Q. I really do believe that my boyfriend has BPD after reading extensively about the symptoms and behavior patterns. He loves me, then he shuts me out. I do believe that he is also a paraphiliac with his sexual fetishes and fantasies. Also, he has definite symptoms of Antisocial Personality Disorder. I have mentioned his philias to him and he is in denial. His reason for fetishes is to show me how much he loves me know matter what it takes!! He has to be doing something all the time and make all the controlling decisions. He has road rage, anger and frustrations way too often. Anyway, I have decided to end this relationship on good terms but, my question is how do I clue him in that he has some serious issues re; his mental health??? Most people with a mental illness don't realize it. He was making me feel like I needed help!! I do want him to be aware of his disorder and get some therapy for it .

A. This is a great question with no good answer. Most individuals with any psychiatric disorder only seek treatment when the illness becomes painful. For example, he might see someone for panic attacks (they are dysphoric/unpleasant) but not antisocial behaviors which have no readily apparent problems for him. People change what they do not like if they are able to. If they cannot, they seek help to have the change done. If you tell him your concerns when you break up with him, he will view it as a hostile part of the break up process and ignore what you say. If you tell him before you break it off, he will view it as manipulative on your part. Truth is, if he wants to change and sees a need to change, he will do whatever it takes to get well. If he does not see it, your telling him will not change it. In the parlance, his behaviors as you describe them, are referred to as ego syntonic--they do not bother him. We do not change things that do not bother us. I do not believe he will change at this time.