Borderline Personality Disorder Question?

Question

I suspect my partner has borderline personality disorder. He's finally agreed to see a professional about it so I want to make sure it's the right person.
Should he see a psychiatrist, psychologist or a counsellor? In my understanding, a psychiatrist can diagnose, use therapy and prescribe medication, whilst a psychologist can't prescribe medication.
The literature I've read about BPD indicates that medication is not always beneficial, that various forms of long term therapy in which the BP's relearn coping mechanisms and appropriate emotional responses is more appropriate.
Therefore, would a psychologist be sufficient? Money is an issue as he has recently lost his job again and I understand a psychiatrist is very expensive.
I have read other peoples questions and answers related to this. There seems to be a popular idea that we all have problems at times and that these people are often misdiagnosed. I am studying psychology(I've only just started) and I know this is real.
Advice?

Fergus: Thanks for your feedback. I couldn't fit in what I wanted to write. I'm not trying to diagnose him, which is why I'm here now asking where he can get help. I was simply saying that although all of us problems, this is more than your everyday, stress related type of problem.

Answer 1

This is a great question (or series of questions); and I think it's great that you are getting involved in improving your partners well being. I've been diagnosed Bipolar/BPD and am under intensive psychotherapy and med management therapy as well.

BPD is a very complex and serious mental illness characterized by pervasive instability in mood, interpersonal relationships, self-image, identity, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self.

I think you're on to something and reaching out at these boards is great. However, we are all pop psychiatrists and none of us can diagnose your partner, so it's imperative that you pony up and have him see the doc ASAP and get a diagnosis so you can begin proper treatment.

I understand the issue of funds, which was a similar issue I faced at the outset of my treatment. It's often difficult for some poeple to rationalize the importance of mental health vs. physical health. For example, if you found out your partner needed a certain surgical procedure, per the Dr's recommendation, where if delayed, came with fatal results, would you factor in the financial roadblocks?

As far as medication vs. non-medication approach. Med Management should be at the forefront of the treatment for BPD where psychotherapy will exist as an adjunct treatment. What's important to understand is that BPD is often co-morbid, where it will exist with another disorder; e.g. bipolar, ADD, unipolar depression, etc. Understanding the patient is struggling in dealing with unstable moods, thoughts and emotions, your Dr. will be able to prescribe meds to bring your partner to a more stable mindset so they can go to the next phase of treatment an begin psychotherapy. Specifically, mood stabilizers are extremely effective and will do wonders for your partner, relatively quickly.

Through my experience, I tend to feel like I'm fighting in a war, battling in the trenches, where depression is my enemy, medication is my armour and weaponry and my psychologists are my commanding officers, providing strategy and tactics in guiding me through the field of battle. All of those tools combined will help defeat the enemy and guide you to safety.

I've tried meds without therapy and vice versa; I couldn't do it. It's very difficult at first to put yourself through Psychotherapy, but over time, you'll find that it will build strength and a better sense of self if you put in the effort.

As for the meds, I saw a psychiatrist regularly at first after going through a combination of different meds/doses. Over time, I've found the right med/dose and acheived stabliization in my moods,thoughts and actions, which has done wonders in my life both personally and professionally.

As for the psycotherapy; I attend regular CBT (cognitive behavior therapy) weekly and group therapy twice a week and attend other support groups as needed. The combination of which have helped initiate motivation and change in combating my illness. When someone lives with such an illness for a long period of time, they develop learned behaviors which are incredibly difficult to change. The psychotherapy will give you the motivation to make yourself better and the ability to change certain problematic behaviors; which is a monumental task in itself, but it is certainly acheivable.

Good luck and I hope this helps

Answer 2

Since BPD is a personality disorder, it cannot be treated with medication because it won't work. It's likely that there may be depression, or anxiety that can be treated though. There is also something called Dialectical Behavior Therapy (DBT) that is geared for BPD. It helps you use rationale's and your wise mind for making decisions and handling the things that come into your life. I think that seeing a psychiatrist and a psychologist, which is a counselor, would both be extremely beneficial. Also the Dialectical Behavior Therapy which is a group therapy. I have BPD and the DBT is very helpful and also being able to have the one on one with a counselor. And the medication that can help some of the other possible problems associated with BPD that only a psychiatrist can prescibe. However I would say that the DBT and the individual counseling would be the most beneficial

Answer 3

I give you a lot of credit, you have obviously done your homework and have a good idea what you are talking about. So many people do not take the time to understand about this illness or are unable to accept the reality of it.
I have BPD and help run an internet support group for it. You are right, it is a very real disorder.
Meds are not the first line of defense, but can help alleviate certain symptoms. If a mood disorder is present (which is not uncommon) it may be necessary to treat that first, before the person is really able to address the personality disorder.
The therapy involved with treating this tends to be long term. There is no quick fix. Like someone else suggested, DBT is an excellent option. In 20 + years of trying everything, it helped me the most of all.
You can go to a psychologist or social worker, if they think he needs medication (and your partner is open to it) then they can refer you to a psychiatrist (most of whom do not do a whole lot of actual therapy anyway) to handle that aspect.
It may take a bit of searching, but it would be helpful to find someone who has worker with bpd clients before and is comfortable and confident about taking on new ones. Bpd people make notoriously frustrating and difficult patients (of course, this is only a generalization, personally I am very compliant with treatment), therefor some clinicians shy away from working with us.

Another thing to keep in mind is that bpd shares many common traits with other psychiatric conditions, especially bipolar and PTSD.

Answer 4

A psychologist can make diagnoses but often they want to have a person see a psychiatrist first or they can refer their client to a psychiatrist if they think one is needed as far as for prescribing medication. So, I think it's fine for your partner to go see a psychologist. A counselor would not be the right person to see though because counselors usually deal with "every day" problems rather than mental health problems.

You're right in that people with borderline personality disorder don't often respond well to medication although certain meds may be prescribed to help with mood swings or depression. People with bpd have a low tolerance for stress and often under or over react to it. Cognitive and behavioral therapy, anger and stress management are often the best types of treatment.

However, your partner may not have this disorder, it could be something else so it's best if they get a proper diagnosis.

Here are some good sites to read about bpd

http://psychcentral.com/disorders/sx10t.htm

http://www.mhsanctuary.com/borderline/artindex.htm

http://www.psych.org/psych_pract/treatg/pg/borderline_revisebook_index.cfm

Answer 5

My partner has been diagnosed with BPD. The best route to go is to use both a psychologist that has been trained to deal with borderline personality disorder (or a therapist trained in treating BPD) and a psychiatrist to handle meds. Meds do help! The latest research says that the best way to get good results is to use both treatments. The meds help relieve the symptoms so the therapy can work. One of the key elements though is to make sure that your chosen therapists (both psychiatrist/therapist) knows how to treat it and there lies the problem. It is one the most misdiagnosed mental health issues around and add to it, it is also now known to be one of the most common. Many people (including my partner) get diagnosed as bi-polar. My partner is currently taking Zoloft and Risperadol.
We were lucky to finally find a psychiatrist that knew what he was seeing. There are a couple of good books that explain what this is. The one her Doc recomended is an older one called "I hate you, Don't leave me". One I have found to be even more helpful is called "Borderline Personality Disorder Demystified" by Dr. Robert O. Friedal. Hope this helps! It gets better!

Answer 6

I've been diagnosed BPD and I had to search awhile to find someone who was right for me. Unfortunately there is no magic answer. Some BPDs will improve greatly with therapy alone. Some will need medication and most will need a combination. The same goes for therapists. One person can fit great with a therapist, another with a psychologist and another with a psychiatrist. I started with a psychologist, then switched to a therapist, but my official diagnosis came from a psychiatrist. It may take your partner awhile to find the right fit, but the key is to get started now, persevere and be patient. It won't happy overnight. I highly recommend starting with a psychiatrist who specializes in the disorder. You can do some research online to see who the psychiatrists are in your area who treat BPD and go directly to them. And please don't read I HATE YOU DON'T LEAVE ME. It's an older book with out of date information. Pick up these:
1) BORDERLINE PERSONALITY DISORDER DEMYSTIFIED
2) SOMETIMES I ACT CRAZY
3) THE HALF EMPTY HEART

I've found these resources to be incredibly helpful and up to date. And as much as you're trying to help, try not to get caught in the "therapist" trap with your partner. He will start to resent it. Be there for him, be supportive, but don't diagnose. Leave that to his unbiased, third party therapist. Your relationship will thank you for it!! :) Good luck...living with a BPD is hard work, but I know you can both do it!!!

Oh and with respect to the financial aspect, many therapists treat on a sliding scale so make sure you ask the question up front. There is help out there on a limited budget but it does take some research. Universities are a good place to start. Alot of times they have grad and doctoral students working to gain experience so they work under the guidance of a faculty psychiatrist and at a reduced rate.

Answer 7

get a second opinion. Personality disorders are not diagnosed until after the age of 18 because until then their personality is still forming and subject to change... a personality disorder is a pervasive pattern of perceiving and reacting to the world that is enduring and long term..... I think it is the new catch all though for some doctors. Was it a psychiatrist who diagnosed her? She could have "emerging" BPD, or she could have Oppositional defiance disorder, or Bipolar... But you are right, technically, according to the diagnostic criteria, she can not have Borderline. Definitely get a second opinion.... if she is Bipolar then the treatment is very different.

Answer 8

Psychiatrists are the person you would go to for medication and that is about all they really do. Psychologist or a counselor, possibly a licensed social worker would be a better professional to speak to. Yes learning coping skills will definitely help and medications at times have been found to not help with bipolar, this tends to be a tricky diagnosis that is often misdiagnosed in clients.

Answer 9

BPD is painful and puzzling. It is usually related to past wounds...
It takes time to heal and therapy can be very useful. It is important to find a therapist he feels at ease with. The therapist must have a very good understanding of BPD too.
Expressing our feelings is like an exorcism to some degree. The therapist guides you, but the real work comes from the patient. One must have the will to get well. Otherwise it is a waste of time.
Psychiatrist usually focus more on giving medications and when it comes to emotional issues, at times they can lack patience and compassion.

Answer 10

A really good book for those trying to understand BPD from a layman's perspective is _I Hate You, Don't Leave Me: Understanding Borderline Personality Disorder_ by Streisman and Kraus.