Diagnoses aren’t evil
I heard this in a group:
A patient was saying that she used to have a lot of friends in college, but lost them after graduation. She hadn’t been able to make new ones because she was weird and no one liked her. When the therapist challenged that idea, she said that she had a personality disorder — so how could anyone ever get along with her? There’s something wrong and pathological about her personality.
Only about a hundred things went through my mind when I heard this comment. There is such gravity to a personality disorder diagnosis… and it’s easy to understand why someone would think this.
There were a couple of things that I felt she was saying:
- having a personality disorder means that she is somehow broken or defective
- having a personality disorder means she can’t have relationships
- the personality disorder is not something that she can overcome.
I’m going to avoid diving into labeling theory… but I think that diagnoses are ultimately meant to guide treatment. You’re really saying “here are a cluster of common symptoms” so that you can research and treat individuals with those characteristics. It’s not adequate to just describe someone as being sad, because the other presenting symptoms make a huge difference. Maybe the individual has major depressive disorder, or maybe they have PTSD. The approach to treatment is not the same! Many diagnoses do carry a negative connotation, but I really believe the intention is to help you. To improve your treatment, to give professionals an idea of where to start and what questions to ask, and as a general warning of other possible common symptoms that may not have been noticed yet. And while I’d say that most disorders are on a continuum, a guide is needed for drawing some kind of line between healthy/unhealthy. Maybe it’s a really fuzzy line… maybe the line moves based on the individual… but there has to be some kind of line. If you can’t draw one, how do you know when you are done with treatment? How can you gauge if you are where you need to be?
Given that this line is so fuzzy, different professionals may diagnose you differently. Ideally this shouldn’t happen… but since the DSM-IV is just a guide, it is an issue. A diagnosis can’t dictate whether or not you can form new relationships. Not only that… but who said individuals suffering from a PD can’t have meaningful relationships? It’s not the case at all. And maybe the label does suggest that there is something wrong with your personality and therefore you’re not compatible with everyone else… but:
- Everyone has something. You know, baggage. Negative stuff from previous relationships, insecurities, neuroses, obsessions, issues, addictions — whatever. Something.
- The absence of a personality disorder does not make you like-able by default. Anyone can cut off friendships, sabotage relationships, isolate, alienate others (and the list goes on…). Anyone!
Can you overcome a personality disorder? Sure. I think so, but others will disagree with me. Can you overcome an eating disorder? How about an addiction? It’s a tough question to ask. Maybe someone with schizophrenia has to take meds forever, or maybe someone with anorexia can never go on a serious diet. It’s a grey area (imagine!). The statistics may not be in your favor, but because diagnoses are so subjective, it’s hard to accurately research recovery rates. With eating disorders, there is at least some measurable criteria (weight, binges/purges a week, caloric intake) – but even that isn’t concrete. Also, eating disorders are based on present symptoms. If you’ve recovered / been in recovery for several years, maybe your chart say “history of bulimia,” but often not. There is no “recovering/recovered from bulimia” diagnosis. However, PD diagnoses do somewhat take your history into account. Often you can go into a treatment program for anorexia, and come out 8 weeks later without the AN diagnosis (instead it’d be EDNOS). It doesn’t quite work like that for personality disorders.
Maybe having these caveats mentioned when you’re originally diagnosed would be helpful — I don’t know. Would they? Some professionals don’t even tell patients their full diagnoses (Axis II disorders are sometimes left out), but I usually feel that ignorance does NOT equal bliss. Personality disorders have a bad rep. With such a loaded diagnosis, maybe it would help to be reminded that diagnoses aren’t designed to label you as broken, defective, or unrepairable.
Thank you for posting this. I work with many PD students and don’t think I could continue doing the work I do if I didn’t believe it was somewhat treatable/curable.
And thank you for reading
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[...] A diagnosis isn't a bad thing | Grey Thinking [...]
I can definitely understand being concerned about an axis 2 diagnosis, but at the same time the person in the opening vignette clearly has been able to develop friendships as an adult (assuming you consider college aged people “adults) so it seems unlikely that her diagnosed PD is the primary reason she feels that she is unable to develop friendships in her post college years.
Like you, I question the utility of tell a patient of an axis 2 diagnosis. I’m not really sure how it could be really helpful, and if anything I think there is a greater likelihood of patient being upset when informed of it. Apparently in this case the health care provider must have thought informing the patient of the diagnosis would benefit her more than it could hurt or harm her. We know from research that there can be a self fulfilling prophesy phenomenon and it seems being diagnosed with a PD and being told of the diagnosis could result in the possibility of patients living down to their PD. I have a hard time believing that arming a patient with that information could help them.
Although I understand why the five axis diagnosis system is used, and feel that it probably is a good way to communicate comprehensive information about the factors impacting a person’s condition, but perhaps there is a better way to utilize that information so that patients don’t see it as something that is set in stone and is an intractable flaw in their very being which is the reputation that PDs tend to have in our society.
Maybe Axis II/Personality diagnoses carry a stigma because people in general view your personality as something unchangeable, fixed by your earlier experiences and only added to by new ones and even how you view your new experiences is affected by you ‘inborn’ personality. Even within the study of normal personality it’s defined as unchangeable – the best predictor of future behaviour is past actions and the like. But perhaps in some ways it is changeable – not as easily as emotion or a medical imbalance, but changeable all the same. Defining personality itself is tricky, so to say it is disordered is trickier still. Await to see whether DSM-V makes a difference???
[...] This post was mentioned on Twitter by VoiceinRecovery, Datagirl09. Datagirl09 said: RT@gretlythinking new Grey Thinking post: Diagnoses aren’t evil http://bit.ly/bHNYzw [...]
[...] This post was mentioned on Twitter by VoiceinRecovery, Datagirl09. Datagirl09 said: RT@gretlythinking new Grey Thinking post: Diagnoses aren’t evil http://bit.ly/bHNYzw [...]
[...] change just because you gain to 88%) and the frequency of binge/purge episodes, but as I said in my last post, diagnoses are meant to guide treatment. Even from just a medical perspective, the anorexia [...]
Thank you for posting this. I work with many PD students and don’t think I could continue doing the work I do if I didn’t believe it was somewhat treatable/curable.
Some groups want the whole DSM done away with. They feel EVERY dx is a “label” (unless it is of a physical nature). They also want terms like “mental”, “disorder”, “patient” (which is what I thought was trying to be while waiting), “client”, “psychiatric”, “therapist” (unless it’s physical), “consumer”, and countless other terms banned. They want to be “people” who go to “care givers” for “guidance”. They agree medical conditions need dx’s but not “emotional” (another bad word). Certainly that will protect their privacy but won’t it make them stick out just a little from the rest of us making them exactly what they are fighting against being subjected to? I must be crazy (oops). I embraced my dx of BPD and DID after going years not knowing what was wrong with me. Was I bothered by the thought that I had a personality disorder? Heck no. I knew I was “difficult” to say the least! By the time I had the actual dx, I had fully recovered – yes you can overcome PD. Could I have a healthy relationship in spite of it? Ask my husband of 28 years. Every dx has a world of variation from person to person. It’s just a guide for narrowing things down and knowing the difference between the serial killer and the mildly depressed.
Meanwhile another doctor, not having my dx, mistook MS and menopause as BP and treated me for years for something I didn’t have. Was I grouchy, fatigued, having difficulty sleeping, achy, feeling a bit down – yes. But those were all typical symptoms of medical conditions. He was even convinced that my hot sweats were caused by undisclosed manic attacks. BP was his specialty. He refused to discuss topics outside his field of expertise. Geeze! I like a fool accepted his word. Plus he was the only doc on my insurance with nighttime hours.
So now I’m post menopausal and have MS. Thank goodness I’m allowed to have dx’s otherwise they would just call me lazy, forgetful and a pain.
I am the daughter, the sister and the mother of diagnosed personality disorder family members. It has been crucial for me to not believe myself crazy and completely unloveable by having an indication that it’s their craziness and ill thinking not me the scapegoat. Frst my sister told me of her diagnosis, then my mother admitted to her(my sister, not ever admitting to me) that she already had been diagnosed bpd. Six months later my beautiful daughter went into the hospital and was diagnosed at 15 as BPD. She totally met all the criteria and so was said to be BPD. The ravaged relatioships I try to hold on with them is so crippling. The DSM gave me a compass to sieve my life occurances through. I found out about all my family members at age 45yrs old. No one in my family will tolerate working on, talking about, anything to do with treatment. It is to, to sad. It would have been much worse for me not to know a diagnosis.