# suspecting B/NPD in spouse - need a proper diagnosis



## TrueToMe (Jun 6, 2016)

... and no, this doesn't mean I am turning to the internet! Just wondering on your advice for how to broach the topic and with whom.

I understand that the 'subject' obviously needs to buy into the idea of therapy. My WW has had therapies before... some lasting years (long story, but suffice to say her problems include her adult-aged realization of CSA at the hands of family minister). We're in fairly dire straits as a couple due to some of the aformentioned B/NPD - she definitely falls soundly onto the symptoms list.

I recently returned to IC (the main reason, unbeknownst to her, is to help me deal with evidence of an EA and likely PA (occurred long ago - not likely happening now) I am just now piecing together - confrontation pending...).

Perhaps inspired by my efforts, she's expressed willingness to seek help for more personal growth, but I do not want it to just be more visits to a 'paid surrogate friend' in the form of a social worker who helps with dream interpretations. I believe I need to get her into a qualified psychiatrist to help her start examining her profoundly fragmented life.

My questions for TAM: 

1) Am I correct that it is certified psychiatrists who are the only ones to officially, categorically diagnose a person's place on the PD spectrums?

2) Does anyone have experience ( @Uptown ?) with introducing these notions to their spouse - I've read that once a person hears these PDs referred to they will shut down/refuse further therapy? Catch-22, if B/NPDs wouldn't abide with talk of this nature!

She would not normally go for this hard-core route by her own volition, so I can't likely convince her to get her butt into a psychiatrist unless this concern is aired with her. 
I'm okay with that; can easily see it as a condition for R once everything I suspect (ie. long ago EA/PA) hits the fan...


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## Uptown (Mar 27, 2010)

cuckolderman said:


> We're in fairly dire straits as a couple due to some of the aforementioned B/NPD - she definitely falls soundly onto the symptoms list.


Cuckold, I assume that by "aforementioned B/NPD" you are referring only to its mention in the title of this thread. Is that correct? I ask because, although I've been following your other threads, I don't recall any earlier mention of you suspecting her to exhibit strong BPD or NPD traits.



> I recently returned to IC.


Smart decision. Even if your W were to seek therapy -- and even if the therapist/psychologist were to diagnose her as having full-blown BPD or NPD -- it is unlikely he would tell her, much less tell you. Hence, your best chance of obtaining a candid professional opinion about your W's issues -- if BPD or NPD is involved -- is to see your own psychologist, i.e., to see a psych who has never treated or seen your W. In that way, you are assured he is ethically bound to protect YOUR best interests, not hers. I discuss this in greater detail at Loath to Diagnose.



> 1) Am I correct that it is certified psychiatrists who are the only ones to officially, categorically diagnose a person's place on the PD spectrums?


No, any therapist who is certified and licensed to operate in your State can perform an "official diagnosis." This includes psychiatrists (who have an M.D.), psychologists (having a PhD usually in psych), and counselors and therapists (having masters' degrees). For more detail, see Dr. Hutt's explanation of the many differences at Ph.D., M.A., MFCC or MFT.

Generally, psychiatrists tend to be better at diagnosing the more serious mental disorders like schizophrenia, bipolar, and severe depression -- because they are medical doctors who prescribe the medications used to treat those disorders. In contrast, psychologists have a PhD but not a medical degree. Psychologists therefore tend to have more experience in diagnosing and treating personality disorders such as BPD and NPD.

Because you are suspecting BPD and NPD to be an issue, I suggest you encourage your W to start with a _psychologist_. As I noted, they typically excel with diagnosing such disorders. Moreover, because they lack a MD degree, they usually charge half what a psychiatrist will charge for office visits. Yet, regardless of whom she starts with, your W almost certainly will end up seeing both a psychologist (for treatment) and a psychiatrist (for medication) if she has a PD and remains in treatment. 

Although meds won't make a dent in a PD like NPD or BPD, the vast majority of PD sufferers also suffer from a co-occurring disorder (e.g., panic disorder, depression, anxiety, bipolar, or PTSD) that is treatable with medication. Hence, starting with a psychologist likely means she will be seeing him weekly for treatment and will be referred to a psychiatrist, whom she likely would see once every 3 or 6 months to follow up on the medications.

As to the counselors and therapists with M.S. degrees, some of them may be excellent at spotting symptoms. As with professionals in any field, the skill sets for psychologists, psychiatrists, and therapists vary greatly from person to person. Hence, after they all have earned their degrees and have been doing clinical work for 10 or 15 years, some of the counselors and therapists may be better at diagnosing certain PDs than the psychologists and psychiatrists are. This is why it would be worth while to do some research to find out who in your area is especially knowledgeable about BPD/NPD -- if you are seeing strong and persistent traits of those PDs.

I caution that the psychiatric community is still unable to do a true diagnosis of NPD, BPD and other personality disorders. That is, they cannot "diagnose" in the way that term is used in all other scientific fields. When a psychologist tells you he has "diagnosed" you as having BPD, he only means that he has determined that your behavioral _symptoms_ are severe and persistent. 

In every field of the medical sciences, however, "diagnosis" does NOT occur by simply telling you the severity or persistence of your symptoms. On the contrary, the doctor usually relies on YOU to provide that information. This is why the very first thing a doctor will ask you is what symptoms you've been experiencing, how severe they are, and how long they have been occurring. 

Indeed, if you cannot spot your own symptoms (or those of your W), the disorder is said to be "asymptomatic" -- i.e., showing no symptoms. By definition, then, symptoms -- including behavioral symptoms -- are traits that you and other laymen should be able to spot on your own.

Consequently, when a _medical doctor_ gives you a diagnosis, he is not describing your symptoms. Rather, he is telling you what CAUSES the symptoms that you have described to him. Likewise, when an auto mechanic diagnoses your car's problems, he doesn't tell you that the car is pulling to the left. Rather, he tells you what is CAUSING it to pull to the left and explains how he intends to fix that underlying cause.

If, instead, your medical doctor were to simply tell you that your stomach pain is at a level 10 on a 10-point scale -- and then tell you to pay $200 on your way out -- you would be furious. I mention this because, when a psychologist give you a "diagnosis" for you or your W, he is not telling you what CAUSED the behavioral symptoms. Nobody on the planet yet knows to a certainty what it is that causes BPD and NPD to develop in some abused children but not in most of them. 

Until that underlying cause is known, psychologists are unable to treat the cause itself. Instead, they do what the medical profession was doing in the early part of the last century: they attempt to treat only the symptoms. The medical profession largely abandoned that "diagnostic" approach over fifty years ago when they acquired the ability to identify the underlying causes of hundreds of common diseases. If you're interested, I describe this is greater detail in my post at Diagnosis vs Symptoms.



> 2) Does anyone have experience with introducing these notions to their spouse - I've read that once a person hears these PDs referred to they will shut down/refuse further therapy?


Yes, you read correctly. If your W really does exhibit strong BPD traits, she almost certainly will project your accusation back onto you when you tell her your suspicions. The likely result, then, is that she will be absolutely convinced you are the BPDer. 

In my case, I knew that would be the likely outcome. Yet, being determined to leave no stone unturned, I told my BPDer exW -- by giving her a book on the subject. Of course, she became angry and immediately thought I was the BPDer.

IME, there is roughly a 5% chance that a high functioning BPDer will have the self awareness to acknowledge her issue for more than a day or two, if that. Having that self awareness, however, does not ensure success in treatment. The BPDer must also have the ego strength to be willing to work hard in therapy for several years at least -- instead of playing mind games with the therapist. I've not seen any convincing statistics on it but I would be surprised if the share of high functioning BPDers who have both the necessary self awareness and ego strength exceeds 1%.



> She would not normally go for this hard-core route by her own volition, so I can't likely convince her to get her butt into a psychiatrist unless this concern is aired with her. I'm okay with that; can easily see it as a condition for R once everything I suspect (ie. long ago EA/PA) hits the fan.


Good luck with that. I took a similar approach. Although my exW was not a cheater, I did insist on her having weekly IC as a condition of R. She complied. Indeed, she went to weekly IC with six different psychologists/psychiatrists (and regular visits with 3 MCs) for 15 years. 

The result was that I spent a small fortune and it did not make a dent in her BPD symptoms. Not one dent. At the end of that 15 years, she had me arrested on a bogus charge and obtained a R/O barring me from returning to my own home (until the D was finalized 18 months later).


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## TrueToMe (Jun 6, 2016)

:surprise:


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## TrueToMe (Jun 6, 2016)

@Uptown - thank you _so _much for your generous reply. My previous emoticon response was a deliberate attempt to indicate how important your information was to me!

And how overwhelming the implications are. 

I am indebted to you. 
Plus I really feel for you in your own life's story.
Thank you for sharing.


* and yes, you are correct, I don't think I even understood her B/NPD patterns of behaviour just weeks earlier, when I posted my original 'novel-length' concerns. Having more insights into a few of the 'whys' helps me, moving fwd, frame the entire debacle that is my relationship with her. This ought to help me strike the most suitable balance of empathy for her as I try to mold my vision of whatever role she may play in my future.


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## foolscotton3 (Nov 13, 2014)

What has helped me understand it, as well as avoid it, is education.

Buy the better recommended literature(s) on BPD, I say "BPD" and not NPD because NPD can be very overwhelming.

From Amazon.com:
Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder

I Hate You--Don't Leave Me: Understanding the Borderline Personality

Borderline Personality Disorder Demystified: An Essential Guide for Understanding a... 

"A Game Free Life" - The definitive book on the Drama Triangle and Compassion Triangle by the originator and author

Edit: Splitting: Protecting Yourself While Divorcing Someone with Borderline or Narcissis...

Giggity Giggity


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## TrueToMe (Jun 6, 2016)

foolscotton3 said:


> What has helped me understand it, as well as avoid it, is education...


Thanks for the reading list, foolscotton - lots for me to delve into.


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## TrueToMe (Jun 6, 2016)

notmyrealname4 said:


> What's with the user name?
> 
> I mean, do you enjoy that your wife had affairs; was it in some way sexually arousing to you?
> 
> ...


Gee, NMRN4, I really appreciate your perspective. 
I already feel closer to you than my WS: at least it sounds like you care about my feelings...
:wink2:


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