QUESTION:

The chief psychiatrist at the clinic where my wife is being treated for "a personality disorder" provided a half-hour orientation session for me, to help me understand my wife's condition and treatment. The problem is that I tend to want to know exactly what she suffers from, but, because of some idea of patient confidentiality, the doctor would only tell me that she has a not very severe personality disorder, it is resistant to treatment because the narcissistic defenses are so strong, and I don't know what the prognosis is.

My wife had a six year affair behind my back, and deliberately became pregnant two times and attempted to make me believe that they were my own children. She never sought any socially acceptable alternative (e.g. divorce), and assumed that "everyone does what she did". She still shows no genuine remorse.

After extensive reading about personality disorders I felt that borderline personality was the closest fit, especially because the therapist told me that my wife had "several" different personalities, and she, the therapist, was trying to "introduce them to one another". My wife's behavioral mood swings especially behavioral extremes suggest this diagnosis, but all the text book descriptions of BPD seem to require extraordinary behavior, whereas my wife's mood changes tend to be mild, unless I challenge her behavior.

Isn't it possible that many personality disorder patients exhibit a pattern which doesn't fit the textbook description, and in fact may combine one or more disorders , such as narcissism, plus mild BPD, plus mild DID as a coping mechanism? My wife is relatively immature and from a Latin American culture background.

I need to understand what is going on with her in order to decide what to do with my own life. If treatment can result in her establishing a moral code of conduct perhaps we can continue. If not, it appears to be hopeless. Is there anywhere I can seek more assistance towards understanding her condition?

DR. HELLER'S ANSWER:

You are absolutely correct. Most borderlines have more than one other "personality disorder" diagnosis. All personality disorder diagnoses are criteria based, and the absence of any one criteria doesn't mean a diagnosis isn't present.

Borderlines tend to feel enormous remorse for their behavior while experiencing dysphoria, so clearly there is more going on than just the BPD - if the BPD is present. In my experience everyone with DID also had the BPD as well. Your wife was a badly injured individual as a child.

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