Please Don’t Diagnose Yourself: A (Semi Light-Hearted) Commentary on Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a crippling psychological problem, one of the most difficult I’ve seen in my practice. Its main features are a way of looking at the world that lead to extreme shifts in emotion, chaotic relationships, and a lack of identity. Clients who suffer from BPD also report that they often feel numb or empty, almost like a shell of a person. What is perhaps most disturbing is that very often clients will engage in self-harming behaviors such as cutting, scratching, or burning of one’s own body (known as para-suicidal behavior) and some will periodically make full-blown suicide attempts.

It is not certain why the para-suicidal behavior occurs, but most of the people I have seen with BPD report that the physical pain not only serves as a distraction from any emotional pain, but can also serve as a reminder that they can experience pain, that the physical sensation of being cut or burned eradicates the numbness that they often experience. Traditionally diagnosed mainly in females, no one knows exactly what causes it, and it is certainly one of the more difficult conditions to treat, with people needing to be in therapy and on medication for years if not for life just to manage the symptoms.

The most prevalent form of treatment for BPD is known as Dialectical Behavior Therapy (DBT). In many ways DBT is more like a course than a therapy, with both individual therapy and a weekly group meeting where clients learn skills to help them deal with painful emotions. Medication is often used as well, which purportedly keeps the mood swings to a minimum and can help with concomitant disorders like depression and anxiety, but the bottom line is: how do you medicate a personality?

Right after I completed graduate school, I took a training position solely focused on the treatment of BPD. It was basically a one-year crash course in DBT, and I worked both individually and in groups with women who were in their own private hell. Because people with BPD often think in “all-or-none” terms, their relationships with other people are often horrendous. When they meet a new person who is nice, that person is placed on a pedestal. When that same person forgets to call a week later, he or she becomes the Anti-Christ.

Because I fancy my therapeutic style as nurturing and rarely confrontational at the outset of treatment, many of the women saw me as the beacon of hope and all that is good, pure and true. Within a month, however, I had one woman attempt to put out a cigarette on my forehead, another throw a half-full can of soda at my chest, and yet a third dump a cup of hot tea on my lap. Maybe it was naiveté, but I never got angry when these things happened. Make no mistake, however: each person was kicked out of session (for what is known as “therapy-interfering behavior”) and I held each one accountable by demanding an apology upon their return at the next session – I was told that I could charge them for dry cleaning if they ever damaged my clothes beyond laundry repair – but I never saw these women as being malicious. I saw them as sick and in pain and needing help.

The women were held to similar standards regarding their self-harming behavior, based on the treatment’s philosophy that the number one priority was to stop the person from inflicting physical pain upon herself. Clients would sometimes get distressed in the group setting and start to scratch at their face. Or a woman would slice the back of her hand with her car key when confronted on being late. I had a client who also suffered from Obsessive-Compulsive Disorder, so not only did she slice her arms up and down with a razor, she did it with precision: a one inch by eight inch box of incisions, making her arm look as if someone had painted a perfectly shaped brick on her arm.

When behaviors like these were done at home and reported to the therapist in session, it was discussed at length, regardless of what the client wished to focus on that session. If it was done in the office, the patient was either sent to the hospital or home. Every client in the program signed an agreement that they would always be nurtured by the clinicians but never coddled, and would be held accountable for what they did to their bodies.

When I went into practice on my own, I left most of that work behind. It’s very difficult to hold group settings in small offices in New York City, and clients with extreme problems such as those seen in BPD very often need to be seen in clinic settings, where there are multiple clinicians available to handle the inevitable emergencies and crises that are part and parcel of doing DBT. A single clinician attempting to tackle those difficulties is begging for a very high failure rate in his or her practice. Along those lines, research shows that a lack of success in one’s practice is the number one cause of “burnout” in therapists.

When Gina contacted me she asked to be seen for “fucking myself up.” She wouldn’t say much over the phone, as she had called from work, so we simply agreed to meet in the office as soon as possible. When she arrived, she proved to be a small woman who couldn’t have been more than 22, with long sleeves over her arms, despite the sweltering 90 degree heat. I flashed back to my days doing DBT, when embarrassed clients would often wear clothes that covered their brutalized skin, independent of weather.

I often begin the initial session by letting a client know that this is her time to tell me what is troubling her and that I will do my best formulate a plan that will hopefully be of use to her. I always tell clients that I may need to interject to ask a question or get some clarifying information, but that for the most part I will be doing much more listening than speaking. Gina quickly went into the story of her life and how she came to feel so miserable. When she had concluded, I immediately asked about her self-harming behaviors.

“Dr. Dobrenski, I know I have Borderline Personality Disorder,” she responded. “I’ve been reading about it on the internet, and I have the symptoms.”

Client Rule: Don’t diagnose yourself.

“Alright, let’s discuss the symptoms a bit. What particular ones are you talking about?”

“I hurt myself all the time.”

“How do you hurt yourself?”

“I hurt my arms.”

Even though I’m not a physician, I often ask to see the cuts that a client makes, just in case the injuries are serious enough to require immediate medical attention. Gina had no problem showing me her arms. She rolled up her sleeves revealing two red patches on each wrist, somewhat circular, about the diameter of a golf ball.

“These look like rug burns,” I said.

“They’re from a razor. My boyfriend’s razor.”

“This may sound like a stupid question, but what kind of razor does your boyfriend use?”

“A Norelco. Cool Skin, I think.”

“Were you trying to cut yourself with an electric razor?”

“I’m so stupid! I can’t even hurt myself the right way.”

It crossed my mind that she could try to swallow the razor, but failing that, she wasn’t doing any damage with her boyfriend’s hair remover.

“Is that why you think you have BPD, because of these attempts to hurt yourself?”

“Yes, that’s what girls with Borderline do,” she said.

“Well that’s what some people do who have BPD, but not everyone. Do you have other symptoms?”

“Um, I have problems with my boyfriend. He makes me so mad!”

“Okay, tell me about that.”

Gina went on to describe what was not the best relationship in the world, but I’d certainly heard – and probably had experienced – worse. Having met her boyfriend at age 16, they had had their share of fights over the years, arguing about things that teenagers argue about. Gina never viewed him as either a saint or vile sinner (one of the potentially necessary criteria for diagnosis of BPD), their arguments never went beyond the occasional hang-up in a fit of frustration (and therefore not a symptom), nor did she ever experience any unusual distress during the many break-ups that young couples have (again, not a symptom).

“Gina, do you ever engage in potentially dangerous activities (yet another potential requirement) to cope when you feel upset?”

“No, not really. I tend to sleep a lot, and sometimes I don’t follow my diet very well.”

These symptoms are more commonly seen in depressive disorders, so I took Gina through the series of questions to confirm that diagnosis. It proved to be a much more accurate diagnosis than BPD.

“Gina, this sounds like a depressive episode to me.”

“Then why was I trying to hurt myself?”

“Only you would know that for sure, but my guess is that you don’t really want to hurt yourself, you’re simply trying to get rid of your emotional pain. And people with depression make suicidal or parasuicidal attempts as well.”

“So I’m not that bad?”

“I would never suggest that you are in less pain than someone else, regardless of what your diagnosis is. It sounds like life is very hard for you right now and that you could use some help. I will say, and this is good news, that therapy and medication have a better success rate with depression than they do for BPD, so I hope that makes you feel a bit better.”

Gina looked relieved to know that she had misdiagnosed herself. “Well, my boyfriend says that there’s nothing wrong with me, that I’m just a crazy bitch. I guess he’s wrong then!”

Gina and I developed a treatment plan for depression, which involved Cognitive-Behavioral Therapy, a visit to the psychiatrist, and a contract with me to dispose of all speciously dangerous items in her home: electric razors, rubber X-acto knives and those little scissors with the purple handles that children use. Just in case.

Eight months later the boyfriend was history, Gina was enjoying life again, and her medication and therapy were done.

Readers take note: you only get one body, so if you’re damaging it, get help. Writing this piece reminded me of many women I worked with who were and perhaps still are suffering tremendously. Psychology and psychiatry certainly have their limits, especially with a condition as nefarious as BPD, but with the intensive help that is available, your life can be better.

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27 Responses to “Please Don’t Diagnose Yourself: A (Semi Light-Hearted) Commentary on Borderline Personality Disorder”

  1. kate says:

    Cutting has been romanticized with movies like ‘The Secretary’ and ‘Thirteen,’ and with self-professed celebrity cutters like Princess Di and Angelina Jolie. I feel like this feeds into the issue of BPD as a wastebasket diagnosis–girls & women who aren’t necessarily borderlines get diagnosed as such due to their parasuicidal behaviors, and subsequently conform to the DSM criteria. Cutting, like eating disorders, is becoming somewhat of a rite of passage for teenage girls and although I don’t dispute the severity of the behavior, I’m disturbed by the tendency for most clinicians to view BPD primarily in terms of parasuicide. It’s nice to see you don’t do that.

  2. Jason says:

    Dr. Rob, you’re either a saint, or a masochist, considering your profession. Thanks either way for being one of the good ones.

  3. Katie says:

    I am going to school for Psychology.
    I find myself sitting in class thinking about people I know who fit these descriptions or myself which isnt the best thing until I find out more about it.
    My favorite thing in class that we have talked about is the 3 relationship styles. I just find it all so fascinating

  4. Joe says:

    OK, Dr. Rob, don’t diagnose yourself. Got it.
    I’ve got a question for you though, and after reading this I’m going to ask it: how do you find a good psychologist in your city, if you know you need one? Oddly enough, I’ve only just noticed that you haven’t commented on this (please forgive me if I’ve overlooked it).
    Would apprecite a few thoughts.
    Dr. Rob Note: Joe, check out http://www.shrinktalk.net/archives/questions_and_answers.phtml
    Reach me through the Contact link if that doesn’t cut it.

  5. Jackie says:

    I’ve heard that research on BPD is starting to be directed towards it as more of a prognosis indicator comorbid type thing rather than as a single entity in itself…
    But then I’ve also been hearing that it was a pre-cursor to bipolar disorder. Although I’m pretty sure that’s crapola. This is why research is so important in psychology, it’s all about scientist-practioner model (scientists and clinicians) or else it would just be schools of thought “who is right and wrong” and that’s where dangerous pop psychology comes from. Theories and treatments and some disorders not based on a good foundation of research can lead to some amazing mistakes, although with good intentions. I think we have to be careful in reifying anything is psychology because it’s not like the medical field at all, it’s much more complex and the lines between disorder ie an actual pathology and what might just be normal variation and just people being different, the lines are vague and without real objective testing. I think I’ve seen all too many times where that road can lead, in a way that hurts many. Hmm I’m not quite sure how this rant started…
    House of Cards by Dawes is an excellent book, actually is necessary i think, for anyone looking into any field concerning mental health. I can’t say I agree with all of it, but there are some good points people need to be aware of.

  6. Amber says:

    ~I had one woman attempt to put out a cigarette on my forehead, another throw a half-full can of soda at my chest, and yet a third dump a cup of hot tea on my lap. Maybe it was naiveté, but I never got angry when these things happened~
    My question is, how do you deal with clients like this and NOT get upset? How can you disconnect yourself, or do you? Is there ever a day that you go home after work and feel unbearably overwhelmed?

  7. Sean says:

    Tell it to TheBunnyBlog.com

  8. Lyra says:

    It seems to me, from being in institutions and having gone to therapists all my life, that BPD is..diagnosed a lot more than i should be…and while i think that DBT and CBT (both of which i participated in for 3-4 years) are healthy enough for anyone, institutions use BPD as a blanket diagnosis for everyone who walks in the door…could that contribute to this problem?
    i hope its ok for people who are just Interested in psychology to post here 🙂

  9. Casey says:

    I had no idea BPD was majority associated with cutting and parasuicidal behavior. A couple years ago I ended up so far into major affective disorder I had reached non-functioning (only I didn’t think of it like that at the time) after out-patient therapy day camp and evaluation I also got panic disorder and GAD added on. After day camp I had my own therapist (PhD) and during camp and with her one of my large issues (failing at life being my biggest) we talked about was my ex-best friend of 5 years, I mean, we were really close. But our relationship had always been unequal, most of it was me taking care of her and smooth things over during these just complete freak-outs and super disproportionate responses to normal life and if I liked something she didn’t it was always “stupid” and “I don’t understand how you can like that”. After one semester on study abroad we lived together, she freaked out even more, all the time, and I would just reach this really quiet place inside, and smooth things over. Shortly after I started having a lot of feelings of worthlessness, feeling world would be better off if I weren’t there (only, and this is great, I could never think of a way to kill myself that wouldn’t inconvenience anyone), I couldn’t concentrate, couldn’t make sentences in books form meanings, blahblah, ended up getting help. My friend, she practically turned on me, when I stopped going to things (If wasn’t going she didn’t want to go she would want to break group plans to drive all the way to me), didn’t want to hang out, didn’t want to continue our online game. She would just scream at me about how she wanted to be with me and didn’t care if I was happy or not. I would go to that quiet place again. My therapist, with the standard disclaimer that she hasn’t seen her in person said it sounded like BPD. Which I had never heard of but looked up on the internet and it was my friend to a T. Her other friends had thanked me for taking her off their hands, all her life she had latched onto one person and then got cycled off to another. I was allowed to bring people to therapy and I wanted to bring her. I fished out responses when me, her, and two other friends were in a car, and the two I didn’t have any issues with said they would be happy to come and then the one I actually wanted to come came back with “I could never go to therapy, I would just get mad and storm out.” Yeah, sounds about right…
    So I’m not saying my issues that developed are her fault, but I do honestly think she exasperated them and that’s hard. As one completely mutual friend told me how mad she was about what maybe-BPD friend was heaping on me I quipped that I might not be the woman I am today without her (the woman on meds, a script for xanax (convinced that stuff is placebo, hah), and having to hype myself up to fling myself out the door to Go. Do. Stuff.) Also. I have to schedule every hour of my day to stay focused now. Actually not so bad, I recommend it.
    Anyway, this post just made me think a lot and I thought I would bring sharing to the circle.

  10. Kate says:

    Dr. Rob, this is the first time I’ve commented, but I’ve really enjoyed your blog since you started writing it. I was wondering if there is a reason that certain personality traits seem to be gender-related; for example women make up the majority of BPD and men the majority of serial killers (not sure what that personality disorder would be…sociopathic)?

  11. Kiddo says:

    I contacted you once before about BPD problem. I told you that I had been diagnosed repeatedly with this disorder. I have ALOT of the same problems especially the abusing myself and the relationships. I was in therapy off and on for a long time. And I never felt I needed it. Deep down I just felt like I needed to get myself together. I told you that they had tried to just medicate with prescriptions that weren’t even for that disorder. BPD is something I hear ever other girl say they have. It’s really scary how badly girls WANT to have this disorder. Like they want a reason to feel the way they do or honestly just appear broken to people. After they told me I had BPD I decided to not do any research what so ever. I dont know the inner workings. I still truely believe I never had it. I still have alot of the same problems, except the abuse, that stopped two years ago. But for the most part I’m in a healthy state of mind, and have been in my first healthy relationship for over a year now. And have a three week old son. So alot of people should know to always get second opinions. Because I’m finding out alot of people WANT to have something wrong with them. And I will never understand why anybody would want to live in that kind of hell. All I know is I’m happy to feel well happy and content.

  12. kate says:

    @ Kate (excellent name, btw):
    yes, serial killers are usually sociopaths, but of course not all sociopaths are serial killers. some are ceo’s. some, like my brother, find their niche in the military. there’s a whole social constructivist perspective on why certain personality disorders tend to be gendered. for example, men are socialized to be independent and place a high value on power and dominance whereas women are socialized to value relationships and interdependence. sociopathology is also called antisocial personality disorder, and the antisocial quality manifests as a dismissal of the need for relationships, which is basically just a pathological expression of mens’ socialized drive for independence. sociopaths also use the defense mechanism of ‘omnipotent control,’ which reflects their need to assert power over others, a very male thing to do.
    borderlines are a little more complex. ‘frantic attempts to avoid real or imagined abandonment’ are part of the DSM criteria for BPD, and since women are socialized to value relationships (particularly ones involving men), it stands to reason that abandonment fears are associated with females. if men value independence they shouldn’t care as much as women about being abandoned. this is why women also load heavily into the dependent personality category. we also have to factor in the whole evolutionary argument about men and women and their dichotomous drives relating to mating behavior…it’s the whole argument about men wanting to spread their DNA and impregnate as many women as possible versus women’s drive to secure a stable provider. from this perspective men’s abandonment of women is natural and biologically-driven and women’s abandonment fears are likewise evolutionarily predisposed.
    in light of the westernized independent ideal, women’s need for interdependence relegates them to somewhat of a secondary status. their need for relationships is consistently invalidated in light of the value placed on independence. women are given lots of these mixed messages in contemporary society. for example, they’re supposed to be both sexually demure yet total sluts in the bedroom (the whole madonna/whore thing) as well as good mothers and successful career women. i think on another level this can be extended to mass media’s portrayal of the feminine ideal as anything but feminine, (i.e. the whole kate moss/twiggy/prepubescent boy look that most women will never achieve). under these circumstances it’s almost impossible for women to feel comfortable with themselves, and therefore an instability in sense of self is a natural outcome.
    there’s a lot more as far as power dynamics, emotional instability and histrionic overlap, but a) this is getting ridiculous, b) i doubt anyone is actually going to read it and c) i’m supposed to be writing a paper on insomnia and depression. sorry for barfing up an essay into your blog commentary, dr. rob!
    ps–anais nin has a great quotation about this in ‘ladders to fire’:
    “Inwardly and outwardly, a pattern was a form which became a prison….Attempts at evasion were frequent, blind evasions, evasions from dead relationships, false relationships, false roles, and sometimes from the deeper self too, because of the great obstacle one encountered in affirming it…
    Anguish was a voiceless woman screaming in a nightmare.”

  13. TengaRay says:

    Here’s what I want you to invent… a private, credential verified message board for professionals to staff cases. K?
    I run an adolescent DBT group… none w/borderline criteria but we are part of the movement expanding DBT to treatment of any emotion regulation disorder.
    Yay for you for supporting these individuals. My fave population is SPMI and most interesting is a toss up between borderline pd and schizophrenia. (Have you read any of the new stuff out of Duke about OCD vs delusions… AWESOME and makes me regretful that I might have missed dx’d a guy a year or so ago…)
    Again, congrats, I’m pleasantly surprised to read this blog and see that it’s written from an empathetic place. The site it was linked from doesn’t necessarily have such an overwhelming tolerance for the world’s unfortunate…
    Keep up the good work and write more… It just might make me start participating on the internet again.. Be well.

  14. Jon Tea says:

    Posters I´m sure the Doctor would appreciate if you separated every billionth line or so, so he can read your posts more accurately.
    Anyways, I had so-called Depression and it became an expensive habit so I simply just stopped it.
    I just said it´s time to stop the bullshit and GET REAL.
    Given my background and knowledge of herbal medicine, meditation and other ¨spiritual¨ esoteric techniques passed down from my Mother and others I have met in life, I mustered up all my skills to indeed do what is not reccomended, self-diagnose, treat, and eventually CURE.
    I honestly don´t trust most DSM-IV classifications and as a college student am righteously skeptical.
    The reality is….the majority of people worldwide cannot afford expensive therapy sessions and/or prescription drug medications.
    Mental and Health disorders are debilitating, annoying and partially in some ways…not real.
    Long story short to this day I give myself two options upon waking up every morning:
    1) Live and succeed, fight hard everyday.
    2) Kill yourself and save some of that precious effort.
    Obviously I have chosen and continue to choose choice number one as I am still here today posting.
    I had to face reality, I have no enablers and I am the only person who can care for myself. I and millions of other Americans have faced the same dilemma and don´t have the privilige of getting affordable mental health care and or medicine AND face mounting student loan/mortgage/marrital debts.
    This site is extremely informative, and I´m not going to draw a black cloud picture for people who believe in the system. But just remember.
    It´s a system.
    It´s a system which is powered by other flawed people such as yourself and is not a charity, it costs lots of money.
    Children in Sao Paolo, Brazil for example don´t have such options, they either make it, or die. Part of the reason I am still in the land of the living today is because of that premise.
    Accordingly, I blame myself for any and all problems I have, and accordingly I discpline myself to manifest the change I wish to occur. It may take 1 year or 10 years, but I still keep rolling the gears, because I have no other choice.
    To me this is the only way I can, and have survived in this world, and is by the premise in which probably I will die as well, preferably a natural death at an old age.
    However, even today I struggle, like most humans to define the purpose for my existence and fufill my earthly and non-earthly desires.
    Even if I do fail in the end, the only thing I can do is fight hard everyday. So that when it´s time for me to truly die, i´ll have no regrets, and if there is a GOD, I will have done no wrong in his eyes.
    However, Doctor Rob, if most psychologists were indeed like yourself, I suppose the world wouldn´t be as fucked up as it is now would it?
    You´re doing a great thing and I hope your ideals succeed and are spread worldwide.
    But the reality needs to be stated.
    There will continue to be millions of people who cannot afford help of any kind, those that are fortunate to recieve it need to keep this in mind. It helps speed up the recovery much much faster.
    So long as America is ruled by corporations, health care and healthy people are nothing more than dreams for peasants and nightmares for the wealthy.

  15. kate says:

    not to burst your self-inflated bubble, jon tea, but depression tends to lift in and of itself with or without therapy. unfortunately it also tends to reoccur in those who’ve had a previous episode. so when it comes back for you i hope you don’t blame yourself for any all all problems you have that relate to it and instead cut yourself some fucking slack and get treatment. it’s worth the expensive pricetag…

  16. Jon Tea says:

    Sorry Kate but kids in Iraq don´t have the privilige of ´cutting themselves slack´.
    People who cut themselves slack in 3rd world countries tend to end up in the following state:
    DEAD.
    The reality of the situation is you could have at least addressed my whole proposition regarding the money factor.
    My Depression has not ´lifted´ and I grow more pessimistic everyday, and righteously so.
    The world is a fucked up place and I´ll be damned if I waste 120 dollars a month on some happy pill that only works in a half assed manner, when it turns out it ISN´T REALLY WORTH THE EXPENSIVE PRICE TAG.
    Rich people lull themseleves to sleep at night by telling them help is readily available to everyone in an equal manner. And it isn´t.
    I can´t afford over-priced medications that don´t really work and risking encountering therapists that could possibly not give two shits about me.
    Kate face it you´re blessed, but not everyone is so lucky, so count your chickens quietly somewhere where no one can see or hear.
    Thanks.

  17. kate says:

    i’m sorry to hear you’re so sad jon. however i fail to see how children in iraq support your argument. SAME THING WITH CAPS LOCK.
    if you’re really feeling this way you should try checking out more affordable therapy options. many schools provide discounted and/or free services for members of the community, and many therapists offer sliding scales for those who are less fortunate. i’m not a big proponent of drugs for what it seems like you’re dealing with, which, imo, is an existential crisis. it seems like you have a lot of justified rage at the world, but when you turn that rage inward it becomes depression. not a lovely thing, and you’re kind of shooting yourself in the foot if you let political inanity and social injustice make you feel like shit about yourself.

  18. Phin says:

    Years of SELF sabotage – BUT No frantic attempts to avoid abandonment – never. No cutting – never. Not even terribly impulsive. No drama. No threats of suicide – never, the one time I tried to kill myself I did it silently and almost succeeded (I was 13). Incapable of jealousy, no lying, no histrionic traits, no narcissistic traits – some avoidant ones. No black and white thinking – I’ve never idealized anyone, certainly not myself. Let’s say from black to gray, maybe. Also capable of very nuanced evaluations of people when not under emotional stress. Although incapable of believing someone could really want my good – not paranoid (except for fairly rare, brief moments of PTS panic) just convinced that apathy and indifference are the best I can hope for. Lots of real life experiences dating from the moment I was born to back this up.
    Not much emotion in general most of the time – not really alive – until the DYSPHORIA hits:
    Extreme shame, overwhelming fear, acute guilt,moments of panic,essentially knowing yourSELF to be worthless and incompetent, total hopelessness and despair, all this cycling rapidly, alternating with painful surges of anger at an uncaring world followed by self-loathing,overwhelming sadness, excruciating conviction that all in life is tragic and tragedy,and that you must be intrinsically evil to feel this way…
    If you don’t give into suicide, all this too shall pass and you will once more slip into your habitual numbed out shell. Or if you’re lucky you’ll slip into dysthymia for awhile (a few months, a few years…); dysthymic states are a blessing in disguise compared to dissociative ones.
    Welcome to my life with BPD. I can assure you that it was not a question of choice.

  19. Phin again... says:

    I was a bit feverish and in one of my down moods when I wrote the above, but I really just wanted to point out that I never would have arrived at a dx of BPD for myself by reading the criteria in the DSM-IV-TR.
    The psy who gave me this dx worked with me for six years – it was “supportive” therapy – and he was great: he was consistently positive, counteracting my negativity and fear with a mixture of tenderness and hardheaded pragmatism – and eventually some of it sank in. He was not hesitant about confrontation – but somehow avoided making it feel like criticism. My anxiety level went way down and I am now able to work, keep my marriage together and when the dysthymia lifts as it does more and more often, I enjoy life to the fullest. The only meds I’m now on are for insomnia. I loved the quote by Anais Nin – I have often silently screamed in my dreams…
    These are all great posts. Thank you Doc.

  20. sara says:

    Thanks for this post…at least it reassured me also that the shrink who told me this was wrong as well.

  21. Jessica says:

    I have a bachelor’s in psychology and for me it’s hard not to diagnose myself with disorders as I learn about them. The trouble is, I don’t want to delude myself and say I don’t have something I do have, so I go back and forth, telling myself I don’t, I do, I don’t, I do have such-and-such disorder. I lost insurance about two months ago so I can’t go to therapy anymore.
    No one ever diagnosed me with BPD (my last therapist, who is the only one I’ve been totally honest with, refused to give me a diagnosis) but I do think I have it 🙁 In high school I was a cutter and I still scratch my legs until they bleed sometimes, and pick and pick and pick my face and the scabs on my legs. And I wear pants when my legs are like that, although when the scabs are gone and it’s just scars I’ll wear skirts now. I have this trouble with getting obsessed with people, especially authority figures. I talk about my mental health problems way too much, it’s like my identity is wrapped up in my issues. I fall into obsessions, with people, things, ideas. My thinking’s been called black-and-white. My therapist did tell me I had very low self-esteem but that’s all she would tell me as far as diagnosis — very frustrating. I’m also a very anxious person. I feel crazy all the time, especially since I stopped therapy. Maybe when I get insurance again I should search for a DBT therapist??

  22. Googl says:

    This is what your website looks like on my computer: http://i.imgur.com/eR3ei.png

    Host your images someplace better.

  23. JP says:

    Amber says:

    “My question is, how do you deal with clients like this and NOT get upset? How can you disconnect yourself, or do you? Is there ever a day that you go home after work and feel unbearably overwhelmed?”

    I actually had to call my psychiatrist brother-in-law for my answer to this in the world of legal practice. He referred me to a crisis management book that is currently sitting in my living room undread.

    As a lawyer who deals with disability claims, my staff and I have to deal with this on a regular basis.

    The problem is that we are sitting here with *no* training in the world of psychology or psychiatry dealing with this.

    I’ve noticed that some people who are acting out give off a vibe that they aren’t dangerous. Other peolple who are acting out give off a vibe that they want to kill you. I called the police on one guy a few weeks ago. Apparently, that’s an unhelpful response. Althout if *did* get him to leave and never come back. And he wasn’t even the potential client.

  24. JP says:

    I also want to say that I cringe when faced with a BPD diagnosis in medical records.

    I try to make my affect as flat as possible when interacting with them. That way they have nothing to grab on to. I figure that if I regesiter as a nothing then I’m safer.

  25. Seviah says:

    No desire to hurt or be hurt. In fact a profound desire not to hurt or be hurt. But I’m not sure I know what’s in a name. To quote Desdemona (OTHELLO), “Am I that word?”

  26. Seviah says:

    I mean, were I cutting myself, a la GIRL INTERRUPTED, I think I’d diagnose myself with BPF, and I think I’d be right.

  27. Mariah says:

    this makes me feel weird about going to a therapist because I feel they won’t take me seriously if I tell them, “I think I have BPD.” lol.

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