My therapist is about to tell me what I have.

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My therapist has issues with psychiatric labels (as I do), but over the past year I’ve been driving myself crazy trying to figure out exactly what I have, flip-flopping back and forth between Complex PTSD, BPD, Avoidant PD, and even the covert form of NPD. Trying to figure out what I have is driving me nuts!

Although I have a BPD diagnosis (and Avoidant PD), those were given to me in the 1990’s and he has said things that indicate to me he thinks BPD may no longer be accurate. It’s true I don’t act out in Borderline ways the way I used to. But is that because I’ve gotten so good at mindfulness it’s become second nature to not act out, or did I actually manage to somehow cure myself of it? Or was I never a Borderline at all? I think I was–or still am–especially since I was diagnosed with it TWICE).

Complex PTSD seems a likely candidate (if he recognizes diagnoses that are not in the DSM). But here’s the worrisome thing. He has said things in session that make me concerned he may suspect narcissism. Of course I could be reading a lot of things into what he says too based on my worries. I’m pretty sure I’m somewhere on the spectrum though, even if I’m not very high on it. If that’s the case, then I’m back to where I was a few months ago, when I thought I was a covert/fragile narcissist. Or maybe I have something that never even occurred to me I could have, like OCD or Social Anxiety or some dissociative disorder. Maybe I have more than one diagnosis. That’s why this not knowing is driving me insane. I HAVE to know and put a stop to this insanity so I can stop trying to diagnose myself!

We didn’t meet this Thursday because of my lack of funds this week–and I also wanted to attend Holy Thursday services. I didn’t make it to church though because I came home and passed out instead (see my last post). Yesterday I sent my therapist an email letting him know that even though I realized all the drawbacks of psychiatric labels and respected his ambivalence about them, that knowing mine would help me feel more in control. Knowing what he thinks I have would provide me with a sort of closure on all this self-labeling nonsense and I’d be able to focus more on what I’m doing to get better, instead of on “what the hell do I have?” I assured him that anything he told me wouldn’t hurt my feelings, but would come as a relief.

He answered promptly and said he’d be happy to share his opinion with me since I want to know. I see him again Monday and he will tell me then what he thinks. OMG. Of course, at the end of the day, his opinion is just an opinion. But I NEED to know his opinion.

I’m both excited as hell and scared to death.

Is BPD a real disorder or should it be eliminated as a diagnosis?

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The myriad ways experts “see” borderline personality disorder. (click to enlarge)

There’s a great deal of confusion and disagreement in the professional literature about the nature of Borderline Personality Disorder. The blogger BPDTransformation (whose blog is excellent if sometimes a little on the scholarly side), who was cured of BPD, thinks the label should simply be done away with and that BPD doesn’t really exist at all–the label being merely a placeholder for a group of symptoms that are widely variable, and that experts can’t even agree on. He believes BPD is categorized as a Cluster B (dramatic/emotional) disorder only because mental health experts can’t decide where else to put it.

The stigma of BPD as a Cluster B disorder.

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The problem with labeling BPD in the Cluster B category of personality disorders is the stigma that classification carries–that people with BPD (like those with NPD or ASPD) are evil, untrustworthy, selfishly manipulative, grandiose, dishonest, lack empathy, and really no better than people with malignant narcissism or even ASPD. (It sure doesn’t help any that an obviously sociopathic criminal like Jodi Arias has a diagnosis of BPD, when she more likely fits the criteria for high spectrum [malignant] narcissism, at the very least.) Insurance companies assume anyone with a Cluster B disorder is incurable, and therefore will not pay claims where a person is diagnosed with a Cluster B disorder. This is very damaging to those of us with BPD who have either successfully learned to modify and control our symptoms–or have even been cured, as BPDTransformation has been. People continue to believe we are lying about the success of the treatments or therapy we have received. Borderlines who have never been treated may find it difficult to find a therapist willing to work with them.

BPD is far more amenable to deep insight therapy than NPD (which is extremely difficult to cure but not impossible for non-malignants) and light years away from a disorder like ASPD (antisocial personality disorder), which can probably not be cured. Because the symptoms of BPD are so disagreeable to the sufferer (and not just to others), it is common for borderlines to present themselves for therapy, unlike people with NPD or ASPD. The vast majority or borderlines are unhappy with themselves and the way their lives have turned out. But many therapists won’t work with borderlines (other than with behavior modification treatments like DBT) because they know insurance companies will not pay such a claim.

What are borderlines on the border of, anyway?

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The name “borderline” itself is confusing. What are borderlines on the border of anyway? Neurosis and psychosis? A normal sense of self and Narcissism? Mexico and the United States?

The experts are all over the map on this, with some recent theories stating that BPD is actually a less adaptive, more ego-dystonic form of narcissism. But the original term “borderline” actually referred to the belief that the disorder was on the “border” between psychosis and neurosis:

[…]It is called borderline because it was originally thought that people were on the ‘border’ of psychosis and neurosis. BPD is also sometimes called Emotionally Unstable Personality Disorder (Borderline type). Approximately 75% of people given this diagnosis are women and 50% have experienced physical and/or sexual abuse.

Because BPD is more commonly diagnosed in women than in men, it’s also been referred to as the female form of narcissistic personality disorder (which is more commonly diagnosed in men than in women).

Psychotic, neurotic, both, or none of the above?

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Credit: Judgybitch/Dzhokhar Tsarnaev

The reason why BPD is sometimes regarded as the midpoint between neuroses (mild and easily treated anxiety or depressive disorders) and psychoses (disorders where the victim is out of touch with reality, such as schizophrenia and the manic-depressive form of bipolar disorder) is because people with BPD can, when emotionally upset, display psychotic or delusional symptoms such as splitting (black and white thinking), dissociation (feelings of unreality either about the self or the environment), magical thinking, severe paranoia, delusions of grandeur or persecution, and sometimes even hallucinations and disorganized speech or thought. However, for a borderline, these psychotic symptoms don’t last and as soon as the emotional crisis has passed, the borderline’s “sanity” normally returns. Antipsychotic medication can be helpful, but isn’t always necessary, as it usually is for a truly psychotic individual.

Others have speculated that BPD is really a severe form of PTSD or C-PTSD caused by trauma, and should be treated the same way as PTSD. Personally, I think it’s more long-standing than a reactive disorder like PTSD and is a true personality disorder, but it does make sense that BPD may have originally begun as a form of PTSD at an early age, often due to sexual abuse.

There is so much confusion and contradiction in the literature about BPD that I’m slowly coming around to BPDTransformation’s way of thinking that it should possibly be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) until mental health professionals can get a better handle on what BPD actually is, and whether it’s even a valid diagnosis (or simply a group of symptoms that could indicate several other disorders). There should at least be more agreement among the professionals at any rate.

Maybe we throw around the N label too freely.

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I’ve written about this before, but I think it’s something important we ACONs need to remember that can save us and others untold heartache.

We need to be careful about labeling someone a narcissist until we have gotten to know them well enough to be sure. I think ACONs and other victims of abuse are sometimes very quick to label people narcissists who may actually have some other, less malignant disorder such as Borderline Personality Disorder, OCD (some people with OCD can seem very cold), Histrionic Personality Disorder, or even Aspergers (Aspies are often accused of being unempathic just because they don’t express their emotions very well). Some conditions are easily confused with NPD because the behaviors shown may be similar.

Narcissists are actually a small minority of the population, but when you’re a codependent, high empathy type of person, they can seem to be everywhere because we attract them like flies to honey. That being said, the times we live in and a society that rewards narcissistic behavior have probably made NPD more common than it used to be.

Whenever we do pin the N label on someone, it’s our own subjective opinion. In most cases, the person in question probably does have NPD (we are all adults here and it isn’t that hard to see the red flags), but remember it’s an informal diagnosis, not a bona fide diagnosis made by a mental health professional.

My daughter is officially BPD, not NPD!

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So, my daughter finally agreed to see a psychiatrist and took a battery of tests and interviews in his office.

She got her her official diagnosis. She has a number of mental issues but I am so thankful NPD isn’t one of them. She’s Borderline, as I suspected, not that that’s any bowl of blackberry/cherry compote either.

She is agreeing to see a therapist, probably because the psychiatrist recommended it to her instead of me (and she also told me he was “hot”!) 😀 I bet probably has something to do why she agreed to it.

I asked the psychiatrist who did the evaluation to write out his findings IN ENGLISH instead of Doctorese. He had his receptionist write out the results for me; here they are.

AXIS I: 296.89 Bipolar Disorder II, 300.02 Generalized Anxiety Disorder
AXIS II: 301.83 Borderline Personality Disorder
AXIS III: 292.2 Cannabis Related Disorder, 291.9 Alcohol Related Disorder NOS, 305.10 Nicotine Dependence, ICD-9 493.3 Asthma, Unspecified
AXIS IV: 309.81 Post-traumatic Stress Disorder, v62.2 Occupational Problem,v62.81 Relational Problem NOS

Not great dx’s, but I’m glad because of all these disorders, even BPD, have a better prognosis and are more amenable to therapy than any form of Narcissistic Personality Disorder. That doesn’t diminish the seriousness of a few of the disorders she does have, though. Hopefully she sticks with her therapist this time.

It’s creepy how close the code for BPD (301.83) is to NPD (301.81). But they’re just billing codes so it probably doesn’t mean much.