Changing Dx to BPD?!?!? Help!

My daughter saw a new psychiatrist today (her old one is now only seeing inpatients). I'm not sure what to think. We've been treating for cyclothymia for a year and a half and it really seems to fit. Today's p-doc, though, said he sees "very strong cluster B traits." I.E. he thinks she's dealing with Borderline Personality Disorder. That scares me. BPD is typically harder to treat. While the dx of bipolar/cyclothymia brought some relief/hope (we know what we're dealing with and now we begin trying to figure out how to treat it), the dx of BPD brings more of a dread/hopelessness than anything.

So... I have real questions as to dx'ng her BPD, but I don't know if it's just because I don't want to see it. Here's the deal... what we've experienced with her has been very cyclic in nature. Every January she starts tending a little hypo-manic... until March/April when we're ready to pull our hair out because she's so out of control. By the time school lets out, she's recovering and the summer is usually great. About the third week of September we start having issues again, but these are milder and we're discovering are more due to depression. Some symptoms are similar, but the reasons behind them are different -- sexual exploits in the fall are an attempt to feel better; sexual exploits in spring are pure lack of impulse control and risk-seeking behavior. Also of note, each spring has traditionally been worse than the previous spring -- it definitely has a progressive side to it as well.

As a side note, her psychologist recently diagnosed me as Mood Disorder, NOS (and I have a cousin who was bipolar) and recently diagnosed my husband as Cyclothymic, and her paternal grandmother deals with severe depression, possibly bipolar. So it seems like Mood Disorder runs in the family - on both sides... and.. As I type, I hear the hypo-manic giggle from the other room -- her January spin is starting and my heart is sinking.

So, a lot of the descriptions of Borderline Personality Disorder could fit her -- but they also ring true with cyclothymics. And wouldn't BPD be more consistent? Or does the cyclical nature we've noted also occur with the BPD?

I think the thing to focus on is treatment. You probably understand by now how hard it is for many people to get the right diagnosis. If the p-doc thinks the diagnosis is something different than what a previous doc said, you're not actually having an unusual experience. You may be right about resisting the diagnosis because it's not the one you want to hear. But did you want to hear cyclothymia way back when?

How effective has treatment for cyclothymia been? If it was only so-so, it may be a good idea to try a new treatment. Whether that's a different cyclothymia treatment or one for BPD is something to work out with the p-doc.

Even if the BPD diagnosis sounds scarier and more hopeless than cyclothymia, doesn't it also sound scary and hopeless to have the wrong diagnosis and get less than optimal treatment?

Keep in touch with the p-doc about what's going on. You're certainly right to ask for his or her explanation of the diagnosis including why other conditions are ruled out. Be aware that you could have a confirmation bias--looking for the evidence that you're right but discounting the evidence that you're wrong. The doctor could have such a bias too, but I think that's less likely. Talking about the diagnosis should help overcome any biases either of you have. You and the doctor can try to work out a way of documenting what's going on to serve you both better when the diagnosis is reevaluated.

Thanks for posting.

Dark_in_the_Light, thanks. You're right -- treatment is the thing to focus on. From what I can gather, treatment itself isn't that different between the diagnosis -- just the likely outcome.

Actually, when we received the diagnosis of bipolar/cyclothymia we DID want to hear it. It gave answers, directions, and a lot of "aha!" moments. The reading on borderline (BPD) didn't give me those same "aha!" moments.

Anyway, my husband and I had a session with DD's psychologist this morning. The psychiatrist had already been in contact with his office (YAY! That's a nice change from the previous psychiatrist!). Our psychologist went through the diagnositc criteria with us and the result is, that while he sees WHY the new p-doc would consider BPD, our psychologist believes, after having worked with DD more extensively, that those behaviors are not pervasive, but flowing out of her bipolar.

So... bottom line, I do like the new psychiatrist; love how he works with pyschologist (whom we love)... but psychologist doesn't really feel a dx of BPD is warranted. And... I guess the way it was written, the new p-doc wasn't saying she didn't have a mood disorder, and wasn't even necessarily saying she had BPD, but was saying that he thought BPD was something to consider as well....