psych says borderline "traits", no diagnosis?

hi. i'm new here. i joined because yesterday i saw a trainee psychiatrist for the first time, as i was referred to my local Community Mental Health Team by my GP.

the assessment was per the usual, going into my history, etc. i mentioned that my doctor and i felt that depression was maybe the wrong diagnosis for me (i was diagnosed at 18 and my then-GP felt it had gone on for four years prior to that) and he asked how i felt and what else i thought i may have, as i mentioned that i was interested in psychology. i said that i thought i had some symptoms of depression, some very severe right now, but that maybe there was something else going on. i brought up borderline personality disorder and he asked why. i mentioned some symptoms i thought were accurate and he said that he thought that that, as well as what i had already said, meant i had borderline personality traits, but he didn't want to diagnose me because it was a controversial diagnosis.

i understood that, i know about its controversy, but i'm left totally confused by how he acted. everything he said after that was in referral to "people with borderline personalities". for example, he said that the most important thing for me right now was stability, because borderlines are often unstable, and that it didn't seem worth trying me on meds at this time, because there's not a one designed for borderline, plus it wasn't worth possible risk to my unborn baby (i'm 26 weeks pregnant). there were other things, like he said that it was important for me to work with someone i could trust, because of "splitting" and black-and-white thinking, and just generally talking as if i was borderline with other references to symptoms that i can't remember. (i have bad issues with concentrating and disassocation at the moment.)

the end result was that he is going to discuss me with the rest of the team, with the aim of assigning me a care co-ordinator. he said he wasn't going to bring up the borderline traits with them, which has left me even more unsettled, and also that it was important for me not to feel abandoned and left to cope alone (which from what he said is a very borderline thing to feel about therapists and such), as i was going to be treated by them, but i still feel very abandoned and rejected regardless (maybe something to do with that i opened up to him but i won't be seen by him again? i dunno) and the confusion isn't helping. does anyone have similar experiences? has he basically diagnosed me without officially doing it?

sorry for the length.

It's hard to say because that is oneway to look at it and the other way is he means you just have traits of bpd, and that is what he referencing you need to work on. I think that question is something you should ask him, and you have a right to do that. From what you wrote though it kind of implies that he thinks you have it, but doesn't want to officially diagnose you because of the controvsey.

He's correct about no meds to treat bpd, but often meds are given to treat overlapping symptoms/diagnosis for ie. depression or bi plolar. There is dbt (dialectical behavior therapy) which several of us have taken or are taking currently, and that has been an effective treatement for bpd.

I do believe that your doctor is doing you a disservice by NOT mentioning it to the people treating. What I think you should be asking your doctor, how can they effectively treat you if information is being withheld from them?

Hope this helps some.

-cbox

hi there alice...welcome to the forums!

congrats on your pregnancy!

um...i'd be a bit concerned that a trainee is offering you a dx so quickly, as in your first meeting? i also find it quite perturbing that he's not willing to bring up your concerns to the team. if you get assigned a care-coordinator, it's going to come up because you're going to have to discuss your feelings and concerns with this person.

i assume where ever you are that a second opinion or working with a different team is not possible? because if it is, DO it. but! do hang out here because we can provide some words of wisdom and support.

thanks for the responses and the welcome.

a second opinion is probably possible, seeing as he's just a trainee (but he is a certified doctor and i know GPs can make the diagnosis of personality disorders) and he's just on placement until August. it's safe to say that i will be seeing others, so i think my worries are a problem that will be resolved, it's just that lately i can't think very clearly, i'm obsessing over everything and it feels like my identity has been thrown into question. i've had symptoms of some mental illness for so long now (eight years) that i never know how to differentiate between my symptoms and personality traits, especially since i have only the slightest trace of self-image and it's always changing. i don't know if that makes any sense at all, but not having a fixed diagnosis after being labelled with depression for so long is bothering me a lot. then again, everything does lately. *sigh*

To me, this is what it sounds like - you brought up BPD, the intern is likely very knowledgeable about BPD - because there is so much more info on it as of the past couple of decades. Newer docs are more familiar with this disorder and less likely to place the old school stigma on it.

Anyway - he's an intern. Many times, a Dx for an Axis II disorder (such as BPD) will be written off as "deferred." This means one of two things: 1) The professional is not qualified to make the diagnosis and/or has not spent enough time with the patient or 2) There is already an Axis I diagnosis. Axis I diagnoses are things like bipolar, depression, etc. Axis II are disorders of a different spectrum. Look at it as confirmed cancer vs. fibromialgia - both authentic illnesses, but one shows up as a dot on a CT scan and the other is a basket of symptoms in common with other people who have the same basket of symptoms.

Regardless, feel comforted that you are going to get treated. Whether a person has BPD or has BPD traits - the disorder is rearing its ugly head in one form or another and the treatment is the same.

Thanks. (New username, realised i hated the username i created) That makes a lot of sense and is reassuring, i've stopped worrying about it so much. Got bigger things on my mind, i guess, my mood swings are getting a lot worse in severity.

I found this very helpful. I was just in a psychiatric assessment to get a diagnoses. And they said that I had borderline personality traits that my condition isn't severe enough to meet the criteria of the disorder. Afterwards I cried, I didn't understand why cause it was good news, turns out I didn't fully understand what it mean't to have borderline personality traits. Now I do, I owe you a big thank you!

Official diagnosis of a pd requires multiple environments so more than one doctor.

You also need to be cleared or treated for bipolar, schizophrenia, adhd and autism.

If you conform to society so have self direction and empathy you don't have a pd.

It was only one meeting?

I was only diagnosed with BPD after talking to the same therapist for a year. And she didn't want to tell me the diagnosis even then. Only hinted I had some PD. I figured out later what she was getting at.

PDs are highly stigmatized. They don't want to label you with the diagnosis if its not absolutely necessary, i.e for insurance purposes. But it does sound like she highly suspected you had it, just didn't want to slap you with the label.

Like others said, seek second opinions, and treatment.

The whole pd stigma
is #######4 except aspd.
They were gonna change it to personality type.

Anyway it implies it's set like autism but psychology is based on being able to change. Cluster c through cbt. Cluster b by dbt and cluster a through creativity such as movies I think. I'm not sure although I think facilitation is key to pds.