present me with an intense plan for how she plans to correct her mistake. Then she will repeat the action, usually within hours or days.

+She seems physically incapable of listening to me with empathy. Even when I try to talk to her about an issue I am having that is unrelated to her (ie a workplace issue or an issue with a friend) she will literally walk out of the room while I'm in mid-sentence. When I ask her what happened, she will say she has no idea what I'm talking about. Then, later, she will complain that I never tell her what's going on with me. Which I don't, because she's made it clear she has no ability to listen to me. When I tell her that, she starts up the sobbing and the self-flagellation and I end up comforting her, so I've just stopped asking her for any sort of emotional support.

+She's never expressed thoughts of suicide to me directly, but she has admitted that "she might have been suicidal in the past."

+She doesn't abuse drugs or alcohol, but she does binge eat (eg 15 brownies in one sitting) and she doesn't seem to have an awareness of the consequences of her actions. For example when she insults people or things they care about, she seems genuinely surprised when they get angry. She often says, "I was just trying to be honest. I thought I was allowed to feel this way."

+She is disproportionately sensitive to criticism. For example, if I ask her to refill the water pitcher, she'll say, "You think I'm a terrible person." Once, while in grad school for creative writing, two people in a writing workshop said negative things about her work and her response was to text me "I'm throwing out my master's thesis and starting over." She was one or two weeks from graduating and turning in the thesis. She still brings this incident up when complaining about why she doesn't write any more. Anytime I ask her to change a behavior (lying, insulting me), she will tell me she isn't doing that behavior. Often this happens after we have had the exact same discussion the day before, and it ended with her sobbing and apologizing and pretending she'll never do it again

How I'm dealing with it? The best I can, I guess. I have worked a lot to not express my anger and to not engage with her defensive arguments. Reading "Walking on Eggshells" has been super helpful, and I've been trying to use the communication techniques in that book in the past few days and it seems to be working. She seems to be hearing me more than she has before. Of course I'm always worried that she is just telling me what I want to hear so I will stop criticizing her, as she has done so often in the past.

I'm also dealing with it by spending a lot of time focusing on myself through self-care, friendships, and pursuit of my interests and hobbies.

I'd like to stay in the marriage if possible, and again, I'm worried that she won't be diagnosed with BPD because she'd never admit to the negative things she does. My concern is that if she doesn't receive a diagnosis her therapy won't be as effective?

I suppose my first step would be to tell her my concerns. I'll admit to being a little scared to do this because of the way she reacts to criticism and how sensitive she seems to be about BPD because of her mother.




 

[pearlsw]

Hi again, 

Wow! There's a lot going on! She actually killed a cyclist while dissociating? Has she stopped driving now? Were there any legal consequences for her actions? Is she getting any kind of help with the disassociating? That seems extremely serious to say the least!

Have you had a chance to read this yet? Telling Someone You Think They Have BPD[/b]

If you can, take a look and let us know what you think!

Sorry for what you are dealing with, but glad to have you here with us!

Hopefully others will join us and share their thoughts and insights as well!

take care, pearl.

[teapay]

My W was dx with BPD, but over the years got it changed to MDD and PTSD because the BPD dx is pretty uncomfortable for her to wear, whereas MDD and PTSD allows her to save face.  The T probably knows is BPD.  What kind of therapy is she getting?  DBT?  My W had benefited from true DBT (which has both group and individual for over a year) followed by a year of IFS and changes in her life circumstances that helped address anxieties.  I did provide her some emotional support, but had to institute a range of  boundaries and pressure to make progress in therapy.  Her getting better to some degree, especially regarding the acute behaviors, was an essential component to us staying together.  Without that it's a pretty hard slog up a cold wet mountain with probably not much reward accept clouds.  Good luck.

[Purplelutris]

This is all so helpful. Saving face is HUGE for her, and I guess it doesn't matter what we call it, as long as she is in treatment for her symptoms and I understand how to relate to her in as helpful a way as possible.

There weren't any legal consequences for the accident, which was ruled an accident by the police. But she has recently (within the past 6 months) admitted to me that she thinks the accident may have happened because she was dissociating. This is honestly my biggest concern. Because it is so hard for her to admit to me or herself when she's dissociating, I am scared every time she gets behind the wheel of a car, which she still does. I drive her whenever possible, but it's not always possible.

Honestly, I'm scared every time she leaves the house, because her dissociation episodes are intense enough that I don't trust her not to walk into traffic. She bumps into things and leaves stoves on and leaves windows wide open so our indoor cats get out while she's dissociating.

She is in treatment with a trauma focused therapist and they are dealing with her dissociation. I just never feel like her therapists seem to take it seriously enough, which is why I ended up in a session with her last therapist. It's not the therapist's fault necessarily, I know she downplays her symptoms as much as possible. I'm wondering if a BPD diagnosis would make a therapist read between the lines of what she's saying more. IDK.

She was in an intensive outpatient program for about six months, with DBT group therapy 3x weekly and individual therapy. That did seem to help somewhat. But there is still weekly lies and dissociation. I would say the biggest thing that has changed is the lashing out. That has become less intense and less frequent.

[teapay]

I didn't really notice much change in my W until after a year of DBT.  She did take to it and continues to practice it after her program disbanded.  Her IFS is therapy for her trauma.  Trauma focused CBT did not work well at all as she takes it personal and critical of her.  It took an additional 2 years of IFS before I noticed other important improvements in her behavior and thinking.  The skills from DBT help had the stress from the trauma sessions.  Both her thinking and behavior are not what most people consider fully healthy now, but better than they were and she is more functional and we can work many things out without dysregulations to either of us.  She has difficulty following through.

There was not any quick fix.  Your W's T might know what is going on, but might not be able to do much more than keep your W in the chair from week to week.  If your W had  DBT, maybe you can get her to go back and do it longer.

[Purplelutris]

Teapay, that's interesting that you didn't start to see the effects with DBT until a year later. The issue always seems to be that she convinces the therapist she doesn't need the therapy anymore, and then they recommend that she step down.

But yeah, I have a tendency to try to manage her therapy, which I'm trying not to do. But if I don't see any improvement soon, I may suggest that she go back into DBT for longer.

[Harri]

Hi.  On the surface, there is often little difference between the behaviors of someone with BPD vs. c-PTSD.  Really what makes the difference is what emotion is driving the behavior. 

[Purplelutris]

Harri, what emotion do you see as driving which? This would help me understand what's happening with her and be more empathetic, which is something I work hard on.

[Harri]

Hi again.  Here is a link to a discussion on the difference between BPD and PTSD or c-PTSD.  Reply #7 especially gives a good breakdown of the differences.
https://bpdfamily.com/message_board/index.php?topic=42598.0;all

There is another article that I am trying to track down for you.  I've been searching but have not had any luck yet.  Probably because I can't remember which board it was on, when it was posted and who posted it!     I will keep looking for it though.

Good luck to you.

[Harri]

This is *not* the thread I am looking at but it does describe the difference between BPD and NPD which are often co-morbid.

https://bpdfamily.com/message_board/index.php?topic=90388.0

(I'm still looking tho!)