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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: Why are therapists hesitant to give a BPD diagnosis?  (Read 58730 times)
karategrrl
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« on: January 08, 2008, 07:25:43 PM »

This took me a while to figure out, but based on what my ex's therapist has told me, here it goes... My ex is high functioning...She can hold down a job, pay her bills, etc. She meets 7 out of the 10 criteria...So it bothered me when her therapist refused to give a BPD stamp...going as far as saying "If I was to diagnose, it would be BPD...I won't do that, but I'll treat you for BPD"... So here's the thing...If a therapist or Dr. gives the actual stamp of BPD, the person is now qualified for SS benifits, or other compensation...This really bothered me because Ex would use her lack of diagnosis as a fighting tool, "see, even my therapist doesn't agree that I have BPD"...So now I'm more accepting of this descision...
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lasagna
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« Reply #1 on: January 08, 2008, 07:51:41 PM »

To my knowledge, insurance companies don't cover treatment for BPD because they are not convinced that any tools work. so most therapists stick with diagnoses more in the anxiety/depressed realm.       Also, it might show up during a custody investigation I am speaking in the broadest parameters here. I have no knowledge of your particulat situation.

I'm surprised the therapist broached the subject of BPD at all. That causes a lot of patients to never return, so it is gingerly discussed way into treatment.       I am unaware that BPD automatically qualifies one for SSI.  Perhaps you have some specialized knowledge in that field. Many BPDs are able to have successful careers.        I wish you the best. 
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karategrrl
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« Reply #2 on: January 09, 2008, 08:28:44 AM »

My friends brother got SS benifits because of his personality disorder...
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Abigail
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« Reply #3 on: January 09, 2008, 12:39:32 PM »

 In my opinion, that is unethical.  Imagine saying to someone, "If I were to diagnose him or her, I would say diabetes, but I'm not going to say that.  However, I will treat him or her for diabetes."  I believe we have a right to know the truth even if it isn't what we want to hear.  I may not be very happy if I were diagnosed with diabetes but I would rather know so I can educate myself and learn what I need to do.  I might make the choice to be in denial, but that would be my choice.

  I do understand that there is still a stigma with the BPD label and that many individuals do not want to hear it.  But you can never get any better if you deny the truth.

  Abigail
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Lincoln
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« Reply #4 on: January 10, 2008, 10:24:24 AM »

I don't know for sure, but it may also be that most therapists simply aren't qualified to offer a diagnosis of BPD.

It's kind of like getting diagnosed with diabetes by a podiatrist. 

But then again, if the therapist suspects it, they should refer you.
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geroldmodel
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« Reply #5 on: January 10, 2008, 02:30:15 PM »

Diagnosis and classification of personality disorders or even health in general,

differs all around the globe.

In USA the DSM-IV-TR is used to diagnose.

In Europe the ICD-10 is used.

But THEY ARE ONLY TOOLS to diagnose.

Other factors -such as a job- has to be taken into consideration.

In Europe most countries have universal healthcare.

When BPD is diagnosed treatment, therapy and a possible loss of income because of the inablility to work,

will be repayed by the social security system.

In the US it seems that insurance companies do not cover anything when diagnosed.

In my country psychiatrists, forensic psychologists and general practitioners can diagnose a personality disorder officialy. Only psychiatrists and general practitioners can prescribe drugs.

Therapists, Councerlors or even standard psychologists cannot officialy diagnose. They can only refer.

Quote
"If I was to diagnose, it would be BPD...I won't do that, but I'll treat you for BPD"...



So imo this is a very reasonable statement.

She has all the emotional issues of a BPD, but she can hold a job and is high-functioning.

He will deal with the emotional issues in the same way as if she was low-functioning.

What does it matter to you karategrrl ?
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Skip
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« Reply #6 on: January 11, 2008, 11:46:03 AM »

"Why is a BPD diagnosis not given out more often?"  It's at the root of a great insecurity many have... is the person in my life "ill" or is it me?   What does it all mean when a person in our life fits many of the criteria of BPD or BPD traits (but not the obvious tangible criteria sch as cutting, suicide)and have seen a therapists and not been diagnosed or treated.

lasagna points out insurer issues. Lincoln points out that at certain types care providers do not have the education and background to diagnose these disorders.   lasagna points out the potential negative impact on the therapy... that patients often don't return (as a dx is telling an insecure, hypersensitive person that they are their own problem. geroldmodel point out that the "diagnosis" can't be made by a social worker, or non-MD therapist. All good points.

But it is also important to consider that even in the case of skilled, specialized psychiatrists, they don't have the equivalent of the low cost technical tools like blood tests and x-rays to diagnose patients like other doctors have.  

1. Clinical Process Psychiatrists are limited to what the patient tells them.  This communication is a function of time (appointments are under an hour), communication skills of the patient (remember, people often see a therapists when they are in crisis), patient self awareness and honesty, and patient follow up (coming in for additional appointments, reporting progress).

My understanding is that many clinicians work through a hierarchy of diagnosis and treatment - treating the more episodic, pharmaceutical responsive, and lower cost conditions first - they go after the "low hanging fruit".  Many of the Axis I disorders fall into this category. If this does not resolve the problems, they dig deeper.  The process is a little like peeling back an onion and dealing with each new layer.  If the patients heals or stop coming in, the pealing process stops. Insurance company reimbursement policies tend to encourage this approach.

Axis II disorders are far more expensive, complex treatments.  And they are often obscured by other comorbid conditions.

In a hospital setting, there is more time to analyze and diagnose a patient.  Outpatient treatment, however, is often very time limited.

Right now with the current medications and therapies that are available, a diagnosis of BPD (except in cases of suicidal ideation, or cutting) is likely to come later (rather than earlier)... the diagnosis of "high functioning" BPD is not obvious and straight forward.  

2. Subclinical The discussion also raises an obvious suggestion that many of the partners, parents, children here aren't  "BPD" by the clinical definition... they have some traits, or many traits, but not enough, or severe enough to be diagnosed.  They are extremely difficult people, nonetheless.  In many ways, the same tools, options, and thought processes are valid in subclinical situations... maybe even being more effective.

Anyway... "General BPD Topics and Questions" is an information exchange board... for me, this was a good exchange of information we have gathered.  Thanks.

Skippy
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ocean401
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« Reply #7 on: January 12, 2008, 12:38:28 AM »

My ex's therapist coddled her to no end.  I remember asking her therapist about BPD and she said to me, "I can see how you'd think that but I'm not ready to go there."  I think her therapist simply knew that she couldn't push her too hard and so she seemed to never push her.  I mean, come on, after meeting every week for over a year you gotta push the client at some point!
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karategrrl
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« Reply #8 on: January 12, 2008, 11:06:12 AM »

My ex's therapist coddled her to no end.  I remember asking her therapist about BPD and she said to me, "I can see how you'd think that but I'm not ready to go there."  I think her therapist simply knew that she couldn't push her too hard and so she seemed to never push her.  I mean, come on, after meeting every week for over a year you gotta push the client at some point!

Not if you want to get paid...You have to ask yourself, are T's really there to help, or are they there to make a living? If they push too hard, the BPD will leave...If they treat them for something and it seams to be making a difference, why lable it? Not that I'm saying their unethical, I'm just sayng, they want to keep their clients...
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lasagna
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« Reply #9 on: January 15, 2008, 12:02:14 PM »

Here's the therapeutic view as I understand it. BPD need a connection to a T that is accepting, not rejecting.  Labeling a pt as BPD certainly can be perceived as very rejecting.   Instead, the therapist acknowledges the very real emotions (fear, sadness) that drive BPD behavior and validates those feelings.  Alternative, healthier reactive  behaviors are discussed in a non-judgemental tone. You cannot do therapy with an empty chair.

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