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Author Topic: Why are therapists hesitant to give a BPD diagnosis?  (Read 59877 times)
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It's a strange game when the only move .... is not

« Reply #20 on: September 19, 2008, 02:26:40 PM »

BPD is "incurable" so they won't reimburse?

I'm not so sure that is exactly it.  From my perspective a personality disorder is perceived as a developmental disorder, noting that it is included in the same category as borderline intelligence.  It's a developmental disorder in that key components of the personality development were missing/not completed/don't exist. (E.G. in NPD what is missing is empathy and a sense that they are equivalent to those around them ... in BPD what is missing is the development of proportionality and consistent sense of self.  These things are not there -they are missing or not developed fully). It is not seen as "curable", but more a condition that just is.  Treating it would be adding to the development of the person - which is different that Axis I treatment -where the person is seen as normally developed with a condition on top of that.

The reason it's not reimbursable isn't so much that it isn't curable, but more that it's a different axis/construct all together.  Reimbursement can occur (on axis I) if a therapist is using CBT/DBT etc. to mediate anxiety or mood disregulation - or other related symptom sets that also carry diagnoses.  A provider can diagnose/treat and include the axis II disorder. It's just that to diagnose ONLY the axis II disorder ... it's kind of like saying one is going to give therapy for the condition of borderline intellegence.  That's not therapy.  That's something else.

Aix II is for reporting personality disorders and mental retardation - and noting "prominent maladaptive personality disorder features". 

Axis III is for reporting General Medical Conditions.  We don't expect that therapists would be paid for treating medical conditions, right?

There is no cure for mental retardation and therapy isn't done for that specifically.  But, that's not to say that some services, therapy and otherwise aren't appropriate for those with this condition. 

I continue to think providers need to include the axis II diagnosis, or at least features if they are recognized.

My thoughts, anyway.


Randi Kreger
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« Reply #21 on: June 24, 2010, 12:35:18 PM »

1. Ignorance, especially if the person is under 182. Belief that people shouldn't be "labeled"3. So the person won't get stigmatized or refused treatment by other professionals who look in the chart4. To get insurance coverage, especially when there is an Axis 1 disorder5. So the person with BPD won't have their feelings hurt, see themselves as unloveable, use the illness as an excuse, etc. Those are the main ones. Randi KregerThe Essential Family Guide to BPD
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« Reply #22 on: January 29, 2011, 09:25:39 AM »

My T said she does give the dx.  She told me she gets one of two reactions.  One, they get upset and storm out and dont come back.  She says these type pwBPD are not able to be helped.  The other ones go ahead, read about it.  Admit that it is like them.  She says these ones can be helped somewhat. 

She has been in practice many years and I liked her explanation.  It helped me realize, my mom will not accept her diagnosis (she has been told).  And it helped me trust her further that she is not going to be keeping secrets from me about my own mental health. 

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« Reply #23 on: January 29, 2011, 01:34:43 PM »

insurance.. can have something to do w/it.. my partners primary dx is OCD/PTSD bc those are covered by insurance for treatment.. 'secondary' dx are BPD/ppd.. even tho thats probably backwards to how he actually is.. his first dx was done in a correctional facility.. so they didnt care too much abt insurance and just ran down a checklist of whatever he 'probably' had.. his current doc explained that.. w/OCD as a primary dx.. he qualifies for a little more flexibility at work and is more likely to get his therapy covered by insurance.. which means he gets to stay in treatment.. and cant get fired from his job for having a panic attack and needing a break or something.. so.. depends on a lot of factors.. R tho.. also aint never had a doctor tell him he doesnt have BPD wink

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« Reply #24 on: April 13, 2011, 01:36:41 PM »

our marriage counselor told me that a therapist is not supposed to hurt the patient that is in denial..even tho a diagnosis would be helpful..if they are in deep denial it can do more harm than good
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« Reply #25 on: May 17, 2012, 02:21:42 PM »

"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.

I very much liked reading what Skip wrote here: It's at the root of a great insecurity many have.  It certainly is for me.

Someone upthread suggested that therapists may be reluctant to diagnose because "you can't do with therapy with an empty chair".  I think that's an excellent point; and it parallels (horribly) how a non (e.g. me) in a relationship with a pwBPD can behave.  Is the other person "ill" or is it me?  I was never able to bring myself to say, clearly and definitely: "YOU are ill" or "YOU are impossible to deal with" or "YOU are behaving in a way I can't put up with - I'm out of here".  Precisely because, like a therapist, I knew that any chance to engage with the person depended on not saying that.  I think that with many kinds of therapy, there's a very good reason NOT to give an early diagnosis, if that'll prevent therapy from proceeding.  (I'd feel terrible if I went into therapy and the therapist simply pronounced "You are suffering from mental disorder X" - I'd say "so what?  It's a label.  How about helping me with it?").

The big difference, of course, is that I'm not a therapist.  It was wrong of me to hold back my "diagnosis", for the sake of continued engagement, because I wasn't competent (or in the right kind of relationship - therapeutic - with the person) to do any good.  But IMHO there are lots of good reasons why someone who is a professional, qualified therapist, and could do some good, to avoid making a clear "diagnosis".

Makes it hard as hell for us recovering nons. I'm back to the point from Skip I started with: wouldn't it be great if there was some undeniable, authoritative rubber-stamp from on high that told us (definitely, in the face of every doubt, and in the face of every protestation from the BPDex that they were behaving totally reasonably) no: this person is definitely ill?
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« Reply #26 on: June 16, 2012, 10:18:42 PM »

My therapist told me that psychologists are moving away from giving patients a label and toward describing them as having a collection of traits. He is a BPD and I am a non... what does that mean anyway? It makes a lot of sense to me to describe that he has these 6 traits and I have those 2 traits rather than just apply a label. I can't explain this well enough, and if someone can elaborate the point better than me I'd be interested to read it.
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« Reply #27 on: June 17, 2012, 10:11:05 PM »


From my understanding there are a couple of reasons one of which the label is very stigmatizing.  Addressing behaviors, while isn't always easy, can be a more functional and less alienating approach to working with someone.  Not every person that displays traits qualifies for a clinical diagnosis, but the behavior is still dysfunctional or distressing and can be addressed.


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« Reply #28 on: June 18, 2012, 06:56:27 AM »

It seems to me that labels are useful in some contexts... how would we have all found each other here if we did not apply the BPD label to our loved ones?

However, on an individual basis it may be counterproductive to oversimplify someone has "a BPD". They have traits of BPD, and no doubt other issues as well, that do need treatment of course. Our brains like things to be black and white, and we want to interpret everything they've ever done as being BPD, which is an unhelpful oversimplification. Therapists are human too. Maybe it's better for them to move away from slapping a label on someone and treating them as "a BPD" instead of a complex human being.
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« Reply #29 on: November 02, 2012, 02:47:00 PM »

I believe that it is. From what I have read the only way to be diagnosed with BPD is by a mental health professional. Thru a series of tests , sessions ect. I do know that there are MRIs and brain scans that can show abnormalities li the brain but they cannot give a specific diagnosis. PTSD and other mental illnesses show up also but to the best of my knowledge the diagnosis of a specific mental illness is done by a mental health professional and not a neurologist and therefore it in my opinion have to be subjective. The skill level of that person , the patient ect all would factor in . I believe this is true with most if not all mental illnesses. I also believe BPD would be one of the more subjective ones because of the wide varying of traits and the range of criteria needed for a diagnosis of BPD. This is just my opinion  ur I have not seen anything to make me think differently. If anyone does have anything I would be very interested to know. My r/s with my exBPDgf affected me in many ways. One thing it did was made me educate myself on BPD which is something I had never heard of . It gave me empathy for those who suffer from it and all mental illnesses. It made me grow as a person and appreciate my life even more. This women touched me in ways that I can't even explain. I have felt emotions with a deepness that I never have before. Those emotions include anger ,frustration , despair , but also joy and especially love . She was the cutest thing ever with cute lil soft feet so also lust :P she def rocked my world and despite all the crazyness I have no regrets !
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