pwBPD who sees a psychologist regularly but is undiagnosed - familiar?

[rattled64]

I am starting a much shorter thread than my prior update because I really would like to hear from the community if anyone else has experienced this.

My psychologist, who has met my wife, has said a few times that border lines cannot conceal their condition to a psychologist; that it would be obvious and there is no way that they could hide it. Since my therapist also saw us as a couple, she also indicated that she did not see it, and she was confident that if it was there her partner would see it too.

My own experience is that my pwBPD hides what she shows to me all the time to the outside world. Moreover, she has many other things to work on with her psychologist - binge eating, depression, low self esteem, etc., so I can easily see those things being the focus and the BPD dimensions of it not being so readily apparent. In fact one of the tells that things are escalating with her emotional dysregulation is that she starts getting very manipulative. I also think she is incrediblly super intelligent and capable of manipulating her therapist even though I have met her therapist and attended sessions with her and have a very high regard for her professionally.

So please let me know in response to this post if you have experienced something similar. To some degree I do not care if she has a BPD diagnosis or not. Our interactions and her behavior is described so perfectly by the criteria that any and all advice on how to react to it (and not react) is really helpful.  I still find it baffling that none of the telltale aspects of BPD are evident to her psychologist.

I ask for this feedback in part because I am still hopeful that my exposing this will ultimately help her psychologist help her. If that does not happen at all, one of my major motivations for the indirect communication will be for naught.

Thanks for any thoughts and experiences you all can share.

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[EyesUp]

My uBPDxw saw the same T and PsyD for years.

The PsyD prescribed various antidepressants and anti-anxiety meds over this time.

The T was old school and probably not fully versed in the latest research on b-cluster disorders.  My X did share that the T attempted some sensory/eye movement therapy, although it was short lived, and no notable or lasting changes came from it.  I gather that there was also some exploration of empathy or lack thereof, because it was something I noted and commented on in discussion with my X long before I knew anything about BPD.  I imagine this was concerning to my X and so she explored it in therapy. Again, nothing came from it.

Near the end of our marriage, my uBPDxw was briefly hospitalized when she threatened self harm during a session with our couples therapist...  Long story short, at that point my wife's T reached out to me to understand what happened while my then-wife was in the hospital - it was the first and only time we spoke, and the conversation lasted about an hour.  The T offered no indication that she felt there was a PD, although I appreciate that the T may have been adhering to a strict boundary re: patient confidentiality.

My general feeling has always been that my uBPDxw was an unreliable narrator - to herself and/or to anyone else - and so she may not present with an obvious PD, even to a trained clinician.

Like most things, I think it comes down to the individual.  Yes, there are overt cases that can be diagnosed in relatively short order - but many more cases likely involve high-functioning individuals with some mix of PD traits - like my uBPDxw - who don't appear to meet diagnostic criteria, and/or who are able to effectively astroturf their shame - internally and externally.

In short, my uBPDxw has been in therapy, with multiple therapists, for years without a PD diagnosis - at least, afaik.  Her T has since retired, and now she uses Betterhelp - I imagine that she likes the attention, likes having a forum to vent about her many grievances and disappointments, and in many ways probably doesn't seem that different than people who simply present with depression or anxiety. 

It would take a talented and very attentive T to notice that the victim narrative never ends, and to challenge certain attitudes without my uBPDxw simply jumping to a new T...

Reading up on b-cluster disorders, it's not only difficult to diagnose - it's very difficult to treat.  From the partner POV, there's not much we can do.  PD'd individuals are naturally adverse to the diagnosis, and disinclined to accept it or sincerely engage treatment. 

From what I gather, the individual needs to find their own path. Partners who nudge/cajole/encourage/insist are often met with increasing resistance and hostility...  Unfortunately, even when your pwBPD is in therapy, outcomes are uncertain.

The alternative is:  We can focus on ourselves instead of the impulse to "fix" or help or caretake our partners...

[Pook075]

My psychologist, who has met my wife, has said a few times that border lines cannot conceal their condition to a psychologist; that it would be obvious and there is no way that they could hide it.

Over time, sure...it may become obvious to a trained psychologist.  But on a single visit...he or she is full of it.

Why? Because most people in my BPD ex-wife or BPD daughter's life have never seen ANYTHING that would indicate mental illness.  My kid was smarter than most of the psychologists she saw and knew how to manipulate them to do whatever she wanted.  Many said she was not mentally ill...instead, she was highly rebellious.  Another said bipolar.  Another said BPD/NPD.  Others have indicated other personality disorders.  One even mentioned mild autism.

Likewise, you probably had head-scratching moments where you told your counselor that something troublesome happened.  Yet your wife had a very different story, she did this because you did that, and you've been abusive for awhile now.  Who's telling the truth?  How could anyone know that off of a few interactions?

For instance, my wife told me the other day that I'm a narcissist.  I asked her why she'd think that.  She said because I'm ALWAYS negative, ALWAYS putting myself before others, ALWAYS angry and bitter, NEVER loving or compassionate.  So I asked her when was the last time I did any of those things...she had no answer. 

Everything she was saying was projection and a great therapist or professional might catch the black/white thinking.  Or they may just assume that I was a pure monster to her and take what she says at face value.  It's really a tossup.

A therapist's job is not to diagnose, but to help the patient get a better handle on their feelings and emotions.  So even if they suspected it, it's worth exactly nothing.

[Notwendy]

My BPD mother mostly was undetected. She has had a lot of psychiatric intervention over time. Most of her behaviors have not been seen by anyone outside the immediate family and so other people didn't have a clue.

BPD wasn't a known diagnosis when my parents were married but it was evident that something was going on and so my mother saw various therapists over the years. Little was said directly to me as a child about her. It was a family "secret" - we were not to speak of it. By my teen years I was looking in psychology books- to find an explanation, and also began to ask my father questions. In retrospect, this probably was uncomfortable for him as he didn't want to say things about her to us but he had to say something when I asked why is Mom like this?
I recall all one conversation and I think Dad just gave the best simplified answer he knew at the time. BPD was not well understood. It was hard to hide the situation from an inquisitive teen.

"Dad, has Mom seen a psychiatrist?

"Yes, many times"

"Why hasn't it worked?"

"Because she lies to them"

I didn't understand this at the time but I do now. It's not actually lying it's that her level of denial is such that she truly doesn't believe she has any issues and that the cause of her discomfort is because someone else has them. Since she does hold herself together so well in public- she presents her own views in a convincing way.

For therapy to be effective, the person needs to have some insight into their own issues and be willing to share that information. Therapists only know what their client tells them. This is what my mother believes and so that is the information they have to work with.

In her elder years, BPD mother began to need home health and this was the first time professionals worked with her over an extended time- so they have been able to see that she has BPD. It wasn't evident in an hour visit. However, since she is cognitively intact and still can pull herself together, she is considered to be legally competent.

 

[Notwendy]

To add to this- this is decades ago when my parents first got married. There is more awareness now about BPD and less shame regarding mental illness. The tendency was to keep things secret- and I think the secrecy was to protect her.

Now, BPD is a known entity and there are approaches to therapy. However, also be cautious about exposure- if it's with her therapist in private- perhaps that might be helpful but also the denial and projection aspects of BPD make confrontation difficult.

I have read that therapists often describe the behaviors rather than use the label to be more effective with a client with BPD. Labels such as "anxiety" or "depression" may feel less threatening a reason- while still working on issues with the pwBPD. They can't be helpful if the person walks out due to being angry. So they may actually know there's a PD but can still treat without the label.

For my mother though, she does not see the connection between her behavior and how other people react to her. She really believes they are the problem, not her. I think we can conclude that therapy has not worked with her because it has been attempted. I don't think one can know this without it being tried.

[rattled64]

Thank you Notwendy - you are describing something that I am now experiencing. Every time I call out her behavior, even calmly and outside of an episode of "the vortex", she keeps bringing it back to "if you loved me you would have more compassion for me when I get that way" and my other favoriate "maybe the problem is more how you react to me, and if you cared about me more you would react differently".

Increasingly, now that I have put my concerns on the table, it is apparent that she has no self awareness about what happens when - as I put it to be less confrontational - she goes "off the deep end". 

Wrt the two therepists involved here though, I am still a bit baffled as we are living in a time where BPD is more understood. They are both Psychologists with PhD's who are well schooled in the DSM, so not even less educated LCSWs, and they both have experienced enough exposure. Her therapist she has been seeing for years, and when we saw my therapist together it was for a half dozen sessions.  My therapist in particular has seen her framing of specific incidents and even pointed out to her the dissonance in her thinking. And yet, they still both contend that if there was BPD she would not be able to hide it.

My experience is the exact opposite. She hides it from close friends who know us both. She hides it from her family. And she hides it from her co-workers, even though I have to hear all the time about how they are constantly "slighting" her and going on and on about who she has designated to be her nemesis at any given point in time. Unfortunately she can no longer hide it from the children. After several outbursts she had to explain to them she was going through some things and labeled it as depression. I guess it is a start. I would never have a direct discussion with my kids about it because I would not want it to undermine their own relationships with her in any way.

My youngest is now a sophomore in High School and my two oldest sons are out of college and nearly done college so the more they observe this directly, the more it feels like I should be more direct. If for no other reasons it might help them understand how my wife depletes me of so much emotional energy that I have not had enough to build good relationships with them. Not ready for that yet however. I am left hoping that my increased awareness will help keep me from getting sucked in and there will be some collateral benefit of having a bit more emotional energy for my kids. 

[Notwendy]

I am not a therapist but I know my BPD mother has been able to hide it very well from people outside the family, even her friends and relatives, and she has seen a lot of therapists. I believe they can hide it during sessions.

I have observed my mother in her "public persona" and it's very convincing. A nurse who works with my mother ( and who has seen her BPD behavior)  has seen it too and told me it's eerie how she seems like an entirely different person. Sometimes it even makes me question- how can somebody who is so impaired with BPD be so competent at doing this?

I agree, you can't hide it from the kids but they can become confused about it. I also don't think you are the person to tell them about their mother or it may become a form of triangulating. I think a counselor would be helpful to them in answering their questions if they are willing to go to one. As to your relationship- while venting to them and discussing their mother may be triangulating- I still think it's good to be honest with them if they ask questions directly. If they ask, they have already thought about it and want to know.

[Pook075]

Thank you Notwendy - you are describing something that I am now experiencing. Every time I call out her behavior, even calmly and outside of an episode of "the vortex", she keeps bringing it back to "if you loved me you would have more compassion for me when I get that way" and my other favoriate "maybe the problem is more how you react to me, and if you cared about me more you would react differently".

Last Saturday, my ex-wife and I brought things to the landfill as we clear out our home and get it ready to sell.  We had an old wooden rocking chair/glider on the back of the truck and my wife tried to lift it herself and throw it over me (I was standing on the ground at the back of the pickup grabbing bags/boxes).  She dropped the chair instead, it came crashing down and landed on the back of my leg...splitting me open from ankle to calf.

Obviously it was painful, and I reacted how someone would expect when your leg is sliced open.  I tried to 'walk it off' as I grimaced in pain and dealt with the initial surge.  My wife's first comment was, "I wish you didn't have to be so dramatic and make a scene."

A few minutes later, we got back in the truck and she once again said that if it happened to her, she would understand that it would be painful but she would have dealt with it silently.  I didn't reply because there was nothing to say- she injured me and could only focus on what I was doing wrong.  It was like she was embarrassed because I reacted to the pain. 

But I think it was deeper than that; she knew that she hurt me and had no idea how to react appropriately, to show concern and apologize for what was clearly an accident.  For whatever reason, the focus had to be on my mistakes and imperfections. 

I bring up this experience because I think it rings true for a lot of us- we get hurt, it's our problem.  They get hurt, it's our problem.  And as much as I wanted to say, "You split my freakin' leg open, do you really need to judge me right now," there was nothing to gain by defending myself. 

At the same time though, our relationship isn't there anymore for her to be vulnerable in that way, to love me simply for me and to show compassion and understanding.  That's where so many of these relationships end up by not doubling down on communication and affirmation, and there's not an instant fix to get back to that place.

Yesterday, my ex-wife showed back up with her truck and we loaded more trash and donations.  I caught her looking at my leg multiple times and once we had the truck loaded, she said that she wanted to go alone.  I didn't argue.  She left and came back for a second load, and again I asked if she wanted help unloading.  She said, "Well, you got hurt last week so it's better if you stay here." 

I told her that my leg has healed nicely (it still looks horrible, but doesn't hurt much) and I could help if she needed it.  She softly replied under her breath, "I can't stand the thought of you getting hurt."

So she does still care...deeply...but can't respond appropriately because of her own guilt or shame.  And that's BPD in a nutshell, it's so very complicated and what's on the surface is rarely what's deep inside.  It takes real work to get back to that place and you have to lead with compassion, even when you're not receiving it.