Help me and my fiancee deal with her untreated BPD and OCD.

August 24, 2005 5:03 PM

My fiancee has Borderline Personality Disorder and OCD. Please help us.

Please be clear that our relationship, though it can be difficult, has so far successfully dealt with the behavior associated with her mental illness for four years. We are motivated to stay together and to work through this as individuals and a couple. Please refrain from simply advising us to part ways.

That said, there are two areas we need advice about. I am not a doctor and don't pretend to understand BPD or OCD or even which behaviors are caused by illness and which are her own free will. I'd like to better understand the illnesses and how others have dealt with being a significant other to someone who suffers from similar symptoms. The best advice would be in the form of your personal experience or books that recount other people's personal experience. Be advised that I don't tend to enjoy self help books or find them useful unless they are particularly thorough and not obvious. At this point, it's evident she's not improving as she ages. It's also not clear whether or not my behavior is helping her or enabling her in some negative way.

Secondly, she's been out of the care of mental health professionals since we have known each other. She is mostly functional, completed school and is entering her professional field as a distinguished and gifted practitioner. She wants help and recognizes the fact she needs help. I've been supportive, but have not pressured her to seek help outside of conversations we both respond possitively to. She's even agreed to times and dates when she would call a doctor and set up an appointment, but those dates always come and go with no action.

As much as we love each other and, in calmer times, can recognize our how well we've worked together, the symptoms she has are unbearable for her and have stretched my ample patience and tolerance very thin. Her OCD is relatively mild, but it's contentious when she throws out my belongings because of irrational fears. The symptoms of BPD, on the other hand, are not a minor inconvenience to either of us. In the past it has lead to promiscuity, drug use, self mutilation and suicide attempts. At present, it leads to scary ranges of emotions, irrational behavior that prevents her from socializing normally and delusional thought that dominates our day to day life. She's suffered long enough but can not help herself. I've learned that while I can help her stay mostly safe, I'd be kidding myself to believe she's any better off because of it.

How would you help a friend or loved one overcome such a fear to get professional help?

(A previous thread on BPD and searches for OCD have yielded little in the way of advice on this specific problem. She is looking for a therapist who does DBT locally, but actually going is an entirely different story.)

posted by anonymous to health & fitness (20 comments total)

From your post, it appears that she's not on meds? Not saying that meds are a "cure" or right for everyone or not rife with problems and side effects of their own, but they often are a damn good place to start.

A local columnist here in Philly has written frankly about her own difficulties with mental illness in her weekly column. (She sometimes writes about other subjects, and is also a staff writer. Best I can do for a link is these search results, click on anything where she's the sole author and you'll mostly hit her columns. Here's an example.)
posted by desuetude at 5:30 PM on August 24, 2005

Stop Walking on Eggshells is a good book about dealing when a loved one has BPD. You might think about checking it out.

The really good news is that your fiance wants to get help, which is always a prerequisite to successful treatment. The newest metaanalyses suggest that previous attempts at therapy, and their success or failure, have no predictive power when it comes to new attempts. So, even if she has not gotten what she wants out of previous therapies, she is just as likely as someone who has never been to therapy to be successful this time around. Keep bugging her about therapy. Have a conversation with her in which you tell her that you will keep bugging her because she has previously indicated that she wants therapy. That way you will both be on the same page about it.

We also know from the research that diagnosis has no bearing on outcome, so although the myth is that the best people with BPD can do is manage their symptoms, the research supported reality is that everyone can experience a cure. Also, and I think this is pretty important, getting better should be a fairly speedy affair. The research says that early change predicts later change; in other words, if your partner does not get relief from symptoms early in a given therapy experience (within 3 months) she should look for another provider, because she is unlikely to experience significant change just because she sticks with that therapist for 6 months. Many, many therapists will suggest the opposite, but they are talking anecdotally, not with any research backing. (For more on this that's readable, try The Heart and Soul of Change; more that's technical, try The Great Psychotherapy Debate.)

As far as DBT goes, don't let finding a DBT therapist stop her from going to therapy. DBT works as a treatment, but it is no more effective than other forms of psychotherapy, even for people with BPD. You can search for DBT on this page (sorry no anchors) for a brief precis of why this is so. I'm not suggesting not to go to DBT, just not to rule out other forms of therapy.

Above all, I think it's perfectly legitimate to make your expectations of your partner very clear. The conversations that you allude to make me think that this would be welcome (on some level) and that it might be the spur your partner needs to get the treatment that can make her better.

My email is in my profile, confidentiality guaranteed, if you have any other questions.
posted by OmieWise at 5:50 PM on August 24, 2005

You also may want to consider going to a therapist on your own. Dealing with someone with such symptoms can be terribly draining, and it is likely that you are not going to get through this unscathed (at an emotional level, that is). I also think, and this is just an opinion, that if she can't start working towards dealing with her illness in a frank and practical way, you are going to bear the weight of this until it crushes you - and that doesn't do anyone any good. A therapist should help you be able to set some realistic boundaries and also help you not enable her negative behaviors. Unfortunately, you can't make her get better. She's gonna have to decide that it is more important to deal with her illness than to drive you nuts too.

Sorry I don't have any books, but I have been in a relationship in the past with someone with BPD and it was not salvageable. There was ultimately no desire on their part to do what was necessary to get better. It was just not on their radar screen. I think the key is that if you want to stay in the relationship you will have to work hard not to let her illness take you down with it.

I wish you the best success.
posted by qwip at 5:59 PM on August 24, 2005

This is not so much in reply to your questions, but I wanted to recommend a really good movie I recently saw which deals realistically with people who have OCDs and other releated issues. It's called "Dirty Filthy Love" and is available to rent. It's billed as a "romantic comedy" but it is neither all that funny or very romantic (but it is oddly sweet). It's about a man coming to terms with his disorders (he has Tourettes and is heavily OCD) and attempting to find help through a support group, where he meets others who are similarly afflicted. Friendship and love ensues... anyhow, it's a great movie that I think people who are dealing with these issues first hand like you and your partner might appreciate, since that is exactly what's going on with the characters in the film.
posted by RoseovSharon at 6:03 PM on August 24, 2005

"I've learned that while I can help her stay mostly safe, I'd be kidding myself to believe she's any better off because of it." From the tone of your post I would guess you underestime your contributions--helping one stay safe is no small feat--your commitment , clarity and desire to understand are notable--As one who has spent their entire professional life working with individuals and families suffering with mental illness I offer only one piece of advice--Find the local NAMI (National Alliance of Mental Illness)chapter and get involved--In most communities NAMI is well organized, professional and an invaluable source of support and guidance in living with loved ones who have a mental illness. NAMI can be extremely helpful in identifying reliable resources, providing first hand accounts and good literature. You already know there are no simple answers nor magic . There is absolutely nothing more important than taking good care of your self, practicing loving detachment from the illness and making available( to both of you) the best in professional help and modern medicine/psychiatry. My best to both of you. If you need help in identifying local resources please feel free to e-mail me.
posted by rmhsinc at 6:05 PM on August 24, 2005

The best advice would be in the form of personal experience or books
I am not clear how much online research you have done, but reading blogs and joining a forum are great resources for a lot of personal experiences.

Finding the right doctor can in turn make you phobic of seeing doctors. I have been failed by many a therapist, and that is a huge issue for me; I don't have a natural trust in them anymore. Yet, from the belief in what OmieWise has pointed out, that it can always get better with the right person, I am back in therapy. I think between the two of you--since you are as much a part of this as she is--you should decide whether seeing a doctor is a commitement you both want to make, a goal you want to set. Then, through reccommendations you would make many appointments until one doctor clicks for her, that she's found someone she can trust. Therapy--talk and medications--is hard work, and it should be for permanent benefits.

So, decide what kind of process you want to have--researching experiences and checking in in a month, gathering reccommendations and starting the search for the right doctor immediately, see how you get through the holidays and reevaluating, whatever is comfortable--and commit to it.
posted by scazza at 6:08 PM on August 24, 2005

Oh yea! David Sedaris has OCD and has many beautiful, funny stories about growing up with it. "Don't you lick that light switch one more time, young man!"
posted by scazza at 6:17 PM on August 24, 2005

From what you describe, you are already doing all the right things. My heart goes out to you and your obvious experience of real love.

I would suggest:

a) Keep being supportive. You can't make her go to a practitioner. You're doing the right thing by continuing to encourage her to go; but you can't force her, it'll be nonproductive or counterproductive. When she is ready, she will go.

b) Don't expect improvement. I disagree with much of what's been written above about the prognosis of BPD. I think in general the prognosis of BPD is: no change. And you've cited a bunch of poor prognostic factors above, too. Some people can get better, even to the point where they might be considered 'cured', but not most or even many. I don't think medications are particularly the answer or even important, unless they curb compulsive symptoms and/or drug use.

Improvement may happen; keep doing what you're doing and it will be an unexpected if pleasant surprise.

c) Mount a serious, no-holds-barred effort to understand what you're getting out of dating a borderline person.

I'm completely serious about this. Most people can't stand being in the same room with a borderline person for even an hour. You've proven over the past four years that you are getting something out of it - something that you desire strongly enough that it's prevented you from leaving and finding a healthy person to experience a normal, intimate relationship with.

That's not wrong or evil or bad, but it's unusual enough to warrant close inspection. It says something about you, and what it says may be something that surprises you when you finally come to grips with it.

This isn't something you'll be able to do by yourself. You'll need the help of a competent therapist.

d) I wish you luck and hope you both find happiness!
posted by ikkyu2 at 7:10 PM on August 24, 2005

Let me throw something in here...are you totally sure she has BPD? It is entirely possible she could have bipolar disorder instead as the two conditions have quite a bit of overlap. And I have heard that sometimes meds for bipolar can and do help borderlines. (full disclosure-I'm bipolar, my sister in law and a good friend are both BPD.)

I agree that if for four years you still want to be with her, there is definitely something there. Both bipolars and borderlines can stretch the patience of a saint.
posted by konolia at 7:23 PM on August 24, 2005

I was going to write a rebuttal to several of IKKYU2's comments but he/she is probably much more right than wrong--medication is generally considered to of minimal value with BPD however this view is not shared by some very reputable psychiatrists--googling will help on that issue--regarding a dispassionate analysis of your self--probably something we all should do regardless of our relationships--between alcoholism, drug abuse/dependence , anxiety disorders, (major ) depression schizophrenia, bi-polar disorder and the smaorgadboard of other disorders (let alone just plain unpleasant persons)-most of us probably need to look at ourselves and why and with whom we are involved--the one statement of ikkyu2 that I take issue with is "not wanting to be in a room for an hour with someone with BPD"--I would feel more confident of his statement if I had more confidence in our ability to accurately diagnose BPD let alone understand it. None of us are r sure exactly with whom we share a room--Take Care
posted by rmhsinc at 8:07 PM on August 24, 2005

You sound like you "know" she has BPD, but it isn't clear how or why you know this. BPD can be somewhat of a diagnostic dumping ground for "difficult people," some of whom would, IMO, be better understood in a frame around early and/or chronic trauma, others of whom would be better understood from an addiction framework.

I personally have known people who thought the Eggshells book suggested by OmieWise was very useful. I've also known people who have felt helped by A Place Called Self, by Stephanie Brown, who comes at these chaotic issues from an addictions/trauma point of view.

FInding a good practitioner who your fiancee can trust may be quite daunting, as it may entail shopping around and trying different people. If you all have a good feeling about DBT, it's probably as good a place as any to start. You don't say where you are, but Marsha Linehan has been deeply involved with the development of DBT, and she is in the Seattle area. This is the clinic associated with her efforts. There are also links to other practitioners in different parts of the country.

Best of luck to you and your fiancee!
posted by jasper411 at 8:32 PM on August 24, 2005

rmhsinc (Frank?): I had second thoughts about my answer right after I posted it. I agree with everything you said and greatly admire your empathy and your supportiveness. I hope that what I wrote can be construed in the spirit it was intended, and its unintentional negativity overlooked.
posted by ikkyu2 at 9:00 PM on August 24, 2005

I second the suggestion of seeing a therapist yourself, or maybe doing couples therapy. I reccomend this not so you can talk about your own troubles--though I'm sure that would be nice, etc.--but rather because I imagine it would be a real help for you to have a professional to rely on as you try care of her and make your relationship work. It sounds like you don't know too much about BPD, and metafilter, google, and even books by doctors aren't necessarily reliable sources of information.

There is always the possibility that she might feel like you and the shrink were ganging up on her. (I don't have the experience to know how these things work.) But it sounds like you have her trust, and you could ask for her permission.

I also imagine the peer pressure factor might help: you start seeing a shrink, rave about it, then suggest some couples therapy, and then nudge her into one-on-one therapy.
posted by armchairsocialist at 9:43 PM on August 24, 2005

You might read through the Personality Disorder forum on CrazyBoards. CrazyBoards is associated with CrazyMeds and its primary purpose is to provide support for sufferers of various mental issues. However, you can learn a lot from reading it even if you are not diagnosed as BPD yourself. The participants are generally very open and honest, and they talk about what has helped them get over their resistances to treatment. They have not mentioned a formal support group for relatives/loved ones of BPD people but they definitely agree with the recommendation that such people see therapists themselves.
posted by rhiannon at 9:54 PM on August 24, 2005

I was with someone with BPD for a time and I sympathize with the symptoms you describe. I think that there is a path from commitment to health, but the commitment needs to be strong. You need to be designated as the "rational" one by both partied and you need to be really patient. I hope in your case that extraordinary sex is also part of the package, as it can be a great motivation to stick it out.

Curiously: when you say she is becoming a practitioner in her field, you mean she is a mental health professional, right? I guess I'm not going to get an answer there, but I'm guessing that's your reason for being vague about it. That might help. If I'm totally off base, counselling is a good idea. There's no silver bullet but it is a pretty well documented and understood disorder. Healthy living is recommended for you both. Alcohol, for example, is mildly risky for anyone but was pure nitro glycerin in my experience.
posted by scarabic at 10:30 PM on August 24, 2005

(Off Topic)--ikkyu2--I read your link on second thoughts--this is not a "cheerleader response"--the thoughtfulness, concern and candor reflected in your original post was refreshing--soft pedaling, understatement, or gentle redirection is never a substitute for clarity and the truth--there is not a day I do not struggle with finding the balance between realistic hope, faith and the rough edges of reality--Take care and I have a strong hunch your patients are very fortunate--
posted by rmhsinc at 3:12 AM on August 25, 2005

My mother was diagnosed with BPD just a few months before her death (at 86). In reality, she'd been borderline all her life. My own psychiatrist referred me to the book "I Hate You--Don't Leave Me" by Jerold J. Kreisman, M.D. I found my mother on nearly every page of it and was able to forgive myself for all the times I couldn't deal with her behavior. I was glad that happened before she died.
posted by Carol Anne at 4:04 AM on August 25, 2005

OCD is very treatable with serotonin drugs like Luvox or Effexor. It makes the habits essentially turn in to background noise and the need to enact "rituals" far less urgent. It might be worth a trip to the doctor for more information. The Boy Who Couldn't Stop Washing is an excellent introduction to the disorder.
posted by captainscared at 6:39 AM on August 25, 2005

She wants help and recognizes the fact she needs help. I've been supportive, but have not pressured her to seek help outside of conversations we both respond possitively to. She's even agreed to times and dates when she would call a doctor and set up an appointment, but those dates always come and go with no action.

Yeah, this is a very difficult hill to climb for her. Have you considered couples therapy? Having you go with her creates a much stronger incentive, as you can be the driver (figuratively and literally). IANAD, nor have I been to couples therapy, but I imagine your therapist will lay the groundwork for your fiancée to see somone on her own. In the meantime, you'll have a neutral third party to help you work through how to integrate her illness into your relationship in healthier ways.

Good luck.
posted by mkultra at 6:53 AM on August 25, 2005

OCD

My wife has a medium case of OCD, and dealing with it is not that big a deal in our lives. She is medicated on a cocktail of drugs for it, Luvox and Effexor are not as effective on their own for her as are some other anti-depressants when mixed with stimulants. Actually, right now I think the combo is Prozac and Provigil. She still has rituals, but they are short and not all that intrusive. The important thing for me to do to make it easy on her is to not challenge the OCD. I do not make fun of it or comment on it, though it took me a while to learn to avoid making comments. Seriously, it is not "helping" to challenge or even to note her rituals, it makes her mad/uncomfortable, and it makes the rituals much longer, since they have to start over at that point. Luckily, she's never had to throw out my stuff, that would be tougher to deal with.

One thing you might not have considered yet is what you will do if/when you have children. The hard part of the OCD in our life together has been when she chose to go off her meds while she was pregnant/nursing. I supported that choice, but those were a tough couple years. Full-fledged, unmedicated OCD can be challenging to deal with, especially recurrent "bad thoughts". We got through it, but chose to adopt rather than have another pregnancy for our third child.
posted by Invoke at 11:08 AM on August 25, 2005