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Old 20th April 2013, 03:55 PM   #181
Downtown
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Join Date: Jun 2010
Posts: 58
Re: How to see our married life through my wife's eyes

Quote:
Originally Posted by chosen View Post
If a husband or wife has such a disgnosis, will it ever improve or will their spouses lives and their childrens lives be forever hellish?
Chosen, recent studies seem to indicate that the folks diagnosed with BPD tend to improve somewhat as they age past the mid-forties. This improvement happens even if they are not treated. What is unclear to me, however, is whether this improvement occurs in high functioning BPDers as well as low functioning folks. Also unclear is how much improvement actually occurs.

The studies show that many BPDers improve so much that they no longer are diagnosed as "having BPD." From the point of view of the spouse, however, this failure to satisfy 100% of the diagnostic criteria doesn't mean much. The problem is that a BPD diagnosis is intended to appease insurance companies, not to help you.

Even when your spouse's BPD traits fall well below the diagnostic threshold, they can be strong enough to make you miserable and completely undermine your marriage. Hence, being told by a psychiatrist that your spouse "no longer has BPD" does NOT mean you are safe. It does NOT mean that she doesn't have strong BPD traits.

This is so because, like all the other PDs, BPD is a "spectrum disorder." This means that, like selfishness and resentment, BPD traits are merely behavioral symptoms that everybody has to some degree. It therefore was ridiculous, in 1980, for the psychiatric community to adopt a dichotomous approach -- wherein a client is deemed "to have" or "not have" BPD.

This "yes or no" approach makes perfect sense in every field of the medical sciences, where clients are found to either have a disease or not. This is why, in the medical sciences, "disorder" means "disease." In psychiatry, however, it does not mean that. There is NO KNOWN DISEASE that causes any of the ten personality disorders (PDs). Hence, in psychiatry, "disorder" simply means "group of dysfunctional symptoms typically occurring together" (aka a "syndrome").

Of course, the psychiatric community knew in 1980 that this dichotomous approach to diagnosis makes no sense at all for behavioral symptoms that vary in intensity from person to person. They knew it is senseless to say a person meeting only 95% of the diagnostic criteria "has no disorder" and a person meeting 100% "has the disorder."

Doing so is as silly as diagnosing everyone under 6'4" as "short" and everyone under 250 pounds as "skinny." The psychiatric community adopted this silly approach only because the insurance companies -- who were long accustomed to "yes or no" diagnosis from the medical community -- insisted on a single, bright line being drawn between those clients they would cover and those they would not cover.

Over the past three decades, however, the psychiatric community (APA) eventually realized the insurance companies had betrayed them because, despite this act of appeasement, these companies still refused to cover BPD treatments. In addition, the APA members realized that, if they are ever to be taken seriously by the rest of the scientific community, they would have to abandon this absurd approach to identifying mental illness.

This is why, when the APA committee was creating the proposed new diagnostic manual (DSM5) that will be released in May 2013, this dichotomous approach was fully abandoned for all PDs in the draft manual. It was replaced in the draft manual by a graduated approach which measures five levels of severity. Yet, due to fears that the psychiatric community was not yet prepared to implement such a change, the APA rejected the committee's proposed graduated approach last December. The dichotemous approach thus will be continued, at least until a revised manual is adopted in another ten years.

I mention all this to explain why, for a person deciding whether to remain married, obtaining a diagnosis of "no BPD" is unlikely to be helpful. It may be as useless as telling a blind man "There is no bus coming" when he is deciding whether to step into a crosswalk. He can be killed just as easily by a truck, car, or motorcycle.
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