Dr. Jabin, Does My Girlfriend Have Borderline Personality Disorder?

I have the expressed written permission of my client to write the following blog. Recently a client asked me if I thought his girlfriend has Borderline Personality Disorder (BPD). He told me that he familiarized himself enough with the symptoms online and wanted my professional opinion on the matter. According to my client his girlfriend was moody, says horrible things to him and about him that are plain “evil,” and recently began blocking his calls while in a particularly foul “spell.” After I told him that since I have never met the woman, his girlfriend, that I cannot ethically reach an opinion as to whether or not she has BPD. I told him that while some of the behaviors he described to me seem to resemble some typical borderline pathology that ultimately there is no simple way to know—especially in this instance where I never met her. Where do doctors who diagnose BPD start? I always, and I mean ALWAYS, ask my clients to go see a medical doctor before jumping the gun and rushing into a psychological diagnoses. It is my humble opinion and with all the advanced education, training and real world experience that I tell my clients to please get a physical beforehand. My client was not thrilled with my reluctance (read: refusal) to confirm what he suspects about his girlfriend. He kept insisting, “Okay, I know what you are saying, I hear you, BUT—do you think she could have BPD?” Here is what I told my insistent client about BPD: The symptoms of the disorder are broad, overlap with many other “disorders,” and may just be the result of a physiological problem versus a psychological problem. For example, he said she is very “moody.” Well, doesn’t drug and alcohol addiction make a person tired, irritable, cranky, depressed one minute and elated the next? Of course it does. Guess what else does? A brain tumor. So do diminishing estrogen levels and/or thyroid problems. It could be anything else other than BPD—and that is where one must begin their thorough investigation. I hope I do not offend some folks who diagnose psychological problems with great ease, but Shame on you! How terrible it is to label a person with one of the most severe types of psychopathology---for which the psychological community largely feels there is no cure. After I ran down other possible things it may be other than the most vilified and disliked disorder in the DSM to my client he told me that his girlfriend did in fact have an addiction to Percocet—and alcohol. While BPD does overlap with addiction it does not mean that addicts always have BPD. Often times when people sober up they become free from demons that have played them personally and professionally. However, some people get sober only to find they don’t have an escape from severely debilitating mental health problems. There is definitely correlation between BPD and addiction—but, we need to differentiate correlation from causation. I told my client that even if his girlfriend does seek a therapist to discuss her possible BPD that a well trained, highly knowledgeable therapist will recognize the need to prioritize the addiction problem first. That is, it is first and foremost to help the client find the right resources to get the active addiction under control rather than to spend years discussing her “other” problems. Life endangering problems are to be put at the top of the list and everything else prioritized accordingly. Active alcoholism and drug abuse is a greater “real” problem than anything else a client may present with—such as BPD. After my client and I spent the hour discussing his girlfriend and the problems she may or may not have I asked my client this: “Why would you choose to be with a person whom you describe as horrible to you, abusive and suffering from drug and alcohol abuse?” He sheepishly said, “yeah, I guess we might want to look at that.”