[CartDown]

I chose to go, I was thinking about it for awhile. I was just too scared people would say I was overreacting. So 5 days in the psych ward and I met with a psychiatrist everyday. He diagnosed me with BPD, something I was questioning this whole time. But my therapist, who doesn't like to label, danced around the question when I asked him. Even when I told him what the psychiatrist said, he in a strange way confirmed it with out saying it straight out. He told me I'm still the same person I was yesterday, I'm still me. A friend told me insurance companies consider it "untreatable", so good doctors don't put it on paper. Even after confirming it all with my psychiatrist a few times, my discharge papers say nothing about BPD, but says I have severe MDD. It sot of freaks me out a little and it's getting me anxious. Why do some consider it untreatable and why is it so stigmatized?

[susannahsays]

To be honest, the reason it is stigmatized is because the effect the symptoms of BPD often have on other people. BPD is really disruptive interpersonally. I'm not saying that's right, just that I think that's the major reason why.

As for the untreatable part, I think that's for a few reasons. For one, personality disorders are just really difficult to treat because they are so ingrained - so people with BPD really have to be strong enough and want to get better enough to go against everything they're feeling to make progress. For another, some of the symptoms of BPD can create barriers to treatment - again, it's the interpersonal component of BPD that can sabatoge things. That doesn't mean that BPD is untreatable, it just means that it's no walk in the park and there are clinicians who just don't want to deal with it or know how to deal with it. I think the idea that BPD is untreatable is also rooted in clinicians who haven't known how to treat BPD coming up short. Instead of acknowledging that they didn't know what to do, lacked the skills, etc., treatment failure is/was framed as the condition being untreatable. While I don't think most therapists are capable of treating BPD, that doesn't mean that it is not treatable by anybody.

[LonesomeTonight]

Your discharge papers may say that for insurance purposes, as insurance generally always covers MDD, but I'm not as sure about BPD.

[CartDown]

Originally Posted by LonesomeTonight

Your discharge papers may say that for insurance purposes, as insurance generally always covers MDD, but I'm not as sure about BPD.

Yeah, that's what I heard. And it scares me a little. It also scares me that I'm now taking an antipsychotic. It's good to know what's going on in my head, but it's a bit overwhelming. Probably why my therapist didn't want to tell me in the first place.

[Xynesthesia2]

I think there is a lot of misdiagnosis and over-diagnosing BPD these days. It's kinda became the go-to label for stubborn, complex problems that do not respond very well to treatment and/or for people who struggle with severe mood issues, interpersonally and with impulse control. It also sometimes is a statement by professionals equivalent to "you are too complicated and I don't know how how to help". The nature of personality disorders is really very poorly understood (many professionals even question their existence as discreet disorders) so no surprise there aren't many effective treatments. What they do is treating the symptoms (e.g. mood issues) and helping to develop skills to manage them. Many people with a BPD diagnosis find treating or learning to handle the symptoms better helpful.

[susannahsays]

I disagree that there is overdiagnosis. I have heard many accounts just like OP's, where the clinicians refuse to diagnose BPD. Anecdotally, BPD was not a common diagnosis when I worked at a mental health agency. The most common were some type of depression, GAD, and PTSD.

I would actually argue that when there is misdiagnosis relating to BPD, it is often diagnosing the person with bipolar disorder when they actually have BPD.

[here today]

Originally Posted by susannahsays

To be honest, the reason it is stigmatized is because the effect the symptoms of BPD often have on other people. BPD is really disruptive interpersonally. . .

While I don't think most therapists are capable of treating BPD, that doesn't mean that it is not treatable by anybody.

I've never been diagnosed with BPD and didn't have those symptoms when I was young. Instead, I was inhibited and overcontrolled and was told by psychologists that I should get in touch with my feelings and express them. I think I may have qualified for OCPD but was never officially diagnosed with that or had anyone attempt treatment, that I know of.

Eventually after "working hard" and trying many different therapists, I did get in touch with my emotions and then I did express them it was, much to my confusion, apparently too much for people, including therapists. I expect that I can look much like a person with BPD when I am in one of those states. I can still turn them off, but I know now that there are consequences to me in terms of suicidal depression and not getting what I need if I do. Of course, if if I'm turning people off that doesn't help much, either.

Since I didn't start out with BPD, DBT was useless for me, though, because I can and did "regulate" those emotions by turning off/shutting down/dissociating and did not actually experience wanting a relationship, which is like a prerequisite for the interpersonal effectiveness module.

I do experience wanting and needing other people's help these days. It's quite awful, especially when I can't see how to get it, and when I don't trust them or their willingness to help, which of course is going to evaporate if/when I am unknowingly difficult or disruptive or suspicious, problems I did not have when those feelings were shut down.

A very important thing for me at this point is to try to find communities and groups that can and will accept me. And accept me as I am, somehow. The last therapist terminated me, after 6 years, because she said she did "not have the emotional resources" to continue. I continue to experience that as an enormous betrayal.

[Xynesthesia2]

I think many "simpler" mental health problems can mimic the symptoms of various personality disorders (and other diagnoses the person would not normally reach) when they get severe. For example, I had a serious substance (alcohol) addiction problem for several years in the past and, during that time, I very much qualified for a bunch of other diagnoses as well. Even some BPDish patterns that I never normally experience and display otherwise. People who only knew me online actually asked if I had BPD during that time. But also symptoms of bipolar, severe MDD, severe GAD, and other things. I was a walking DSM really, while in reality the culprit was the drinking, causing everything else. Without that, sober, I only ever had an eating disorder in my youth and ~life-long anxiety but not even that very severe. I have heard similar experiences from many people, especially others with substance abuse but also stubborn MDD can precipitate/mimic a lot of other things. This is why it can be a good strategy to focus on the most serious, primary issue and try to treat its symptoms first - see if it perhaps resolves other things as well.

It is very common to be diagnosed with multiple mental health issues these days and attempt to treat them all in sloppy ways, or focus on the wrong one. For example, if someone has substantial chemical imbalances in the brain due to depression, I think they can do all the psychotherapy in the world, or learn new coping skills, it is unlikely to solve the basic medical problem. My addiction was similar - of course it seriously messed up my brain and caused all sorts of physiological issues that are never present without it.

[Lemoncake]

As someone with BPD, my T didn't tell me until we were 9 months in. I think it is treatable but you just need the right therapist for it and it's likely to be a long a ride.

Two documentaries I really liked:
1. Dr Aguirre's Insights on Borderline Personality Disorder

2."Back From the Edge" - Borderline Personality Disorder

There's also this old research paper I found called: Stages of Change in Dynamic Psychotherapy With Borderline Patients by John Genderson. I liked it because it tracked around 5 patients over 5 years.

[susannahsays]

@here today I'm getting the impression that you took exception to what I said about people with BPD having to work hard. I understand that sometimes, all the hard work in the world doesn't matter if other circumstances, such as the incompetence of therapists, get in the way. However, the fact remains that people with BPD do have to work very hard constantly to see improvement. They can't just take some medication and call it a day.

I am aware that your final therapist abandoned you. I did not express an opinion on therapists who are not emotionally capable of treating BPD because of the interpersonal symptoms. All I said was that there are many who aren't and I think that contributes to the idea of BPD as untreatable. There was no judgement towards clients or people with BPD behind my words. It was an explanation, not a defense of therapists.

[here today]

Originally Posted by susannahsays

@here today I'm getting the impression that you took exception to what I said about people with BPD having to work hard. I understand that sometimes, all the hard work in the world doesn't matter if other circumstances, such as the incompetence of therapists, get in the way. However, the fact remains that people with BPD do have to work very hard constantly to see improvement. They can't just take some medication and call it a day.

I am aware that your final therapist abandoned you. I did not express an opinion on therapists who are not emotionally capable of treating BPD because of the interpersonal symptoms. All I said was that there are many who aren't and I think that contributes to the idea of BPD as untreatable. There was no judgement towards clients or people with BPD behind my words. It was an explanation, not a defense of therapists.

So sorry, I did not take exception to what you said. I am aware that people for whom the BPD category is a good description do have to work very hard to -- retrain their nervous system? Is that a good way to describe it?

I thought the description you wrote about why people who have the BPD diagnosis are stigmatized was very realistic. And can probably apply to me somewhat as well. Anybody with extreme states can probably have that effect on others. And it is something that I did NOT understand for a long, long time. I think it could be helpful for therapists to explain it to people, just realistically, the way you did.

Thanks for giving me a chance to clear that up, and I hope I have.