QUESTION:
Hi, Doc.
I have book marked your great Website! I am a US Navy veteran. In 1991, while still in the service, I was diagnosed by a military psychiatrist with BPD after a single half-hour visit. I had presented with great depression and a desire to die. I was physically ill, as well, with a fever of 103. I had been working 100 hours a week and was exhausted. This was not addressed by the doctor, who seemed unconcerned about those issues. I was then hospitalized for a week in a military hospital psych ward. No medication was offered, nor was any follow-up therapy after my discharge. In fact, the entire experience was very negative. The doctor who diagnosed me was very condescending and seemed to regard me with scorn, as if I were a troublemaker. The hospital staff, while generally kind, basically regarded us patients as children to be babysat until we gave a satisfactory MMPI test result. Upon my return to work, I was treated like a pariah by my peers and superiors, and so I put in for a welcome transfer. I was honorably discharged in 1992. I never again sought care until last week, when I basically decided that I have had enough of feeling lousy. I called a local mental health office and made an appointment. Three questions: 1. Could the military doctor have been wrong about my diagnosis? 2. Can BPD be determined after talking to a patient for 30 minutes? 3. Should I mention this to my new doctor? Given that so many clinicians appear to dislike working with borderlines, I don’t want to get started on the wrong foot. However, I don’t want to withhold any important information either.
Thank you!
ANSWER:
Of course the doctor could be wrong. I often say my name tag says “MD” not “GOD.” 2) Yes, a short interview focusing on DSM criteria can clearly determine the BPD. I try to work together with my patients so that we are on the “same page” and come to the same conclusions. Since there are no blood tests, psychological tests, or imaging studies, the patients opinion and experience are what matter most to me. 3) I would recommend it to your physician. If nothing else youll find out if the physician will be honest and up front with you. Hiding things from your physician is rarely a smart choice. There is a wealth of useful and important information in my BPD section, particularly an article for primary care physicians. Both of my books, and the BPD section of this Website go into the BPD at length. My first book, “Life at the Border – Understanding and Recovering from the Borderline Personality Disorder” is on the recommended reading list at the National Institute of Mental Health. I also strongly recommend you review the screening test.