BPD or CPTSD? Wife claims only CPTSD, but so far no improvement in treatment.

[KayakerDude]

So my wife has diagnosed CPTSD.

I believe (especially since reading others stories on here) that she has BPD and maybe CPTSD.

Basically I experience all of the classic BPD behaviors and in our years together haven’t seen any behavior that would indicate CPTSD. I agree she had a at times crap childhood into her teenage and young adult years, but never any avoidance or triggering based on childhood memories.
Now I realize that these very often coexist and are based on some similar origin points but the one is a much milder issue of a mood disorder and the other is a disorder of personality and will take a lot more work to heal from and change behaviors.

So she’s been in an IOP for mood and anxiety disorders for 6 weeks now and although she reports ‘feeling better about myself’. I keep having the experience where she tells me: “I am treating you so much better, and I haven’t insulted you, put you down, or name called or accused you lately.”
I let her know that it is wonderful she is feeling better though her treatment, but that as good as that is for her, on my end I would feel seen a lot more if she were to ASK ME about my experience rather than telling me how much better she treats me.
This pretty much always gets an angry response and how I am am invalidating her, and how I am ‘refusing to let me get better’. Now, after this many years of her bending reality to her version of emotional thinking I at times find myself lately having trouble knowing if I am being reasonable. But I ran this idea by a few people including my therapist, that she needs to ask ME how she is treating me, not tell me how much better she is treating me. Which was a huge point of needed validation for me.

Earlier this week her and her therapist at the IOP had talked and asked me to come in for a joint session so the therapist could observe us interacting. Basically the therapist tried to slightly referee the moment but I was verbally attacked, insulted, called a liar over and over and treated in a way that honestly messed me up a bit for the remainder of my day. I think that the therapist let a lot of it happen just to get an idea of how things really are, vs. how my wife describes them.

But where I am stuck is that in 6 weeks shouldn’t there be some small improvements if it’s CPTSD? For BPD I would doubt based on what I am learning, that it might not make much difference yet. But if she’s suffering from CPTSD it is emminently treatable, in comparison to BPD (and I am guessing some narsissistic tendencies as evidenced by telling me how much better I am being treated).

Maybe I don’t have a well formed question yet and just need to vent.

And I keep getting these attacks where everything is a double standard, and every one of her issues is blamed on me, and I am accused of being the source of. Like the verbal abuse, I have spent our entire marriage saying things like: ‘no matter how you insult me I won’t insult you back’ but I get accused of being verbally abusive all the time.
Does this sound like CPTSD to anyone here? Maybe it’s both . . .

[ForeverDad]

"and how I am 'refusing to let me get better' " ...

We often note that we can't fix the other person, the dysfunctional person has to want recovery bad enough to do the work.  While we could 'support' their process, blaming us is not the way to success.  Oh, did I write blaming?  Maybe we've gotten away from phrases we used years ago, but when I first learned about BPD it was also called a Blamer's disorder.

While at this point progress seems minimal.  But what if she does manage to turn her life around?  One of our early members had some insight that even recovery does not guarantee the relationship survives.

One of our most prolific posters some 5-10 years ago was JoannaK...  She wrote that if persons do work to attain some recovery then they would not be the same persons as before and there was a real possibility the relationship would not survive, one or both had changed that much.

I'm just mentioning that there are no assured outcomes.  It may be better but will it be sufficiently better?  We hope it does turn out well for your relationship but also hold onto realism as well.

[kells76]

I can touch on this part of your question a bit:

But where I am stuck is that in 6 weeks shouldn’t there be some small improvements if it’s CPTSD? For BPD I would doubt based on what I am learning, that it might not make much difference yet. But if she’s suffering from CPTSD it is emminently treatable, in comparison to BPD (and I am guessing some narsissistic tendencies as evidenced by telling me how much better I am being treated).

I was in a 12 week IOP as young adult, for an eating disorder. That was a few years after the initial hospitalization stint (at age 16), DTU, and 3x week appointments (medical, family T, individual T, group T... etc). So, the IOP wasn't my first plunge into treatment. I remember when I was starting the IOP how I really grabbed on to something I heard a staff member say, that "sometimes you can finish in 10 weeks if you're doing well". I was so completely convinced I was doing awesome, that I was sure I'd be one of the special ones done early. I resented having to quit my job to go to the IOP and felt like what we were doing in it was beneath me ("I quit my job to do crafts?!?").

I ended up having to do the full 12 weeks, and even then, looking back at that process from now, I'd say that I didn't really develop much true insight into what I was doing. I'm thinking that it was more to physically reset our "life focus" and habits -- forcing us to stop structuring our lives around ED thinking and obsessions, and make us structure a daily life around generally normal things, like social interaction and positive hobbies. We did do group check in, skill building, CBT, individual T, group T, etc, but 12 weeks compared to the year(s) that many of us spent with an ED-focused brain is not a ton of time. I think it did give a lot of us a good foundation -- kind of a "cold turkey" approach to stopping the ED focused life and building a new life -- but you really can't "make" someone improve that much in 12 weeks... to say nothing of 6.

Mental health issues are deep and significant. If an individual has had dysfunctional/disordered mental structures for years, it may be helpful to reset expectations about when improvement will be seen. This is not fast stuff.

Just because I didn't leave the IOP with profound insight into my behavior doesn't mean that it didn't help. It was worth it more as a way to fundamentally move the needle on the compass. When you're close to that needle pivot point, it doesn't look like a big change, but down the road, further away, you can see a more profound difference in direction. It takes patience.

...

So it does sound like you and her IOP T are in touch? I wonder if you can set up an appt for yourself and the T, or any of the team members there, and raise this exact question with them -- what can you expect to see after 6 weeks? Can you have them help you with levelsetting for expectations?

[jaded7]

So my wife has diagnosed CPTSD.

I believe (especially since reading others stories on here) that she has BPD and maybe CPTSD.

Basically I experience all of the classic BPD behaviors and in our years together haven’t seen any behavior that would indicate CPTSD. I agree she had a at times crap childhood into her teenage and young adult years, but never any avoidance or triggering based on childhood memories.
Now I realize that these very often coexist and are based on some similar origin points but the one is a much milder issue of a mood disorder and the other is a disorder of personality and will take a lot more work to heal from and change behaviors.


And I keep getting these attacks where everything is a double standard, and every one of her issues is blamed on me, and I am accused of being the source of. Like the verbal abuse, I have spent our entire marriage saying things like: ‘no matter how you insult me I won’t insult you back’ but I get accused of being verbally abusive all the time.
Does this sound like CPTSD to anyone here? Maybe it’s both . . .

My ex was diagnosed with cPTSD as well, she told me. She said it was from years of being in an abusive relationship with her exh. As I've written here before, early on in our relationship she had a very important thing she needed to tell me, we had to go to a quiet place to talk about it. There she outlined for me that her marriage was abusive and she needed to sneak out of the relationship, quietly making her plans and getting an apartment, acting like things were normal. Then one day she just got her stuff together and left, taking the young song along and then sending an email to her husband that she was filing for divorce.

I don't know how much of this about the abuse was true. During our 2-year relationship she often forwarded to me his texts and emails to her, wanting me to validate that he was a terrible person. Firstly, they were just regular text communication, no Our Family Wizard required, which surprised me since I thought that when there was obvious and dangerous abuse-like she described- the court would require OFW. Secondly, these communications were not abusive in any way, and didn't seem like those from an abusive person- no cursing, no real anger, no put downs, no name calling. Just matter of fact, and some frustration...which I understood.

Finally, after our breakup, word got around to me that her sister had told a client of mine (strangely enough, this client was a good  friend of my ex's sister since childhood) that "she was worried about me" being in a relationship with her sister because my ex "is not a good person/is a bad person". I got along great with my ex's sister, I really liked her and she really liked me. It was a shock to me that my ex's SISTER would tell a client of mine, who I knew well and was friends with, that.

Perhaps on a related note, my ex told me that her ex boyfriend committed suicide "after a fight" with her, and left a note saying it was her fault. She says that also was traumatizing to her, as I imagine it would be. But, I do know what she calls 'fights', and they are not a typical fight. It starts with her accusing of doing something 'bad', telling me what my intentions were, then comes the JADE from me, and then the circular argument begins as she gets very angry and around and around we go. Once during an argument that started in that way I told her "honey, you seem to need to win when we have a disagreement, and I want you to know that is not my goal. I just want to feel heard, you don't have to agree. I have no need to win". I also note that if I were to ask her the most simple question about something she said she'd do but didn't, or something confusing to me about her behavior, or even just ask her to stay on the phone and chat a little bit when we weren't arguing, she would call that starting a fight.....or just say "what...you trying to start a fight?" in a very angry tone. Or talking about a certain weekend that she made a commitment to me to do something, then didn't, and so I ask her about it and she gets really angry....months later when discussing it becomes "oh yeah, that weekend you started a fight".

Which leads me to believe that my ex's behavior- highly controlling, angry, yelling, name-calling, put downs, mocking, mimicking my voice with sarcasm and contempt like a child, dishonesty and evasion, ghosting- predated me, and predated her marriage with her ex.

I know from all my reading and video watching that cPTSD is not easily differentiated from BPD. They share angry outbursts and abusive behavior. I also know that some therapists and psychiatrists will avoid using the BPD diagnosis since it's so stigmatized.

[Turkish]

KD,

This is a bit dated, but might help.

COMPARISON: PTSD vs BPD

My mom confessed to me in about 2018 that she had been diagnosed with PTSD and had been going to counseling since around 1980. My first thought was, "did it help? If so or not, why my childhood???" She also told me at the time that she thought she had BPD. I'm 52.

Whether CPTSD or BPD (or others), these are deep seated personality issues.

[jaded7]

"I keep having the experience where she tells me: “I am treating you so much better, and I haven’t insulted you, put you down, or name called or accused you lately.”
I let her know that it is wonderful she is feeling better though her treatment, but that as good as that is for her, on my end I would feel seen a lot more if she were to ASK ME about my experience rather than telling me how much better she treats me.
This pretty much always gets an angry response and how I am am invalidating her, and how I am ‘refusing to let me get better’."

KD, I meant to comment on this. It seems like a familiar behavioral trait where the person tell you what you're feeling and thinking and doing.

She does seem to want to be better, which is good. But she still 'needs' you to validate her reality and therefore herself. The angry response is still the behavioral/thinking problem underneath, inability to see your point of view and to empathize with your experience. Which becomes you doing a 'bad' thing to her, "refusing to let me get better". You aren't doing that, at all, of course. But it's the game of invalidation and ascribing to you motives that 'make' her respond in a certain way.

[Gerda]

I am starting to wonder if BPD is often misdiagnosed as PTSD, perhaps because BPD has such a stigma that therapists don't want to make that diagnosis and put it down as PTSD instead.

My mom has been diagnosed with PTSD, but I've been strongly suspecting for a while that she actually has BPD. Some other family members actually tried to do an "intervention" with her years ago that they thought she has BPD (a bad idea in hindsight, I know), so when she was diagnosed with PTSD, she used it to say "See? You were ALL WRONG, I don't have BPD, I have PTSD!" Of course, nothing she's done over the years have actually made her get any better. I don't think she's even in therapy anymore.

Now, my mom might also have PTSD. She was sexually abused by her father as a child, so that would make sense.

I also suspect that my husband has BPD, which is why I'm on this board, but he's not in any kind of therapy or treatment for anything. Many years ago he told me he used to think he might have BPD, and I was like, "Oh no, of course you don't!" Well, that was back when our relationship was still good. Now I'm thinking he was probably right, except now he thinks there's absolutely nothing wrong with him, and all our relationship problems are my fault.

As for his childhood, his father was an alcoholic and used to abuse his mother. I'm not sure if that's enough to trigger PTSD and/or BPD but it's possible. Or maybe he just learned to be abusive from his father's example.

Anyway, I don't know that much about PTSD, but it seems to me like one of the main issues that people with BPD have is an inability to admit they're wrong about anything or anything's wrong with them. My husband and my mom are both like that. It's like they have such delicate egos that any indication that they might have made some sort of mistake or done anything wrong, from minor things all the way up to serious things (like abusing me, their daughter/wife) just sends them into a fit. My mom freaks out and cries about how she's the most terrible mother ever and she should just kill herself, while my husband gets into a rage and screams at me that he's a good person, not some kind of "scumbag" like I say he is, and really I'm the abusive one in this relationship, and he's an awesome father and husband in almost every way.

I'm not sure if that's a thing with PTSD. I've never heard of that as being a symptom of PTSD. Maybe that's a way to tell the difference?

That trait also makes BPD really difficult to treat. If a person can't handle admitting to themselves that they're anything less that perfect, it's really hard to get them to improve anything about their lives. Everything wrong in their lives is always someone else's fault.

Plus the diagnosis of PTSD also seems to give them the "excuse" they need to shift blame. My mom is certainly using it that way. She thinks since she has PTSD from her father abusing her, that means it's not her fault she is this way, and therefore everyone just needs to be nice to her and she shouldn't have to do anything differently.

There's a therapist who has a YouTube channel that I like to watch who says, "Your trauma is not your fault, but it is your responsibility." I like that, but people with BPD don't seem to understand that. They won't take responsibility to improve anything about themselves. They just think it's everyone else's job to cater to them all the time.