Brian came into therapy describing his wife’s behavior as having Borderline Personality Disorder. He looked up the definition online and said he knew she had it. He gave numerous examples of how perfectly she fit the profile and how he and the kids had been traumatized by her behavior.
Brian said she was fearful of his abandonment and in desperation would rage anytime he mentioned separation. He talked about her alcohol abuse and how she seemed like an addict. He said she would be happy one minute and furious the next. Yet every time the conversation was redirected to him, he became evasive.
Physically, Brian’s face seemed unusually red. He was a bit shaky, noticeably uncomfortable, and yet meticulously groomed. His manner of speech seemed rehearsed and he was hyper-focused on his wife. He desperately wanted affirmation from me, the therapist, that he was right in his diagnosis of her and was upset that I was unwilling to give it immediately.
It took nearly the whole session to gain the most basic information about him. Every direct question that was asked about his history, relationships, trauma, or substance use turned into a story about his wife. That’s when it became clear. He was an alcoholic. Several sessions later, it was apparent that she was not Borderline, but rather severely co-dependent and an enabler.
Brian attempted to use the therapeutic process as a way of justifying his addict behavior. By exaggerating his wife’s symptoms, he looked normal in comparison and therefore could hide his addiction longer. Unfortunately, this is not an uncommon tactic. It is a defensive mechanism of projection (putting one’s issues onto another) and deflection (distracting from the real issue). Here are a couple more examples of how personality disorders are sometimes misdiagnosed by clients:
- An exquisitely dressed female came in describing her husband as having Narcissistic Personality Disorder. Her marriage was on the brink of divorce due to his abusive behavior. She was engaging and likable but when questioned about her own failures, she was elusive. She described him as being controlling but refused to allow the session to be about anything else other than his disorder. When confronted, she played to role of the victim a bit too well. She too was seeking affirmation for her diagnosis of him.
- This is another example of projection. In this case, she was the narcissist. In an effort to make herself look better than him, she projected her own disorder onto her husband. This is commonly done when a person is narcissistic. When a narcissist feels they have lost the upper hand by being superior, they revert to playing the victim role. To reinforce their position, they exaggerate the faults of others to make themselves look superior.
- Another client portrayed her partner as on the brink of a mental breakdown and having Borderline Personality Disorder. She showed erratic text messages, recounted stories of physical violence, and periods of isolation. Everything seemed just a bit too calculated. In order to discover the truth, I intentionally interrupted the stories with unimportant questions about random details. This frustrated the client whose agenda was devious. She was trying to commit her partner and get me to sign the paperwork. A quick scroll on the phone to the previous conversation before the erratic text message revealed verbal and mental abuse from the client.
- It turned out that the client was a sociopath who was trying to drive her partner crazy. After being confronted, she revealed that her plan was to drain the bank accounts while her partner was hospitalized and leave. Given the right environment, many people willingly confess to deceptive behavior. This was a case of dishonesty and deceit.
- The parent of a failure to launch twenty-something year old labeled her child as having Narcissistic Personality Disorder. She described him as entitled and unwilling to do simple tasks around the house. She said that he was shut down and quarantined himself in his room constantly. His attitude towards the other family members reeked of superiority and a lack of empathy.
- At first glance, he did appear to be narcissistic. But several sessions later, it turned out that he was the victim of sexual abuse and in his attempt to hide it from the world, he presented as narcissistic. This is not unusual. Unfortunately, sexual abuse causes shame which is an uncomfortable emotion that people often try to conceal. On the outside, they appear tough, arrogant, and indifferent when on the inside they are traumatized, hurt, and fearful.
The Greek philosopher Plato wrote in Phaedrus, “Things are not always as they seem; the first appearance deceives many.” This is very true when working with personality disorders. What is frequently presented initially is not necessarily accurate later. Some have ulterior motives such as hiding their addiction by exaggerating problems, projecting self onto a spouse to avoid accountability, using counseling to commit further criminal acts, or concealing trauma through disengagement. A brief look beyond what is offered might just divulge some hidden truth.