Difficulty in getting diagnosis for veteran husband

[Loving Peeta]

I guess I should start off by saying that my husband was never formally diagnosed with borderline personality disorder but with PTSD from military combat depression and anxiety. He is on Prozac mirtazapine and prazosin. But after a year of weekly PTSD group therapy, smart recovery and individual therapy every other week, he is actually worse. Because our marriage is on the verge of ending I asked him to get an assessment for BPD before I came back to the home. He agreed but because the VA pays for his mental health therapy we could only use someone from there. She did not assess him but instead assigned him more groups like anger management and a dual diagnosis Recovery Group. I told her that he didn't need another group but he needed DBT. Unfortunately she said to let the professionals do their work. So my question is at what point do I just let go of me wanting him to have a diagnosis and let the professionals do their job when this entire past year  of intensive therapy has had no effect on my husband except to make him feel overwhelmed? I know everyone hates an armchair psychotherapist but everything points to my husband having severe BPD. And I believe that the therapy hasn't worked because it's not giving him the skills he needs and he continues to suffer emotionally and display all of the heartbreaking symptoms of BPD that have affected myself and our children so deeply. Do I let go and let his therapy team add to his therapy plate or do I go outside of the VA in the private sector and have him assessed for BPD? Am I just desperate for an answer to his behavior? Should I trust my instincts that this man has severe BPD or do I just let go of needing a diagnosis and hope all this other therapy does the trick?

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[SunandMoon]

Hi Loving Peeta and welcome to the boards. I'm sorry that you feel your marriage is on the verge of ending... .that's a sad place to be.

You obviously feel the VA is misdiagnosing your husband but there may be valid reasons for this. Two that I can think of are:

1) symptoms of PTSD are often very similar to BPD and BPD is sometimes referred to as Complex PTSD.
2) BPD is sometimes not covered by insurance whereas PTSD is - especially as a result of combat, therefore psychologists may sometimes diagnose as PTSD to comply with insurance, or in this case, VA guidelines. BPD could also be seen as a pre-existing condition; not a result of combat.

It's a very difficult situation for you and your husband but I think that treatment in this case is more important than a diagnosis, which is after all, just a label.

You have voiced your opinion and, although you didn't get the response you may have liked, it's likely that the doctor will keep this in mind during treatment. The dual diagnosis group may even be her solution, without actually labelling the illness.

Have you asked if there are also resources available for spouses? Is there a support group for you to help you cope?

It's quite common for things to get worse during treatment before they begin to get better and it sounds like your husband is really struggling. It would be good to get some support for yourself too during this time.

[Hart_Payne]

Loving Peeta,

SunandMoon is right. The VA has a limited resource for various issues. And it sounds like they're grouping all the symptoms under one banner. One of the most important thing you should understand is that a pwBPD will not see or admit to their problem. That could be why previous treatments didn't take. To admit they have a problem is major fight back response for pwBPD.

They must see and want to change. There is rarely a "ah-hah" moment for them to notice their problems, they usually go into a denial stage. The more you push, the stronger the resistance. Usually BPD starts at a young age from family interactions, then if he when goes to a high stress environment such as combat, the problem compounds.

Yes, the biggest issue is having resources for yourself. Believe me I was resistant to me going to therapy. I said I'm the one with the issue. In reality I had the issue of dealing a pwBPD which needs help to handle. You must help yourself before you can even help anyone one else. Dealing with their many problem requires advice and tactics. It helped me deal the problems better.

Be strong. 

[Harri]

he is actually worse

How so?

Trauma therapy is pretty intense and very difficult.  When I first started it, I ended up more upset, depressed and feeling lost than when I began but I expected it and knew it was going to happen. 

[Loving Peeta]

Thank you all for responding.  I know that some psychologists believe that BPD is just C-PTSD and while that's up to them to figure it out, I feel that having a constructive label helps in getting the right treatment. If it's used to justify behavior or used to limit a person then I agree it's not a good thing.  I understand better now why the VA may be reluctant in giving my husband an official diagnosis or even testing for a personality disorder, but it still makes me angry and I still want him to do the right kind of therapy. But, I know becoming over involved is counterproductive for myself and can make the person more resistant or dependent.  I had to leave recently because of the escalating violence. We had separated early last year when he was violent toward me and he put himself in the mental hospital for almost 3 months.  Nearly a year later he is back where he was mentally because of what I feel was ineffective therapy ie., individual therapy twice a month and a ptsd support group. I believe he is also worse because they started prolonged exposure therapy with his sexual trauma as a child and was working with the combat trauma as well.  When I asked the director of a separate Dialectical Behavioral Therapy program of the wisdom of that, she agreed it was better to get the DBT first before working through past traumas because it helps the person handle difficult emotions while working through it. Now he is in Batterers Intervention class and Veterans Treatment Program (instead of jail) and yes, I'm in therapy too. I can't control this nor let myself get frantic and anxious.  So, I am not with him right now and not falling for the emotional blackmail or manipulations to get me back, encouraging him to still do DBT if it is available for him and taking care of myself mentally. I feel like I'm in recovery now after being with him for a year. Did I tell you we were married for a month before his symptoms blossomed? Thank goodness for bpdfamily...for giving me a voice and for your responses.

[Hart_Payne]

Loving Peeta,

Don't fall for the emotional blackmail. That's a definite sign that they have NOT changed. Use it to your advantage. You can't see him unless you feel safe AFTER he seeks treatment along the PDB or DBT lines. You love him, but can't commit to anything until you see results.

[Radcliff]

I'm so sorry that you are dealing with such a heavy load, and am glad to hear that you are receiving support through therapy.

Can you give us details on the timing of your husband's combat exposure, when you were married, when you had kids, etc.?  Did you know him before the combat exposure?

Can you tell us about your husband's violence?  Have you had any contact with domestic violence support services?

RC

[Loving Peeta]

Well, his first hospitalization was when he was 14. He has been married twice before and had children from those wives. We didn't have children together. He had two other hospitalizations for suicide threats/attempts after his second marriage dissolved. He was in military training during his second marriage and went to Iraq to an imminient danger zone for a year after it ended and after the hospitalization. From others, I understand he was laid back, solitary and sweet, worked obsessively and in his intimate relationships prone to extreme jealousy and anger. He had a leadership role in military, loving and attentive father. He also worked in Recovery as well as a mechanic while in Iraq. When he got back to the states, he isolated himself with minecraft for several years, taking care of his children half time with the help of his mother who had been abusive and neglectful as a parent. I had known him a year or so before we married in October 2017 and he was a wonderful father, loving and helpful in our congregation and was on the surface one of the best men I had ever known. One month after we were married ,the intense jealousy started and the grabbing, pushing, the foul insults and anger. At the 3 month mark of our marriage, he strangled me while he was intoxicated (I had no idea his past history with alcohol-he didnt drink for several years). My daughter called the police just in time. He was arrested and a few days later went to the hospital after being talked down from a bridge. There he stayed for almost 3 months. During that time I received assistance on many levels. But when he got out, he only got therapy from an inexperienced therapist two to three times a month and ptsd group once a week and did no personal mental health work on his own time. From the beginning I would leave when necessary for a few days at a time telling him it was unacceptable for him to hurt me verbally or physically. This went on way ,way too long.  3 months ago He was accepted into Veterans Treatment Court and he began 7 day a week groups like  AA meetings, ptsd group and court appearances. Thats when it got bad again.  He had been verbally abusive but refrained from anything physical.  He grabbed my wrists one night and that was it. Ive been gone for a couple of weeks. And yes, my father was an abusive alcoholic and my first husband was too. But this was a completely different animal. I do believe the mindset and  trauma he experienced in the military exacerbated his BPD symptoms greatly. But they were always there to begin with. The VA has added more mental health groups as well as Batterers Intervention class. To end, I wont be going back for a very long time if at all. I know I was a co dependent,  I know why I allowed it and I know what I need to do now.

[Radcliff]

Thank you, all of that detail is a great help for us in understanding your situation.  It sounds like you are doing a lot of hard work to process all that has happened, both in your current marriage and in your prior history, and to stay safe.

Being a domestic violence survivor and a caretaker at the same time is a tremendously tough situation to be in.  Have you connected with any local domestic violence agencies and attended any support groups?

A diverse support network with face-to-face contact throughout the week is important.  Part of this can be Al-anon.  Have you attended any Al-anon groups?  If so, have you found it helpful?

RC

[Loving Peeta]

I am considering which group to attend. I have attended Al anon in the past but I already attend a similar support group and have learned alot. I left my husband while I had only partial employment so my focus is finding more work. But even the short  time I have been a member of bpdfamily, Ive felt support and more clarity. I know I need another face to face support group though.

 I was trying to figure out what aspect of being with my husband was so draining and while theres a lot to choose from, I think it may be all the lies. Lies, lies, lies. And something doesn't quite sound right or feel right and so you're always doubting and trying to piece information together that in real life doesn't go together. I am worn out from not trusting and not understanding the lies. Its not enough for me to get that he has BPD. I know where it comes from; its about survival for my husband. But what relationship could ever prosper or even survive without honesty?

[Radcliff]

I'm glad you're developing a diverse support network.  I've appreciated how the diversity works.  This board is available 24-7, covers the mental health aspects of things, teaches tools, and lets me write, which I find helpful.  Al-anon is ubiquitous; I can find a meeting any day I need one.  The DV support group I go to has been tremendously useful.  I find that I need to be around folks who understand DV, and have been there.  I'd encourage you to try a DV support group.  There may be more than one in your area; if so, it's worth it to try a couple to find one with the style and timing that suits you.  The DV agencies may also have support programs to help you with getting to fuller employment -- the journey to economic independence is a common theme for DV survivors.

RC