Diagnosis of BPD NOS but Dr. is confusing.

Hi. The diagnosis on my wife’s bills have always stated Bipolar Unspecified, or Bipolar Not Otherwise Specified. This diagnosis has never been discussed with my wife, instead he talks about vague things that I can’t even look up, like Bipolar Disorder w/Borderline Traits Caused by trigger. I see the same doctor and he basically told me she doesn’t have Bipolar but rather Borderline Personality Disorder. The problem is my wife really has no clue about what her actual diagnosis is. So if I bring up anything specific related to Borderline, I’m accused of “psycoanalizing” by my wife. This vague diagnosis and my wife not knowing exactly what’s going is causing all sorts of stress. If the billable diagnosis is Bipolar Unspecified, shouldn’t my wife be told this?

Is your wife happy with BP nos as her diagnosis? This is something that you really have to talk to her dr about. Does she take medication? Is she in therapy? I'd be very weary of a dr that wont be honest.

That is strange. I don't understand not telling your wife her diagnosis especially since there are treatment options like DBT and it might help her to know. I have heard of psychiatrists not telling patients about diagnoses before especially BPD but don't see many reasons why they should avoid telling them.

Where you mention the Dr. says she doesn't really have bipolar, but borderline, I can't help but think he is simply using the BP NOS code for insurance purposes. It is regrettably common. It's about what insurance will cover. Really, there are two reasons this happens, the other being that many people with borderline don't react well to being diagnosed with it (as you have discovered, and this is why she accuses you of psychoanalyzing her even just bringing it up). It is a highly stigmatized dx. Your wife's reaction to your talking about it pretty much confirms reason number two. I personally would guess it is both factors.

While I don't have any real reason to believe that you are psychoanalyzing her, I would advise laying off the borderline stuff, because it won't go well. Actually, I'd advise not getting into any of it (bringing up the borderline or playing along with calling it bipolar). Has the Dr. advised you to be involved? It's very tricky territory to navigate.

I do understand that it's frustrating.

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Mr. Robot

Makes me sick to the heart, Oh I feel so tired. And the way the rain comes down hard, that's how I feel inside.

--The Cure

My experience with people who have Borderline Personality Disorder is that they'd rather be diagnosed with just about anything else because they see the BPD diagnosis as delegitimizing their suffering. I've seen people with BPD seek out psychotic disorder diagnoses in order to feel more legitimate. This is the fault of the mental health establishment. The stigma people with BPD endure is pretty severe. Therapists dump them. Hospitals don't treat them with respect. Their social relationships are in a shambles and few clinicians reach out with the kind of mental health treatment needed. The terrible part is people are given diagnoses and medications for disorders they don't have just so the system will treat them better. Taking a medication for an illness you don't have can be life-threatening. The mental health community needs an overhaul on how it treats and diagnoses people with BPD. You shouldn't have to seek out an alternative diagnosis just to get properly treated.

There’s usually no meds given for BPD unless there is a comorbid condition (like depression, anxiety, etc.) Having Bipolar NOS would give her access to meds (and a psychiatrist) that BPD would not. What others have said is true as well; BPD has a lot of stigma even in the mental health field.

Sorry to hear of your struggles. In my opinion, it sounds extremely unethical that the doctor is willing to tell you your wife’s diagnosis but not her. Did she sign a release for this? This sounds messed up.

It could be helpful if your wife's psychiatrist discussed what symptoms she's exhibited that lead him/her to their current diagnosis. Or if they're actually unsure, to say that straight out and say what makes them unsure. The fact is that some psychiatrists just don't have sufficient information to make a firm diagnosis. Sometimes they need to observe patterns over a longer period of time. Sometimes patients and/or family members put emphasis on concerns that may be confusing or misleading. I am not saying the latter is necessarily the case, but can be. Or, too often psychiatrists just don't dedicate sufficient time and effort to get to the root of patients' issues. Just as people make rash judgements about those they just meet, so do psychiatrists.

I agree with all of the good points others made above. Stigma and insurance coverage are major issues, and like others said, the proper treatment is the most important. Unfortunately, some psychiatrists don't provide or properly refer the best treatment. Various reasons contribute.

I think the term "personality disorder" should go. I don't think it properly describes the issues people with BPD, Schizoid, Antisocial PD, or other "personality disorders" deal with. In the case of BPD, perhaps it would be best falling under an emotional dysregulation disorder category (a term out there, but not officially found in the DSM-5). I think most in the personality disorder category would be under emotional dysregulation. Unless others disagree, that sounds more palatable to me. "Personality" in itself is far too prone to being labeled with "goods" and "bads" and to my point of view, seems to imply choice/possible faults vs. real mental illness. The term "borderline" is even stranger. Borderline what? On the verge of having a personality? On the verge of what? It's a lousy word choice, in my view.

If the American Psychiatric Association asked me, I'd be happy to work on the DSM-6. There would be some renaming and recatagorizing of a few things.

I totally agree with, Innerzone. The bill might be or not be insurance billing but why do you care so much? I don't talk to my wife about my sessions with my pych and I don't want to. She already said you're psychoanalyzing her. But you keep pushing the issue which could be triggering unnecessary stress from her. From my experience when my wife was all in my health privacy I had to tell her to back the F off or I'm moving out. I have my boundaries and don't owe anyone an explanation. No one expect who I live with knows about my mental health and this website.

I'm very surprised the dr talked to you about her mental state. That's a HIPPA violation and extremely unprofessional regardless if you pay the bill.

Now to answer your question, yes she should but are u present at her sessions? She might want to keep that part of her life private. Just because your married doesnt mean you have to tell your spouse everything. I'm married and I have my stuff that I keep private and don't want to talk to my wife about. Seems clear she doesn't want to talk about it when she said you're psychoanalyzing.

Just want to inform you about the exact situation my wife and I dealt with 2 years ago. Things are better now that she doesn't ask me about my sessions or mental state. It took a good year of fighting but i finally got what I wanted. Silence and privacy on that subject. Hope this helps coming from someone that already passed this moment in my own life.