Q. . I am a 43 year old female. I have been in therapy for 2 years for Reactive Attachment Disorder. I have met many diagnostic criteria for many diagnoses through out my life. RAD (undiagnosed as a child) ODD, CD, PTSD, ADD, Even Anti-social. I'm confused that the BPD is being pushed at this time. RAD is a childhood diagnoses, but it is the core issue for me. The therapy for RAD has offered a degree of hope to me, it's working. I know I will need both healing from the attachment issues and also behavior modification training for what I missed out.

When asked the criteria questions, all my answers to the criteria are either "no" or "kind of". Only on 2 questions can I answer a full, "Yes" to. But while I have enough "kind of" answers to "meet" the BPD criteria, I have not had the emotional, frantic reactions I hear common in BPD. I have seen where RAD behaviors mimic BPD, but without the drama. I have never threaten suicide, been hospitalized, or have had any intense moods. Most of my emotions have been just this year, after a year of intense RAD therapy. I have cut, since 3rd grade, but mostly surface scratches and picking, common in RAD. And twice I have had problems with self-destructive dreams that carried over to the day, but I never want to act on them, but did seek help for the intrusive thoughts and images from my dreams. Both time were in this last year in therapy. My biggest connection is in instability of interpersonal relationship, but that is what RAD is all about too.

So my questions are: How severe do the criteria need to be? Can you be BPD without emotions, other then some anger? Why, when I meet more of the criteria for other diagnoses would BPD be pushed? Is there a strong correlation between adult RAD and BPD?

A. A diagnosis is meaningless unless it helps get you better by showing a direction for treatment. I do not know enough about you to make a diagnosis. If you meet criteria for borderline, and they overlap with RAD, and you are not all the way better, I see nothing wrong with trying on another diagnosis if it helps get you better. Go over it with your doctor, and follow their advice.