Therapist doesn't believe in personality disorders?

I've been seeing this new psychologist for 3 months now and decided to ask her about borderline personality disorder. My psychiatrist thinks I may have rapid-cycling bipolar disorder and I was afraid to ask him if he would consider bpd instead as my "cycles" are not regular and not rly cycles (I also fit 7 out of 9 criteria), so decided to ask her.

I texted her a non-scientific article about bpd and she said we'd talk about it on the next session. When the day came she said I couldn't have bpd because bpd doesn't exist. I was a bit shocked as I had already read many scientific researches on bpd, but maybe she was trying to make it simple for me? She said most of the mental illnesses can be striped down in depression, schizophrenia and anxieties, and they mix and blend with our life experiences and condition to generate patterns that will later be categorized in labels. Bpd is a label, nothing more (according to her).

She also discouraged me into reading about bpd because of the risk I'd be trying to fit in a box. I think this was stupid, but ok, let's say she is "worried" about me or something.

Not satisfied, I texted her a couple of links about scientific researches on bpd, including Lineham's book about bpd and cbt/dbt. She said they were great articles but I doubt she read them...

I don't know what to think. I think therapy is sometimes corny, but I like her and we were bonding? Now Idk anymore, I think she is dumb and I'm angry at myself for overlooking the silly self-help texts she made me read when we started because when I tried to have a higher level conversation with her she did this. I'm not stupid, for sure, but I didn't think I had more information than a professional about something that belongs to their area and daily work.

*sigh*

I would find a new therapist.

Unfortunately, you're never going change her mind about personality disorders, so you'll be wasting your breath trying to convince her otherwise. You need help (you want to know if you have BP or bpd), but you're not going to get that help from an ignorant therapist who doesn't believe in personality disorders

Despite all of the education and training she has, she is not qualified to be a therapist.

Sorry you're going through this.

I think many clinicians and other mental health professionals do not believe in personality disorders. These things can be quite vague and there is no easy test other than self reports and observation mostly, to diagnose them. I also think that some clinicians are against it because they are often associated with stigmas in public perception, which can be damaging to identify with for some people. I would say if you feel it's useful to explore it for yourself, maybe find someone who is clearly interested and has experience working with it. See if it helps you.

Sounds to me like she's carrying her own personal belief system into her professional practice. That sounds dangerous to me. It may be that her beliefs are valid for discussion among her colleagues. But . . .to assert her beliefs as "true" in contrast to other possibilities. . .? ? ?

For me personally, I have found the idea of personality disorders helpful. It helped me to pinpoint and label some things about me that I found troublesome.

It may well be that what some people observe about some attitudes and habitual behavior I have, or had, are the results of (unresolved) childhood trauma and defense mechanisms. If/when that trauma is resolved, then perhaps I may have a chance to develop new behaviors and attitudes.

But in the present time -- or at least as of 5 years ago -- I found the personality disorder concept helpful, and reading about causes of personality disorders in the psychological literature was also helpful.

Perhaps you could give her the benefit of the doubt and ask her to elaborate on her beliefs and the reasons for them?

Some psychologists - I saw one for a bit - think of BPD as just a way of describing relationship patterns and not a disorder. Though I don't have BPD, I actually like this approach - it seems far less stigmatizing to me than slapping a label on someone (but that's me, I hate labels and diagnoses). The diagnosis is a judgment call - difficult patients tend to get labeled with it, for instance. It also bothers me that women are more often diagnosed with it than men, like 3:1. Something's up there (to me, anyway).

So I'd probably like your psychologist (and I think she is right that you can strip down mental illnesses to a few key symptoms, the ones that can be medicated). I don't think she's dumb, she just has an opinion - but if her approach on this has this kind of effect on you and your relationship with her, yeah, you should probably move on.

I'm not sure her not wanting to label you is a bad thing? The question isn't so much about what label you have but is she giving you tools to help manage the symptoms? She may come around to it but I don't know that sending articles is going to change her mind. I was eventually dx'd with both but it took quite some time to get there. My T has said they are very similar and it can take time to determine which is which. Just give her time.

What you are describing does not, to me, seem unprofessional.
The diagnostic ideas floating around are not written in stone. People used to label homosexuality as pathological.
And borderline personality disorder, especially, has a long history of being a term that therapist used in a derogatory way for patients they did not like or who made them uncomfortable.
My therapist said that he sees diagnoses as useful only for insurance claims. Other than that, putting a label to a person doesn't help him.
People are so individual. What difference, really, if someone gets called borderline or "rapid cycling bipolar" or what have you? It's still the same person, with the same problems.
This wouldn't bother me, in other words. I am happy to have a therapist who treats ME and not some diagnosis.

Your t's thought that "most of the mental illnesses can be striped down in depression, schizophrenia and anxieties, and they mix and blend with our life experiences and condition to generate patterns that will later be categorized in labels" makes some good sense. However, if these labels of depression, anxiety, life experiences like trauma, etc. can manifest into something bigger that needs it's own label, it's seems a contradiction for her to say pd's do not outright exist.

Maybe your t is trying to get you to focus on working through the actual symptoms you do exhibit. Psychiatrists are better qualified to make formal diagnosis' anyway. Based on the symptoms (not labels) you do have, do you think this t can help you work through them? Has she been helpful at all in the last 3 months?

Maybe ask your T what she feels about " traits " of personality disorders ? Different traits can appear in different forms - I think it's traumatologist John Briere who said the DSM would shrink to the size of a small pamphlet if we didn't see all these things as being separate from each other.

I agree with you and whoever said similar stuff, yes, her opinion on mental illnesses being dissected into elementary issues pleases me, tbh. I just felt upset because I showed up a good list of traits and behaviours I display and she didn't even hesitate and missed the chance to understand how I feel. BPD diagnosis is very controversal indeed and there's a lot of bias around some diagnosis.

I definitely don't want a label, but if a "label" helps me (and her) to chase the root of my issues than it is worth a second look? But, honestly, the stigma and all came directly from her. She depicted a "bpd person" as the worst movies ever. However, my guts tell me she is trying to scare me away from this as if it was something less important and ended up "you surely don't want to be this" without using the words.

The second thing that annoyed me is that she asked me to avoid googling stuff like this, which is very stupid for me.

Thanks you all for the replies. I'm sticking with her until the rest of this month at least. I'll see how it goes from now on. One of my thoughts was to quit therapy and see a nice private psychiatrist because mine is from insurance and I'm not satisfied. Idk how you measure how useful therapy can be.

Sorry, I'm a little euphoric and verborragic. My thoughts on therapy rn are just very confusing and I don't know if it is for me anymore.

I was a math major in college so I come at things from a kind of "natural science", looking for the root of the problem, perspective.

"Social science" is also important -- and in that perspective a label on a person and a stigma are not such "good" things.

Both perspectives have merit, I believe. But they are different. ????

I don't think the issue of BPD being real or not real is important in this situation because to me the issue is not how your therapist views it but how she addressed your desire to explore it.

She was dismissive and pushy with her own agenda when she suggested you not to read any literature on the subject because she was "worried" about you putting yourself in the box. This kind of "caring" is a little too patronizing for my taste. One of the major things I detest in therapists is when they treat clients like kids who need to be told what to do.

I happen to believe that the entire DSM system is not very useful, but that is a separate discussion. Regardless of what I believe, if a client started a conversation about some Dx criteria she believes she fits I'd give her enough respect to discuss this as fully as she wants to. I would be honest about my beliefs and if she wanted to discuss it further and to analyse the existing literature, I'd be happy to do so. This is her therapy and I am fine to do it however it suits her as as long as it's in line with my style and my personal ethics.

So, to summarize, I understand why you were bothered by your T's response. It was disrespectful of her to shut down the discussion you needed to have with her IMO.

I just wanted to add this... in some places, they can't bill for axis II, only axis I, which might unfortunately be an influencing factor. I know we've had issues with that before.

I worked for years with a Psychiatrist who did not believe in personality disorders. He felt BAD was used to describe behaviors that were not caused by anyrthing chemical. They were coping skills that were adapted usually in childhood to get their needs met.

He was a well respected doctor for many years even though many disagreed on this aspect. So people trying to give him scientific information wouldn't change his mind. He knew what was out there.

I have a problem with people telling me what or what not to do without giving me decent arguments. This is very annoying.

Your therapist is not dumb--at least, not dumb for having this view. But if you want a therapist to diagnose you with a personality disorder, there are plenty out there who would do that. They even list it on their websites and other advertising platforms.

Actually I do question the intelligence of Ts that take this approach. They ought not to be afraid of patients doing research.

My comment was to the OP.

I already stated I'm not chasing a diagnosis whatsoever.

I think the diagnostic system in place is stupid, but I have a high interest in this sort of thing, so I'll add my 2 cents.

My first thoughts were it's totally normal for MH people to think of diagnoses differently, as there are many different theoretical orientations. But...

On second thought, I think she is highly negligent and her behavior can put people at risk. Not much different than a doctor telling a patient something like joint pain is merely from 'old age', then the patient finds out later what the real problem was but didn't have the doctor's information to make an informed decision to address the problem, and now the damage is too late. People need to make informed decisions. I think it's ok for her to share her beliefs about the diagnosis, but her not providing you with the technically correct diagnosis can be considered malpractice.

There are certainly a lot of MH people that don't believe that rapid cycling is a form of bipolar and instead attribute it to borderline. Likewise, there are groups of the same who think borderline should be classified as a form of bipolar, as the biological etiology has been proven time and time again. Imo, personality disorders are from developmental trauma and should be referred to in that context.

Anyway, here's an article that you might be interested in:

"Disentangling Rapid-Cycling Bipolar From Borderline": https://www.mentalhelp.net/articles/...om-borderline/

Your reply was very helpful and so is that link.

An update: I saw my T today and everything went fine. Again, I repeat, I never meant to chase a diagnosis and she IS helpful for trying to teach me some impulse controle and emotional regulation. I have way too many cognitive distortions and I, obviously, don't know exactly why?

Someone I know also sent me a bipolar disorder encyclopedia so I can (try to) understand rapid cycling, mixed episodes and hypomania.

I understand having a pet peeve with diagnosis and labels because I have it myself, but one thing is questioning it, another is bashing your patient from doing it, which isn't helpful at all. Let's suppose I had been diagnosed with bpd a day before by another specialist. That would have been a really weird situation.

Regarding a few points from above:

the existence of personality disorders ---- I was a psych major and haven't graduated yet because my illness blasted me off of the life plan I had made. I would have been more flexible about the existence of them UNTIL I met my sister-in-law. She truly has BPD. Unequivocally. I had never known someone to be so manipulative, destructive to relationships, recklessly abusing drugs and alcohol regardless of her children there - I'd never seen anything like it. (I'm not saying people with BPD are horrible people. I think this is how she copes with what she's experiencing inside. She's doing the best she can with what she has.)

So, after meeting her and seeing her behavioral patterns, I have no doubt that BPD exists, or whatever the real truth is under the label "BPD" that professionals have best tried to create. I don't believe the DSM represents absolute truth. I just believe it's imperfect efforts to categorize people similar symptoms so that hopefully some could be helped by the treatments that have been shown to help other people. So when I say I have no doubt BPD exists, I don't mean the diagnostic criteria or literature are necessarily truth, only that there is some truth in it.

I also believe there are less severe cases.

I myself was (mis)diagnosed as BPD many, many times while my bipolar was at its worst. Like here_today, the diagnosis was helpful. It was the first time my providers saw how very, very bad things had gotten inside. I was too good at functioning and acting like I thought I was "supposed" to, and so most of my providers were treating for moderate illness which obviously wasn't enough since I ended up in the hospital, which is where I got the diagnosis. After getting that diagnosis, they realized I needed SERIOUS treatment, and they sent me to DBT, which is the single most helpful therapy I've ever received. Bipolar is aaaaaallllll about big emotions, and the DBT emotion regulation and distress tolerance skills have kept me alive many times.

But there were negatives to that. There is indeed stigma with BPD.

The other negative for me was the treatment. Treatment for BPD is therapy first, then medications. Treatment for bipolar is medications first, then therapy. That was absolutely true for me. I was in therapy for seven years working DANG hard but making almost no progress. I was still struggling horribly with constant depression and anxiety and insomnia and more. Then after seven years of antidepressants and therapy, I was put on mood stabilizers. It changed my life. All of a sudden I had a happy day for the first time in years.

Skies' post is right.

My ultra rapid cycling bipolar has been really confusing for my providers to diagnose, but is definitely right. Mood stabilizers, the treatment for bipolar, were what I needed. Therapy is great and helps, but without meds, bipolar doesn't get better regardless of therapy amount.

Anyway, a LOT of thoughts on BPD and its existence and the diagnosis of it and pros and cons.

I'm interested to see if you decide to continue therapy with this lady or not.

I decided to stick with her for now. Guess what? She texted me a pdf book by Marsha Linhem about CBT for BPD. This means she truly read my links or is willing to listen to me.

I don't "believe" in the DSM and I hate when therapists os psychiatrists dismiss BPD because you don't seem "sick enough" in their reading of the criteria. For years I thought I could be BPD when I read about the symptoms and how they experience feelings, but would always think "naaah" because of the stereotype. After meeting people who were diagnosed and were nothing like they show in the movies, I thought it was a possibility. I'm very self-destructive, but an introvert. I can function, I can keep a daily schedule but it's a juggling game that costs me a lot of energy and sometimes I fail miserably. The first time I asked a psychologist about BPD I was seriously judged for not looking sick enough when I was abusing of meds while crying and cutting everyday, just because I would appear smiling at his office (and because I was young at the time and, god, some male therapists are very biased when it comes to late teenagers/young adults girls)

However, I don't believe therapy only can help me. I need meds or therapy is just words flowing from one ear to the other. Or it could be depression too, but hey, I have mixed episodes and hypomania. :T

BPD or bipolar, my mood regulation doesn't work well. And I need someone to understand this because I'm very tired of talking to therapists who suggest the obvious "you need to do this" without teaching me HOW. I don't know how to regulate my emotions, I just don't. It's like asking a kid who doesn't know how to draw letters to write their name. This is the first therapist who says things like "hey, I know it won't happen today, tomorrow or even next to week and that is ok. but next time try to think about what we talked and you'll be one step ahead of yourself", which is very reassuring.