The other day, a client came in describing his wifes behavior as Borderline Personality Disorder. He had numerous examples of how perfectly she fit the profile and how he had been traumatized by her behavior. For example, she was fearful of his abandonment and in desperation would rage anytime he mentioned separation. Yet every time the conversation was redirected to him, he became evasive.

Physically, his face seemed unusually red, he was a bit shaky, noticeably uncomfortable, and yet was meticulously groomed. His manner of speech seemed rehearsed and he was hyper-focused on his wife. He desperately wanted affirmation that he was right in his diagnosis of her. It took nearly the whole session to gain the most basic information about him. Thats when it became clear. He was an alcoholic. Several sessions later, it was apparent that she was not Borderline, but rather severely co-dependent.

He was attempting to use the therapeutic process as a way of justifying his addict behavior. By exaggerating his wifes symptoms, he looked normal in comparison and therefore could hide his addiction for a longer period of time. Unfortunately, this is not an uncommon tactic. Here are a couple more examples of how personality disorders are misdiagnosed by clients:

  • An exquisitely dressed female came in describing her husband as having Narcissistic Personality Disorder and her marriage on the brink of divorce. 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 a victim a bit too well. She too was seeking affirmation for her diagnosis of him.
    • 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.
  • 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. So the stories were intentionally interrupted with unimportant questions. This frustrated the client who was on an agenda of trying to commit her partner. 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. Her plan was to drain the bank accounts while her partner was hospitalized.
  • The parent of a failure to launch twenty-something year old labeled her child as Narcissistic Personality Disorder. She described him as entitled and unwilling to do simple tasks around the house. He was shut down and quarantined himself in his room. 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.

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.