Question: Dear Doctors,
Re: Wife suffering from OCPD+EUPD+ANGER DYS CONTROL SINCE HER YOUTH
Wife Problems facing since youth:
“Her indications of anger problem on little issues, her repetitive working or behaviour pattern of arranging things in order, keep cleaning things, confrontation and trying explaining on each and every act she does to other and try proving hard or justifying herself that she is right and others are wrong, trust deficit, the abnormal way of handling anger by locking herself in a bed room for 1-2 days, disassociate from love ones. “- These were the problems mentioned by her that she is undergoing since youth.
We got married in April 2014, observed since day 1 of our marriage, severe eating disorder, based on her rigid behaviour, thought and belief system and psychological issues like hitting herself if something goes against her will, giving occasional suicidal threat somehow I convince her to visit psychiatrist n there OCPD n EUPD diagnosis in April 2015 based on the symptoms narrated before the psychiatrist along-with ANGER DYSCONTROL also advised cant planned family in this state of her mind.
I am living with my parents 75 year old father who is an old diabetic on insulin, a cardiac with breathlessness problem and under oxygen-nebulizer support SOS and mother 65 yr old recently diagnose with hypertension and sleep deprival and under treatment seeing disturb home environment, despite their ill medical condition, my wife argue loud and rudely, suspect them of planning ill against them, restrain my mother or anyone attending any kitchen job and address my father in very insensitive manner.
Towards me again she holds lot many suspicion and checks my XXXXXXX daily that whom I am talking to, she charge an illicit relation of mine with my real elder sister and daily comment harsh relating that, once she found me talking to my brother’s batch mate infront of her who is a doctor and like a family to us; she again charge and doubted the relation, doesn’t allow me to go out for evening walk or so else she feels I am talking to my sister or so, I am in real estate and operating from home on call I use to go out but she feels very distress and uneasy and keeps on calling messaging me till the time I am back home. Daily she discuss the household and kitchen issues with me over night till 2-3am morning and badmouth on my parents and sisters myself going thru severe sleep deprival too since and in stress affecting my personal and professional life. Tried all the available options like counselling meeting psychologist but still after all the sessions, she feels the problem is with others not with her.
She refuse to accept the disease and apprehended to take medicine too, we have been attending the marital counselling session too but without any improve in her condition.
Like to mention few of her behaviour condition:
1.     Find it very difficult to trust other people, believing they will use or take advantage of her all the time very suspicious and in stress.
2.     Extreme Suspicion behaviour towards all including me and easily lies on anything and make the conversation complicated.
3.     Enjoy her life without any interference & rigidity in her thoughts and approach
4.     Emotionally cold towards others/ No sense of guilt even if she has miss-treated other: Anger on small issues/Irritable and aggressive/No sense of guilt-mistake if committed.
5.     Suffers from mood swing with anger outburst-lie in floor leave food communication for 1-2 days (12-15 days in month)
6.     Slap herself, bang her head against wall, sit or stay out in balcony for long hour.
7.     Believe that she has a ‘sixth sense’ and prejudge the people; “Something bad is going to happen”
8.     Insecurity/Jealousy: Sense of superiority ‘I am the best’ ‘I am different’Build negative imaginary thoughts,Fear of Criticism/Rejection/Attention seeking/upset when people ignore her.
9.     Illogical questions and arguments with absurd explanations.
10.     Overemotional-Dramatic/irrational reasoning/Weeping without tears:
11.     Very low self esteem/lack of motivation
12.     Inability to cry (occasional weeping sound without tears)/childish tone and behaviour
13.     Fear of locking herself in toilet, room so keep the door open at home or outside.
14.     Forgetfulness and unable to concentrate on anything
15.     Keep re-checking the things in kitchen, cabinets, kitchen items
16.     Keep things in order and under control, get very disturb upset if things are not in there place.
17.     Feel dirt everywhere and shut door windows of room and keep on cleaning.
18.     Reluctant on spending money & feels satisfied in Bargaining loud and felt victory on meagre amount occasional shoplift and feels like sense of victory.
19.     Collecting item/moneys
20.     Despite having hand dermatitis she carries a wet cloth whole day and clean and urge to wash hand repetitive-from 8am to 4pm engage in kitchen and cleaning household job still don’t feeling taking rest or sleepy in noon or at night, once she is exhausted physically and mentally then only she feels sleepy.
21.     Repetitive/lengthy work pattern/Frequent
22.     Irresponsibility/forgetfulness-light on gas and forget to switch off.
23.     Sleep problem urge for watching horror-investigative movies late night
24.     Dual minded/Deep and lasting emotion/Depressive/negative thought prevails
25.     Sad and scary dreams/murmurs at night to herself.
26.     Visualises images whenever she is alone trying to hold the imaginary figure in air and talk to them.
27.     Negative depressive thoughts & Suicidal threat whenever in anger

Please guide me how to deal with it and to convince her to take proper treatment. I am losing patience, seeing the condition at home is really worrisome as anything could happen to parents who too are in severe stress seeing or wife too can harm herself as she mention out of anger.
QWERIES:
IS OCPD (ANANKASTIK PD), EUPD (BPD) AND ANGER DYSCONTROL-
a)     Based on the symptoms mentioned and ailment diagnosed are you agreed with or differs?
b)     Is this ailment hereditary?
c)     Is this curable?
d)     Can it be carry on in our kids too, though she is suffering from PCOD and is under treatment?
e)     In her current state of mind where she is not accepting her ailment and occasional anger outburst and suicidal threat, what could be severity of her disease in future like is it going to accompany other mental illness as well?
f)     What should be the future course of management for her?
g)     Do we have any permanent relief medically?
h)     If your diagnosis is varying from the one which actually diagnosed at XXXXXXX then any specific personality test required identifying the real disorder to draw further line of treatment?
i)     Or for this kind of multiple personality disorder, is there any permanent nature of treatment available?

Appreciate your insight and further assessment to it.

Thanks.

Appreciate Dr XXXXXXX for your kind insight to my qwery.

Like to appraise you that the diagnosis is been viewed by two more psyciatrist and commented as.

Quote:
"Her personality is preserved, she enjoys her life and this rules out psychosis as there is no social or personal dysfunction. Some symptoms suggest some anxiety disorder with OCD also. Fear of locking in toilet, mistrust etc suggest anxiety. Visualising images, repetitive work pattern, keeping things in order, jealousy, obsessive ideas of cleanness, feeling dirt everywhere etc are pointing to OCD, in my opinion before making personality disorder as diagnosis we have to rule out some psychosis and possibly Schizophrenia. Her behavior like suspiciousness, doubting you, suspiciousness on you even while you talk to someone, obsessive ideas, very rigid in eating habits, doesn’t allow others in kitchen etc can be explained by psychosis. A lot of individuals with psychosis or schizophrenia show obsessions or even OCD as co-morbid complication. Though her behavior like self harm can be explained by borderline personality disorder but other symptoms suggest more towards some psychotic disorder. "

Now here, the diagnosis done at XXXXXXX based on the mentioned symptoms is been ruled out and made the disgnosis more comfusing and complicated.

Kindly show some insight to it and PLEASE let me have Differential and Probable diagnosis with treatment plan. IS IT CURABLE if not, can you provide me any certified journal link mentioning that these kind of illness/personality disorder is not curable.

Dear Doctor,
Its been 18 months of our marriage, experiencing her erratic, suspicious, rude behaviour alongwith psychological issues from day1, patiently I tried all available options from treatment to counselling with positive frame of mind if she could have taken it in same manner and responded to the treatment as on date which she fails miserably.
Though with great difficulty somehow she agree to visit NIMHANS n MANIPAL and we attended the counselling too which were 3-4 hour long....each sessions and continues for 8-9 days but without any result. She has been asking for medication which she refused to take straight away. Now on the name of doctors, hospital she refused to attend the sessions and seeing her rigidity even I stopped asking her to do so. Now we are in the same status as day1 without any result.
Seeing our family condition and atmosphere and the way her condition affecting our lives on hourly and day today basis which is alarming for my cardiac father and ailing mother, left me with no other options of taking a call on seeking legal help and met a lawyer who advised that as per XXXXXXX court of law, the illness should be:
{Any marriage solemnized, whether before or after the commencement of this Act, may, on a petition presented by either the husband or the wife, be dissolved by a decree of divorce on the ground that the other party-
“has been incurably of unsound mind, or has been suffering continuously or intermittently from mental disorder of such a kind and to such an extent that the petitioner cannot reasonably be expected to live with the respondent”}
So now my limitation of understanding her illness from legal point of view is rather its curable or not, and if I can get some authentic credible medical journal, research paper mentioning OCPD-EUPD/BPD as ‘incurable’ status can be helpful in getting relief.
Kindly share some insight and available medical journal would be really helpful.
Live long n Prosper.
XXXX XXXXXXX
XXXX

Dear Dr. XXXXXXX
Consulted the psychiatrist and lawyer and according to them:
As guided by lawyer:
“Personality disorders are not curable but they can't be made basis for divorce because the Personality Disorders are diagnosis of exclusion. In most cases psychosis especially Paranoid Schizophrenia is made as basis for divorce. “
The previous judgements have been made over psychosis especially Paranoid Schizophrenia is made as basis for divorce.
The Differential diagnosis made by the doctor here at XXXXXXX is:
“Based on the above details, I think that your wife is suffering from cluster B personality disorder (Borderline plus histrionic personality). Along with this, she has OCD with poor insight.
•     Schizophrenia
•     Paranoid personality disorder
•     OCD with poor insight
Probable diagnosis:
•     Cluster B personality disorder”
I read about Paranoid Schizophrenia online and can see lot of symptoms mentioned are matching her conditions.
1.     How to go ahead and assess her further to confirm or rule out Paranoid Schizophrenia?
2.     Can Psychologist be eligible enough to diagnose her condition as they can spend enough times with her in knowing her actual conditions or mere interaction of 40 minutes to 1hour by psychiatrist is enough for their diagnosis?
3.     Psychologist diagnosis is acceptable by court of law?
Thanks