40 year old son

[Oldermom]

My son aged 40 has always been somewhat withdrawn but is ok in social situations.  He is married with two children and now seems to be heading for divorce. He and his wife have both been for individual counselling and couple counselling but the relationship seems to be deteriorating rapidly. They are living apart.  I suspect he has BPD but has not been diagnosed as such.  I read the section on Higher-Functioning Invisible BPs and almost all of the characteristics seem to apply to him.  He blames his wife for things that happened when they were first married eg persuaded him into marriage before he was ready, blames her for buying their first home.  He is the victim and does not take responsibility for anything.  He can be verbally abusive (not physical) and sends her nasty messages.  He blames her now for losing friends since they separated. He behaves in a very withdrawn manner with me and my husband and only contacts us when he needs help with the children.  He functions at work but starts off well at each job and then seems to fall out with colleagues later on. My problem is how to get him to acknowledge that he has a personality disorder and to get him to the right therapist.  Thank you in advance.

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

[Sancho]

Hi Oldermom
It is really difficult when there hasn't been a formal diagnosis. We can look at things and tick the boxes but there are conditions that overlap so it can be complicated.

You use the word 'withdrawn' and I am wondering if ds is suffering depression to some degree? People with depression can also blame others and be negative about everything - the world being against them as it were.

I also wonder if that would be a way into a discussion with him about mental health. I am thinking along the lines of connecting it to his recent separation etc eg The stress of separation and divorce can be very high and can cause significant depression. You seem to be fairly withdrawn and I wonder if you would benefit by having a checkup for depression - what do you think? I am worried about you under these stressful circumstances'.

Sometimes medications for comorbidities such as anxiety and depression can be helpful when someone also has BPD.

[Oldermom]

Thank you Sancho.
I agree that my son is depressed and I like the way you suggested that I approach him in this regard.  However his behavior is extreme and is the reason that he is now separated from his wife.  What type of therapist should I look for? Should I try and find a therapist who specializes in DBT?  Or should he go to a psychiatrist?

[Sancho]

Hi Oldermom
A DBT therapist would be the best for BPD therapy, but I am wondering if that is a step too far too soon. If he is open to the idea  that he could be depressed due to the separation etc, then just to get him to a GP in the first instance would be a good step I think.

A GP can prescribe usual antidepressants and keep reviewing him. If he has a comorbidity of depression it could be interesting to see how he functions if this is addressed even in a small way. For example he might become more open to discussing further issues etc.

I think the way forward is small steps. The whole idea of 'personality disorders' can be very confronting to someone who is quite vulnerable.