[substancelessblue]

I have been seeing my therapist for 3.5 years. I was diagnosed with severe anxiety and severe social anxiety and we also talk a lot about emotional regulation, self-harm, binge drinking, dissociation, etc. Last week I went to see a psychiatrist for the first time as I have been feeling much worse in the past couple of months. She diagnosed me with Borderline Personality Disorder and C-PTSD as well. She said I needed to change quite a few things in my treatment plan. I am just feeling very uncertain and frightened.
I don’t know why my therapist never brought it up, especially after the psychiatrist showed me the DSM for BPD and it was very similar to what I had read in the letter my therapist wrote to my doctor, and I assume the letter she wrote to my psychiatrist though I didn’t read that one. She had pretty much written out the criteria for BPD applied to me in the letter. I had heard of BPD before and thought maybe it fit but I assumed it wasn’t the right diagnosis because my therapist never mentioned it.
Why wouldn’t she have mentioned this possible diagnosis to me? I know psychologists can’t/don’t usually diagnose but it feels as though she was keeping something from me. I’m not even sure I agree that these diagnoses fit me, even though I do have to admit I fit the criteria. I’m also not sure why neither my therapist nor my GP referred me to a psychiatrist. I only went because my mother could see I was getting a lot worse and recommended it.
I’m also angry because my psychiatrist said a whole lot of stuff about medication – basically that I was on nowhere near the dose I need – that my GP had never told me, just left me on the same medication for 2 years. I feel like I was just left for 3.5 years in therapy with not enough information about my illnesses. I have a lot of feelings about my therapist that I can’t sort through, but basically confusion and fear and hurt. Why do you think my therapist kept such things from me?

[ruh roh]

I don't know for sure, of course, but maybe she didn't want to label you. She should not have sent things on to the pdoc without telling you how it would be interpreted by them, though.

[TimTheEnchanter]

I don't know the situation down under but here in the US, therapists cannot diagnose for crap, even pdocs fail a lot but I cannot understand why you'd expect an exact diagnosis from a therapist? What is her degree/background in?

Originally Posted by substancelessblue

I have been seeing my therapist for 3.5 years. I was diagnosed with severe anxiety and severe social anxiety and we also talk a lot about emotional regulation, self-harm, binge drinking, dissociation, etc. Last week I went to see a psychiatrist for the first time as I have been feeling much worse in the past couple of months. She diagnosed me with Borderline Personality Disorder and C-PTSD as well. She said I needed to change quite a few things in my treatment plan. I am just feeling very uncertain and frightened.
I don’t know why my therapist never brought it up, especially after the psychiatrist showed me the DSM for BPD and it was very similar to what I had read in the letter my therapist wrote to my doctor, and I assume the letter she wrote to my psychiatrist though I didn’t read that one. She had pretty much written out the criteria for BPD applied to me in the letter. I had heard of BPD before and thought maybe it fit but I assumed it wasn’t the right diagnosis because my therapist never mentioned it.
Why wouldn’t she have mentioned this possible diagnosis to me? I know psychologists can’t/don’t usually diagnose but it feels as though she was keeping something from me. I’m not even sure I agree that these diagnoses fit me, even though I do have to admit I fit the criteria. I’m also not sure why neither my therapist nor my GP referred me to a psychiatrist. I only went because my mother could see I was getting a lot worse and recommended it.
I’m also angry because my psychiatrist said a whole lot of stuff about medication – basically that I was on nowhere near the dose I need – that my GP had never told me, just left me on the same medication for 2 years. I feel like I was just left for 3.5 years in therapy with not enough information about my illnesses. I have a lot of feelings about my therapist that I can’t sort through, but basically confusion and fear and hurt. Why do you think my therapist kept such things from me?

[Lauliza]

Therapists can diagnose clients. If you use insurance then try have to give a diagnosis or they won't get paid. Some are reluctant to diagnose someone with borderline or any other personality disorder because they have negative connotations. Was she treating the symptoms but just not labeling them? There is no medication specifically for BPD and therapists will be more likely to suggest certain therapeutic interventions, especially DBT. A GP has very limited knowledge of psych meds so I'm surprised they never referred you to a psychiatrist earlier. I would definitely bring this up with your therapist. Sometimes psychiatrists and therapists disagree on diagnoses and sometimes they just have differing philosophies about what they think is helpful. I think it's important for you to discuss it so you understand what your T was thinking.

I can see how that situation would be disconcerting and frightening. When do you see one of your doctors (pdoc/therapist) next? Maybe it would help to make a list of questions that you have for each one including your questions as to why no one told you and why your meds. need to be changed, and ask what your new treatment plan includes. I'm so sorry this has happened to you. Keep us posted.

[substancelessblue]

Originally Posted by TimTheEnchanter

I don't know the situation down under but here in the US, therapists cannot diagnose for crap, even pdocs fail a lot but I cannot understand why you'd expect an exact diagnosis from a therapist? What is her degree/background in?

I'm sorry. I didn't really expect one. I guess I was foolish in any case.

[substancelessblue]

Originally Posted by ~Tsunami

I can see how that situation would be disconcerting and frightening. When do you see one of your doctors (pdoc/therapist) next? Maybe it would help to make a list of questions that you have for each one including your questions as to why no one told you and why your meds. need to be changed, and ask what your new treatment plan includes. I'm so sorry this has happened to you. Keep us posted.

Thank you. I will see my T in a few days. I know why the meds need to be changed and I got a copy of the treatment plan. It's just a lot of overwhelming information at once. I'm struggling with anger about complete silence on this front for years...

I don't know about other countries but here in Ireland only a psychologist or psychiatrist can diagnose. Therapists may suspect that you have an illlness or personality disorder but they can't diagnose you. I think it was wrong if your therapist to send information to your doctor / pdoc without telling you first. That's very unethical. I would have to bring that up with her and ask to see her notes. How do feel now that you have been diagnosed?

[Perna]

People treating you diagnose you according to what they see/what they want to work on treating. Diagnoses are for the treatment teams, not the patient. If you think about it, BPD is not really a very useful diagnoses for a therapist? There's too many symptoms, all over the place to get much of a handle on. A psychiatrist that believes they have medication that might help is perhaps going to think differently. But working on one symptom, your anxiety, could be a good place to start for a therapist. Doing practical work on a known issue can help the whole. You break your arm, you're going to work on casting and healing the arm, even though there might be aches and pains in other parts of your body from the accident or whatever broke your arm? The rest required if you injure your foot/leg and have to sit for a bit, not be running all over, rests your entire body?

I would talk with your therapist about what the psychiatrist said, get her take on it and make a plan that you and she agree would be helpful as you work with her. I'd maybe try a higher dose or whatever the psychiatrist says, see if it does in fact help you with your recent downturn of the last few months. There is no hard-and-fast "right" answer to You and the difficulties you are having. You are a wonderful, multi-faceted, individual and if you went to see a different therapist or different psychiatrist you'd perhaps get yet another different diagnosis.

[TimTheEnchanter]

Just to chime in a bit more...sorry..I have a therapist and she is a family therapist with many years of experience but she is used to discuss and talk, she provides great ideas and feedback. Then I have my doctor (actually a second one) who treats and diagnosed me. Now I know and suspect that besides of being bipolar I might have other maladies but I do not want any medications as the maladies are ancillary and a cocktail of meds would do me more harm than good. Nobody I mean nobody has a clue how these cocktails of meds interact and effect your brain on the long run. No to mention the severe health,m wight and other problems they cause. So I just keep it simple take as little as I need to survive. I could be taking a heel of a lot more meds if you consider all the problems I have

[Salmon77]

I've read that therapy for personality disorders is not always covered by insurance, so that might be another reason why your therapist gave you a different diagnosis, if you're paying through insurance. Plus maybe therapists don't want to put something in your medical records that could be a disadvantage down the line. Right now [eta: in the US*] insurance can't deny you for a pre-existing condition, but in a few years who knows. Being officially diagnosed with a personality disorder could cause problems.

I'd talk to the therapist about what the psychiatrist said, see what the therapist thinks about it and talk about her reasoning for the diagnosis she gave. Also maybe think about whether you feel you've made progress in therapy or not, because in the end that's the most important question--has it been working? Could it work better? Maybe the new medication will help change things up, but if you're on the right track don't consider that three years wasted.

*sorry, just saw you're in Australia and realized this may not apply

[junkDNA]

You could go to 5 different pdoc and end up with 5 different diagnosed

[MBM17]

New diagnoses can be terrifying, especially when you don't see them coming. To me for a while it feels like someone has shaken the world and left it diagonal. I feel horrified at myself and what this means about me. I'm so sorry that this caught you off guard. Hearing that it came from an old therapist would make me feel hurt and vulnerable.

A few thoughts, echoing much of what others have already said but that I agree with.

Many mental health practitioners feel like diagnoses aren't very important and treatment is. My current therapist wrote on my chart when we first met that I had depression. A couple years later, we realized I actually have bipolar. Just a month or so ago, I found out that his office was still billing my visits with a depression code. I was really hurt and asked him, "Do you not believe I have bipolar? Are you just pretending, going along with something I want to believe about myself?"
He said, "Oh, I never thought to change the diagnosis code. I usually just write a code initially so I can meet with people, and then I don't really think about it again. I just focus on what we're working at any given time."

Your therapist may have diagnosed you with BPD or something else but just never mentioned it because she didn't think about using those exact words. She preferred to use the words like "binge drinking."

Even with that said, I would be very upset if I left therapy with my current therapist and found in a letter that he had given me other diagnoses but never actually told me. I'd feel betrayed. I'd feel like he didn't trust me, like he went over my head. If you're having those feelings, I think they're totally understandable.

Could you talk to her about it?

If he had done that and then I couldn't talk to him, I'd probably be trying to reframe it in my head like I've done above. I'd list reasons like, "He may have forgotten to tell me. He may have cared more about how I was doing than about giving me a label." That would reduce my distress.

One reason you may have not been referred to a psychiatrist is that if you really do have BPD, that disorder is most effectively treated with therapy, then meds (in contrast to bipolar, for instance, which has to be treated by meds first and most importantly, and then therapy can help). Therefore, they may have been treating with therapy and not meds.

Your psychiatrist said that you should be on higher doses. Your GP probably has no idea. GP have almost no training in psychiatry. They're better for treating simple depression or anxiety, not the multiple co-morbid disorders or really complex disorders that many of us here on this forum have.

Last - I'm not sure where you're getting the idea that psychologists don't diagnose? I think TimtheEnchanter was talking from the perspective of having providers who didn't diagnose well, but they did diagnose. Therapists and psychologists are THE diagnosers. They diagnose almost all mental illness, with a small number of people originally diagnosed by a psychiatrist. (here in America, that is)

I really hope you're able to find some peace. This is a really hard spot to be in.

[substancelessblue]

Originally Posted by monalisasmile

I don't know about other countries but here in Ireland only a psychologist or psychiatrist can diagnose. Therapists may suspect that you have an illlness or personality disorder but they can't diagnose you. I think it was wrong if your therapist to send information to your doctor / pdoc without telling you first. That's very unethical. I would have to bring that up with her and ask to see her notes. How do feel now that you have been diagnosed?

She is a clinical psychologist. But I didn't really expect any diagnoses from her because I just don't expect much in general. I feel kind of terrible now I have been diagnosed.

[ADeepSandbox]

What I have been told by a family member who worked in mental health for many years, is that there's every chance different providers will give you different diagnosis. At the end of the day it comes down to each individual provider's decision-making and how they think they can best treat your symptoms (and bill your insurance). Go to a different provider, and they might diagnose you with something different. Frustratingly, a lot of conditions have symptom overlap, people can get misdiagnosed, and the brief amount of time you typically spend with a psychiatrist can make an impact too.

The important thing is your doctor is supposed to listen to you and work with you and if you feel you've been misdiagnosed, you have a right to discuss that and be heard by your doctor. Even if you feel you're correctly diagnosed, these are all questions you have every right to ask both your therapist and psychiatrist. You deserve an explanation of why they feel you have these illnesses. One of the ways I realized my ex-psychiatrist was full of crap was that he hemmed and hawed when I challenged him on a particular diagnosis he gave me.

I'm sorry you feel terrible. The thing to remember, I have found, is you are not a different person after the diagnosis than you were before. You're the same person, with the same problems, and the same good qualities, and you're still valid and deserve kindness, respect, and good things in life.

[kecanoe]

I see three ts, all of whom have a copy of the extensive psych testing that I did and the diagnosis made there (DID, MDD, Mixed personality disorder). All three ts use a different diagnosis code when they bill. One uses DID and alcoholism, and I have been sober for 29 years and that is definitely not playing any part in the treatment she is providing. I figure that the insurance company probably prefers having the different diagnoses. Oh, and they would all agree that I have DID and am recovering from MDD and probably would agree with the personality disorder. And my pdoc agrees with the DID, treats me for depression and anxiety because (like BPD) there is no generally accepted medication to help with DID.

All that to say, take the diagnosis with a grain of salt. Mental illnesses overlap a lot, with the same symptom appearing in numerous lists for various disorders. It's not like cancer where knowing the exact diagnosis has a huge impact on treatment. The same stuff that helps my anxiety that comes with the DID probably helps you with your anxiety which may be or may not be part of BPD. And the anxiety of someone with PTSD, or generalized anxiety or depression or probably other things.

[substancelessblue]

Thank you everybody. I know many have mentioned insurance, so I should probably add that is definitely not a factor as in Australia we have a longstanding universal healthcare system that doesn't discriminate based on different diagnoses. So, it is more about my own knowledge of my health and the kind of medication and psychotherapy that is best for me. I'll ask my T this week about the diagnoses. I still have the hurt of her keeping things from me, as I explained in the OP, but I'm trying to keep some of the helpful things on the forum in mind.

I agree that your primary practitioner did not do anything wrong by underprescribing, as more advanced psychiatry is out of the scope of their practice.

C-PTSD covers all of the borderline criteria, so it's not really different although those with certain symptoms may be more prone to getting the actual BPD diagnosis from some. And I think your therapist was trying to protect you from the negative stigma, though perhaps she should have brought up BPD. It doesn't sound like she meant to betray you. I do think they should be honest and upfront.

Although it is true that diagnosis is a matter of opinion more than science and does not necessarily represent what a client truly has, however, I don't think the psychiatrist has any business putting a personality disorder in your record. That can have really harmful consequences and follows you the rest of your life. I think they should discuss it with clients, but they better damn have a good reason to label you by including that in your record. He's the one I'd be angry with-not my GP or therapist.

[substancelessblue]

Originally Posted by Skies

I agree that your primary practitioner did not do anything wrong by underprescribing, as more advanced psychiatry is out of the scope of their practice.

C-PTSD covers all of the borderline criteria, so it's not really different although those with certain symptoms may be more prone to getting the actual BPD diagnosis from some. And I think your therapist was trying to protect you from the negative stigma, though perhaps she should have brought up BPD. It doesn't sound like she meant to betray you. I do think they should be honest and upfront.

Although it is true that diagnosis is a matter of opinion more than science and does not necessarily represent what a client truly has, however, I don't think the psychiatrist has any business putting a personality disorder in your record. That can have really harmful consequences and follows you the rest of your life. I think they should discuss it with clients, but they better damn have a good reason to label you by including that in your record. He's the one I'd be angry with-not my GP or therapist.

Thank you! Nobody ever discussed C-PTSD with me until my psychiatrist appointment either. So I was newly diagnosed with 2 illnesses nobody had mentioned. It was a shock. My psychiatrist is a woman. But yes, I will take those concerns up with my therapist. Good to know the other side of the story, so thank you.

Sorry this happened-I can certainly see how this could be a shock.

I think the important takeaway, regardless of dx used, is that depression, anxiety, etc., are symptoms of a larger issue--sense of self/identity, relational/attachment issues, and maladaptive behaviors, such as self-sabotage.

Here's an article that discusses some of the identity issues, if you are interested (it's older but short and to the point): https://www.myptsd.com/c/gallery/-pdf/1-90.pdf

Despite having these issues myself, I've been to dozens of psychiatrists and therapists, and have never had either the C-PTSD or BPD diagnoses (although i was labeled with PTSD, depression, and anxiety). I had to teach myself about these and arrive at my own conclusions. I know that therapists don't necessarily follow these, but I don't understand why they keep this from people, especially when they are marking it in your record.