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Author Topic: Why are therapists hesitant to give a BPD diagnosis?  (Read 59917 times)
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Gender: Male
Person in your life: Ex-romantic partner
Posts: 577

« Reply #40 on: November 16, 2014, 01:46:45 PM »

I have seen this question asked several times on the boards and found the following description helpful, and likely quite accurate, as it’s that of a Therapist who has BPD.  This was copied from a site that’s recommended ‘by us’ for BPD sufferers:

I'm a Therapist and the truth is, BPD is the diagnosis most people in the field absolutely detest. I came into this field to work with pwBPD, people like myself, so I was very taken aback by the way others in the field reacted.  

BPD does not respond quickly to medication like acute Schizophrenia or Bipolar. BPD takes extended time in therapy (YEARS) which in today's managed care system, is time that therapists just really aren't given (8-15 sessions). BPD isn't covered by many insurance companies (this is why many have a difficult time getting the diagnosis in the first place). If a doctor can't bill for it, then they won't give you the disgnosis or they just won't treat you altogether.

Above all, many have experienced splitting from a pwBPD and it's something that drives therapists/psychiatrists insane. One minute you're bff's, the next minute you're Satan. Many just simply don't have the patience, empathy or sympathy to have to walk on eggshells with their client and never know who they're going to get from session to session. From talking to colleagues about it, the disconnect seems to be in misunderstanding the motives of pwBPD.


The part of this that’s ‘us’ is our willingness to doubt ourselves.


This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board.

You will find indepth information provided by our senior members in our workshop board discussions (click here).

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« Reply #41 on: January 30, 2015, 05:57:22 AM »

I have looked but nowhere can i find figures for the proclivity of patients to be misdiagnosed with BPD ( e.g. % of complex PTSD mistaken for BPD ) there are plenty of figures for BPD being mistaken for something else but not vice versa.

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« Reply #42 on: January 30, 2015, 01:45:34 PM »

This could be very hard to find, because it is not in the researchers' interests to track mistakes in diagnosing people. This could be for several reasons; for example, admitting that patients were misdiagnosed would undermine the validity of the researchers' own studies; it wouldn't support their view of themselves as competent professionals, and so on. Even if they don't mind admitting the mistakes, they may not feel it benefits them to expend extra time and/or money searching for who was misdiagnosed. There are probably not many government grants for this type of thing!

What you could search for might be "reliability of diagnoses"; that is I believe a close term related to mistakes in diagnosis. The reliability for BPD is often questionable in studies; I remember reading that about 30-40% of the time, doctors in certain studies cannot agree on who has the same diagnosis. This is discussed further in the book Mad Science by Stuart Kirk. Also, the British Psychological Society did a study of the reliability of diagnoses that was interesting; it showed that often, patients were diagnosed with contrary diagnoses by different doctors. They said that one could even make an argument that, given the subjective/descriptive nature of psychiatric diagnoses, that the symptoms of each do not cluster together nearly as closely into distinct syndromes as psychiatrists assert that they do. This is not at all to say that the symptoms of any person's condition are not real and painful; of course they are. But it could suggest that BPD and ptsd are less distinct than is commonly thought. If I remember right, I read about this BPS study in Paris Williams' book, Rethinking Madness.
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« Reply #43 on: February 20, 2015, 06:37:53 AM »

thanks BPD there is an interesting post on epigenetics you might be interested in gist is mistreatment / trauma as a young child may trigers genetic switching on of certain BPD relavent genes as a defense mechanism to protect child
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« Reply #44 on: February 28, 2015, 12:00:02 PM »

thanks BPD there is an interesting post on epigenetics you might be interested in gist is mistreatment / trauma as a young child may trigers genetic switching on of certain BPD relavent genes as a defense mechanism to protect child

Or, those genes are fully active, thus the child is prone to seek or create trauma and chaos…  My conclusion is this ‘behavior’ begins far earlier than is discernible and has far less to do with nurture than nature. 


The part of this that’s ‘us’ is our willingness to doubt ourselves.
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