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I have BPD, Bipolar and High Functioning Autism. I'm not going to get into my life story because it doesn't really matter here. What does matter here is trying to find a competent therapist. I've been in the mental health system since I was eleven, almost ten years, and the only adequate treatment I've received (out of numerous) is Lithium.

I'm still in the process of finding a competent therapist for my "problems." Since I can only see therapists who accept Medicaid it takes about a month to get an appointment anywhere and some actually refuse to see me because of my diagnosis. They don't flat out say "I'm not going to see you because of your BPD diagnosis" they just politely "refer" me to someone/someplace else. Therapists usually want to help me until they discover my diagnosis. After they discover my diagnosis they suddenly see me in a new light simply because of that even though I have not changed: what has changed is their perception of me because of BPD prejudice.

You'd think that since BPD/trauma disorders are quite prevalent among those seeking therapy that therapists would be a bit more knowledgeable about it, but they aren't. Some automatically assume I have done or do drugs (which I never have), that I am sexually promiscuous (I've never had sex and was not planning to anytime soon), that I have angry outbursts (which I never have) and other stereotypes. You'd think they know that according to studies I have a very high chance of recovery. The traits that lead to recovery have been shown to be the following:

"In this and other studies, "good" outcomes were related to the following: "likableness, candor, perseverance, talent and attractiveness, high IQ, and obsessive traits."

I have all of these traits. You'd think they would know about these studies and actually want to proceed with treatment since I am more than willing. But they don't.

I'm really just starting not to care anymore since no one else appears to really care, not even those who are supposedly trained to care. I am a full-time student and am also attending Vocational Rehab so I can get a job as I have to pay for my own education. But still, simply because of my diagnosis every therapist I have "refers" me to someone/someplace else.

The community mental health center here is really a joke. The "therapists" are actually social workers and most have no training to treat people with severe trauma. The CMHC is mostly for those with severe psychotic disorders that do not respond well to medication, not for people who are quite capable of having a very successful life but need therapy for severe trauma.

How did everyone else manage to find a competent therapist/psychiatrist/help of any kind?

Hi ferret, and welcome to BPDR.

Mercifully I haven't had to deal with Medicaid...yet. I've been really lucky -- I got a decent psychiatrist when I was admitted to the hospital, and when he retired recently I seem to have landed with another doc who knows what he's doing, and when my former workplace referred me to a counseling office after a major meltdown, I landed with a therapist I'm still seeing 8 years later. I know that probably isn't that common, but I'm not complaining at all.

Do you have to disclose your BPD diagnosis to your therapist? I mean, is there some paperwork or something where you're required to list all your diagnoses? Can you just admit to the Bipolar part, and then say you have certain other issues you would like to work on without giving the overall label? If they didn't have to know you have been diagnosed with BPD, they couldn't hold it against you.

They should also know there is a *lot* of misdiagnosis when it comes to BPD and Bipolar -- they get confused with each other because of the mood swings, though from my perspective (and I don't have Bipolar, just severe and recurrent major depression), the mood swings of BPD don't seem to me to be like those of Bipolar. I swing from (semi)happy to sad to angry -- I'm all over the lot, as most people with BPD are. Bipolar can be rapid cycling, but I don't think the moods are as erratic as with BPD. I don't know what behaviors got you the BPD diagnosis to begin with. It can really only be made by a psychiatrist, not a therapist. So maybe there's some way you can revisit this with a psychiatrist, and convince him/her that the BPD label doesn't fit you. Since you responded to lithium, you probably truly have Bipolar. Maybe you also have BPD, and maybe not.

If you can get into a therapist without BPD hanging over your head, you might have better luck. Then you can concentrate on trying to help yourself overcome any behaviors or problems that are messing up your life. You said you don't have problems with anger or impulsive problems like drugs or promiscuity. So figure out what issues you do have, and work on them. Most people who have had long-standing mental health problems also have developed dysfunctional coping mechanisms of one kind or another. I can imagine the Autism only magnifies things for you.

Hang in there and don't give up. It can be really frustrating, I know, but there are good therapists out there. (Mine, by the way, is an MSW. A social worker. But she knows as much as anybody else I've ever encountered. We almost never mention the words "Borderline Personality Disorder." We just tackle whatever problems I'm having at any given moment, so that hopefully I can learn to cope more effectively.) In the meantime, check out our "Tools" (in the box on the left) -- they have helped a lot of us straighten out our thinking, and thus our behavior.

For about two years I really tried to pretend that all of my problems were because of bipolar and autism but they aren't. I suffered severe trauma for years (emotional/psychological, physical and sexual), my mother and grandmother have BPD and my father is an alcoholic with bipolar disorder, among other things that I won't discuss.

I am a "high-functioning acting in" BPD, which from everything I've read is fairly rare among those with BPD. I can easily fool everyone into believing I'm competent when I am not and I am tired of doing that because it only harms me. I have a severe abandonment issues, emptiness, self-hatred (and etc.) that I deal with through severe depression and self-mutilation. I believe my manifestation of my BPD is simply because I am a very introverted person and also because of my autism (extreme introversion!). It's too complicated to explain here but because of my inherent nature I would never do most things that most consider to be "core" BPD symptoms. I have never even had a relationship and I don't desire one! Instead of drugs, sex, impulsive behavior, etc. I dissociate. My dissociative symptoms are much more severe than most with BPD because instead of "acting-out" I "act-in" and turn it all into myself. Obviously, I can't deal with so much pain so my brain decides to escape from it.

And not to sound narcissistic, but I have a very high IQ (over 160) so the way my mind works, what is important to me and how symptoms manifest are very different from those who are not "gifted" in the sense of IQ. I can also "outsmart" everyone, especially myself, but I can't run away forever. I'm only 20 so I know I am doing what is best by seeking treatment. Past memories float around and torment me, driving me to self-mutilation and depression, and I want to have a better life.

And why should I have to lie to a therapist about BPD when that is what I am seeking treatment for? I shouldn't have to do that although I know many are forced to in order to receive treatment. The BPD stigma really needs to end because it hurts so many people. Someone needs to start a campaign or something about BPD stigma so that all of those who need treatment and who are being refused simply because of stigma can finally receive it. I am an intelligent, creative, compassionate, kind person who had bad things happen to her. Unfortunately, most see me as a bad person, period.

I also know that some social workers are quite competent, but I've found that those at the mental health centers here are of pretty low quality and/or just graduated from college so they don't really have any idea what they are doing, so I don't have any problems with competent social workers.

I looked over the list of therapists my insurance would pay for and started calling. I left messages saying I was looking for a new therapist and wanted 5 minutes of their time to ask about their style and approaches The ones who called back -- which was a good sign in and of itself -- I asked about their experience with the kinds of issues I had, and the treatment approaches they start with on such patients. The nuts and bolts of their answer was as important as how they related to me on the phone. I got a good therapist out of this.

I am also a 'high-functioning, in-acting' BPD individual (although I no longer fit the criterion). There are a few of us here on this site.....I'm not sure it's as uncommon as you might think.

My story with therapists is similar to Jim's. I 'interview' my therapists before I was willing to go under their care, but I did it in person rather than via phone. His way sounds better to me! I think the role-reversal of interviewing them rather than yourself being interviewed kinda turns the tables and elicits more of a dynamic that puts them in the 'proving their worth' seat. It worked for me, I've never had issues with a bad therapist.

I'm also thinking it seems like you may be pre-judging all therapist in the way that you don't want them to do to you. There IS a stigma for BPD, but there is also a stigma against Medicare patients. Who knows the real reason they are referring you? It won't do you any good to assume or jump to conclusions.

In my experience it was more me wanting/seeking a good therapist that over-rides the stigma of the diagnosis. If they know you want to participate in therapy and are willing to go through what it takes to get better, they are more willing to work with you. Not all therapist, or social workers, think alike. I think it would be wise not to pre-judge them, especially if you are asking not to be pre-judged yourself.

In the meantime, there is good help here on this site. Really, I have done more to help myself than any therapist has done 'for' me, even though my T's have all been good ones. Check out the tools and begin working by yourself and with us while you are searching for a good T. It can't hurt!!

I feel like I pissed you off a little bit, ferret. It wasn't my intent at all to invalidate your BPD diagnosis. There was no way I could have known your family history -- mind reading isn't one of my strengths. If you fit the criteria, and feel like the criteria fit you, then there you go. No problem.

I personally don't think "high-functioning acting-in" is all that rare, though I could be wrong. It's certainly been my path. I "functioned" well, to outsiders, with only repeated episodes of depression that would temporarily derail me, until I had a total breakdown 8 years ago, at age 50. I had never even heard of BPD before, but once I had (after I was hospitalized for depression and tried to self-injure while there), and researched it, I found it explained a lot of what I had been dealing with since my teens. I had been a successful student, wife, mother, and RN, with no one ever guessing at my inner turmoil. I never acted out with sex or drugs or anything like that, and while I might get very angry, I almost never raged outwardly (other than with my mother, which is a whole 'nother story), but turned it inward in self-hatred. I've "fixed" some of the problems, in terms of developing better coping mechanisms for stuff like abandonment. I'm rarely tempted to self-mutilate anymore. But I can't get rid of the "chronic emptiness" part of this no matter what I try. It's just always there.

I understand what you're saying about the stigma against BPD and that a good therapist should be able to deal with it and you shouldn't have to deny or pretend that you have it. You're right. I'm just saying that if your treatment options are limited, and BPD is the sticking point, and you want to get help, then working around it might be a way to go. It might be that any therapist who hears "self-mutilation" and "abandonment issues" is going to hear "BPD" anyway, but not every self-mutilator has BPD, and not every person with BPD self-mutilates. If you say to a therapist "I want to deal with this particular issue" and leave labels out of it, you might be able to make some progress. Maybe not, given the people you have to work with, I don't know. It was only a suggestion.

Good luck --