[Victoria'smom]

I'm stealing a quote from Supanova so that thread doesn't get derailed because I think it's a very important question

Do pdocs just like to put labels on every single symptom there? Is this beneficial or detrimental?

For me I've always wondered why people have so many labels.

Each one in my family has 2 dx's on paper. I don't know if GAD or OCD is actually in my file but that's what I'm working on in therapy. When I was filling out the paper work to move T told me only to put BP and history of anorexia. ED's can't be a symptom of BP. The more I deal with things the more I feel my ED was how I dealt with my mood swings before receiving proper help. She doesn't want me to put 1 or 2 and she doesn't want me to put w. psychosis. She's hesitant to give me a personality test. I think she believes that it will be inaccurate given my situation but I haven't asked her why. T does feel I have tons of neurosis. I think when I move it'll just depend on what information my new team will have from my files what my dx's are going to be. I will insist on having the least possible Dx's

H has OCD and BP on his file. Again his paper work for moving will only say BP and OCD.

Now my son's case is a bit harry ADHD, OCD and mood disorder-NOS can fall under PDD-nos. So though he's being treated for all three with 2 meds what will be transferred I don't know.

I think the reason why people are given multi Dx's is that the symptoms are to severe to fall under bp, outside mood swings or can not be related to BP it's self.

[dubblemonkey]

Originally Posted by Miguel'smom

I'm stealing a quote from Supanova so that thread doesn't get derailed because I think it's a very important question


For me I've always wondered why people have so many labels.

Each one in my family has 2 dx's on paper. I don't know if GAD or OCD is actually in my file but that's what I'm working on in therapy. When I was filling out the paper work to move T told me only to put BP and history of anorexia. ED's can't be a symptom of BP. The more I deal with things the more I feel my ED was how I dealt with my mood swings before receiving proper help. She doesn't want me to put 1 or 2 and she doesn't want me to put w. psychosis. She's hesitant to give me a personality test. I think she believes that it will be inaccurate given my situation but I haven't asked her why. T does feel I have tons of neurosis. I think when I move it'll just depend on what information my new team will have from my files what my dx's are going to be. I will insist on having the least possible Dx's

H has OCD and BP on his file. Again his paper work for moving will only say BP and OCD.

Now my son's case is a bit harry ADHD, OCD and mood disorder-NOS can fall under PDD-nos. So though he's being treated for all three with 2 meds what will be transferred I don't know.

I think the reason why people are given multi Dx's is that the symptoms are to severe to fall under bp, outside mood swings or can not be related to BP it's self.

I dis-agree...

bipolar is a very intense broadly affective condition.

I was diagnosed with a whole bunch of stuff before 'they' arrived at BP...

bipolar is a terrible mindset for doctors but they are glad that after some time they can actually diagnose and that's that

it's an illness that kinda tops most others...

it's like the head of the family

the only thing that can compete with bipolar is borderline...

and the two together are a very interesting combination...

scary

[~Christina]

A couple years ago I lost my health insurance and they had a program that would allow me to continue seeing my Pdoc and Therapy and assistance with medication .. But .. Just the diagnosis wasn't "enough" So he added a few others BP w/ psychosis , Anxiety and panic attacks and poor impulse control ... All of which were valid problems I had/have. prior to this there just was no real reason to list them .

He could label me as a purple person with yellow spots ..I seriously don't care it doesn't change the way I handle my Bipolar.

[ultramar]

I was actually interested in Supanova's post as well and was thinking of starting a new thread about it!

First, the below is all about 'labels' --so I'm not saying whether it's a good or bad thing to have them, just exploring what they mean in this context of multiplicity. Many people put their lists of diagnoses in their signature and/or in the 'about me' thing (as I do), and I think labels can affect/influence our identities.

I agree, Miguel'smom, that some things just fall well outside the realm of BP (and occur outside of episodes) that make sense to diagnose, so this is certainly one reason why someone would have more than one (or multiple diagnoses).

But I wonder if, in some cases (and I'm not really talking specifically about BP here, just in general) there aren't other reasons at play. For example, if someone changes pdocs (once, twice, or more, over the course of a lifetime) then those pdocs may disagree with each other --if current pdoc offers different diagnoses, then does this mean that they are added *on top of* previous ones or *replace* previous ones? I think if the conversation of whether current pdoc agrees with previous diagnoses or not, can potentially lead to multiple ones i.e., current doc believes you have x, previous pdoc believed you had y and z, so do you now have x, y, and z, or do you only have the current diagnosis of x? I think if you go through different pdocs, and they diagnose different things, the question becomes: are these guys disagreeing or are they actually adding on?

If previous pdoc said you had OCD, but current pdoc says you have an 'anxiety disorder' --is the patient supposed to believe they now have both? Or, since OCD is an anxiety disorder (I think?) does current pdoc disagree with previous -doesn't fit OCD criteria, but suffers from anxiety?

Maybe one pdoc diagnoses PTSD, another 'Anxiety' --so do you consider yourself to have both? But PTSD is a kind of anxiety disorder, maybe it's just that current pdoc doesn't think your anxiety stems from PTSD, or doesn't think you fit the criteria, etc.

One pdoc diagnoses 'major depression' and a different one BP are your diagnoses now major depression *and* bp (but isn't depression part of BP, so don't they overlap?). Or if one pdoc diagnosis BPD and another BP, do you now have both or do the pdocs disagree?

If therapist and pdoc disagree (or offer different diagnoses) does that mean you have both or do you have to decide, as a patient, which you agree with (pdoc or therapist) and choose one?

Anyone have any experiences of asking current pdoc if they agree with old pdoc's diagnoses? Has anyone experienced having to decide if everything new is a kind of 'add-on' or if some replace others?

I'm not saying, at all, that multiple diagnoses are inaccurate, just that it's complicated and there can be many roads to this.

So what are your guys thoughts? Can some diagnoses actually be part of just one (i.e. depression and bipolar, etc.) and it would make more sense to diagnose what encompasses others instead of adding and adding? What about the issue of different pdocs (and therapists) diagnosing different things, thus adding to the list, even if they disagree with each other (pdocs disagreeing with other pdocs, therapists disagreeing with pdocs, etc.)?

What a mess, right? But this is the system we have to deal with!

[Moose72]

I got a new pdoc and a new T relatively recently and all four- old and new- seem to agree with each other so thank goodness for that. Even the drs in the PES and the hospital didn't vary too much as to my being bipolar.

[Victoria'smom]

I would keep the Dx's that encompasses as much as possible. Honestly though I'd go with the person that knows me the best. Pdoc knows me really well but if T said I had a different Dx. then I would go with her's because she see's me twice as often and knows all my twisted ****ed up thoughts in my pretty little head.

Pdoc generally knows but not in detail. He hasn't seen my scare of myself, lit up and animated about disturbing topics, not able to understand English, or talked to me in-depth about my suicidal intentions. So he's missing parts. So I trust T's dx more then pdoc's.

I think in most cases you could probably just ask your dr if you are unsure of your specific dxes and discuss why they do or do not agree with previous dxes.

In my case the dx of adhd was made 5 yrs before the dx of bp and gad . The actual dx of soc anx dis had not been given until this year (7 yrs after the bp dx) though clearly I have lived with it through my entire life.

What I remember from when my son was in sp. Ed., the label is what gets you the necessary educational or medical services or treatments. Or gets the provider the correct payments. We hope.

[IndieVisible]

Fair assessment, valid points. So why do we keep bringing them up and even include those labels in our sigs? Are we not using them as much as any one else? How can we say we don't like these labels yet continue to use them ourselves? Not trying to rock the boat or any thing but one fair observation deserves another fair observation no?

I think one of the reasons we share our labels here, is an ice breaker. To see that at least here there are people who have things in common with ourselves and we can see this at a glance. Not to label ourselves but to share ourselves quickly. I guess I could just as easily share more but that is for my profile page if someone is interested in knowing more.

I can see at a glance that 2 other people take the same med I do and can ask those 2 people a question or I can see that many people take a particular med and not feel out of place.

[cashart10]

My old pdoc said that whether you are BP or BP and GAD, etc is determined by whether or not the other symptoms subside after your BP episode is finished (I hope I said that clearly enough).

My old pdoc dx me with bp1 and said I had "anxiety" but I'm not sure what that meant; I saw him for years. My current pdoc also says BP1 but I have no idea if she thinks I have "anxiety" or not. And I'm not sure if that "anxiety" is GAD or something else and always felt too akward to akk...don't know why.

Also, I become psychotic quickly in some of my manic episodes. I've never heard of "psychosis" as a dx. I'm just curious if the "psychosis" is an actual dx or if it is just a reference by anyone who has been psychotic. Does anyone know? Thanks!

[Victoria'smom]

So why do we keep bringing them up and even include those labels in our sigs?
I put my Dx so that others understand I've been through similar things. I include my families dx's so other's understand I come from three different view points.
Are we not using them as much as any one else?
I find it no different than telling others the name of my physical disability. The labels are just what they are a list of symptoms.

I'm just curious if the "psychosis" is an actual dx or if it is just a reference by anyone who has been psychotic. Does anyone know? Psychosis NOS is a dx. I have BP w. psychosis because it seems to be one of the first things that I'm going up or down.

[BipolaRNurse]

My pdoc runs against the current of putting an alphabet soup behind a patient's name. My only psych dx is bipolar 1, even though I have some pretty severe anxiety/panic attacks and can be more than a little OCDish as well---he just calls it all part of my BP. That's fine with me, I don't want or need a bunch of labels to explain what's "wrong" with me.

Thanks for continuing the discussion

I tend to think my anxiety falls under the BP diagnosis too. I do have a diagnosis of GAD and OCD but I dont believe its separate to the BP in my case. I dont think are necessary as I see them as symptoms of BP anyway, and I have only ever share them on this forum so that people know I can relate.

I dont feel my pdocs putting more labels on affected me in any way, but I have seen a lot of people who get very stressed over the extra labels, and I wonder if perhaps telling them that their symptoms exist under a single diagnosis may put their minds at ease a little, rather than a list of letters and the patient thinking they are doomed for life having so much "wrong" with them.

[mzunderstood79]

Dumb question maybe but what is a pdoc???

Originally Posted by mzunderstood79

Dumb question maybe but what is a pdoc???

pdoc means psychiatrist

[Zabine]

Originally Posted by dubblemonkey

I dis-agree...

bipolar is a very intense broadly affective condition.

I was diagnosed with a whole bunch of stuff before 'they' arrived at BP...

bipolar is a terrible mindset for doctors but they are glad that after some time they can actually diagnose and that's that

it's an illness that kinda tops most others...

it's like the head of the family

the only thing that can compete with bipolar is borderline...

and the two together are a very interesting combination...

scary

Wooooooooow. Do you always ladle people like [I]that[I]? How offensive.

[ultramar]

Originally Posted by dubblemonkey

I dis-agree...

bipolar is a very intense broadly affective condition.

I was diagnosed with a whole bunch of stuff before 'they' arrived at BP...

bipolar is a terrible mindset for doctors but they are glad that after some time they can actually diagnose and that's that

it's an illness that kinda tops most others...

it's like the head of the family

the only thing that can compete with bipolar is borderline...

and the two together are a very interesting combination...

scary

I may be misunderstanding, but it sounds like you're saying that Bipolar Disorder is the 'worst' (or most challenging, or whatever) diagnosis someone can have (if I'm wrong, I apologize)? Regardless, I'll put out there that I think suffering cannot be quantified or certainly compared -someone with MDD, severe anxiety, PTSD, etc., etc., everyone suffers -and everyone's experience within any diagnosis (including BP) is different as well.

There are also tons of people who fit no diagnostic criteria for mental illness, but suffer horrendously due their circumstances (I lived in a war-torn 3rd world country for a couple of years, but there is plenty of poverty and violence in this country as well). Many of these people, no doubt, suffer 'just as much' as many who suffer with mental illness -it's just different.

[ultramar]

My old pdoc said that whether you are BP or BP and GAD, etc is determined by whether or not the other symptoms subside after your BP episode is finished (I hope I said that clearly enough).

Thanks for this, I had never thought of it this way. As I've said before, one way in which I personally conceptualize bipolar is that, between episodes, you are just 'you' (your 'normal,' your 'baseline'), if that makes sense. In other words, you're not bipolar between bipolar episodes, you are who you are (with all of your psychological issues, personality characteristics, quirks, etc.).

In this context, what you say above makes a lot of sense to me. So if you suffer from a great deal of anxiety between episodes, then it's likely you suffer from a co-morbid (or separate) anxiety disorder -do you think this is what your pdoc was saying?

About psychosis, since you're diagnosed BP I and psychosis can be a component of this, maybe it's encompassed within the bipolar diagnosis? As someone said, there is a psychotic disorder nos, but if it occurs during your episodes, I would think it would be the BP? What does your pdoc say?

Good topic with interesting timing. I do like this idea of what remains between episodes being "something else", that potentially is significant enough to be a separately diagnosed condition. For me, I do notice that all sorts of symptoms exacerbate during episodes, including those that are unlikely to fall under the BP umbrella. Their (non-episode) level of interference determines if/what they are dx'd separately. Pretty sure my psych operates that way. Here's why it's of current interest to me... I thought I knew my dxs. But when she filled out some paperwork, one (of the three) was different.(Not insurance purposes, btw, as I don't have any.) On that one, what I thought and what was written are both anxiety disorders. She did not just tack one on with the other. Was it fine tuning? Was it observing one variety as ongoing and independent of episodes, while the other waxed and waned with them? I'll definitely be asking.

As for beneficial or detrimental, I 'd have to say detrimental to tack on more than necessary. Regardless of how it "reads" or makes one feel, each diagnosis has its own parameters. To toss them together/add on because of overlap issues would only confuse the issue because it suggests probable/assumable symptoms that the person doesn't have*. (This is very much a concrete example of why I take such issue with people lumping BP and BPD together.)

(And let's face it... really, how many of us need people thinking we have more problems that we already actually deal with(!) )

[IndieVisible]

I'm not sure I would consider diagnoses labels pro pdoc labels. They are needed to identify a condition or illness. I don't place a whole lot of weight in them, because they can change from pdoc to pdoc, but they are at least identifiers. I think labels are more fitting if thrown around by people towards other people. In which case they are usually intended to be sarcastic or hurtful. He is a liar, she is a slut, he is crazy, she is a B-word, he is a total jerk, etc. Which get even less weight then pdoc diagnosis's in my book.

I would like to know every thing the pdoc is writing down in his notes and in my file. Full disclosure. I feel I have a right to know what will be in my file or folder. Certainly a person has a right to say they don't want to know, and the pdoc would need to determine if that request is reasonable or not for that patient as knowing may be part of the treatment.

I disagree with the poster who said BP is the worst or most difficult to treat. Of course the amount of success from any treatment will be determined by the cooperation of the patient. I still would not say BP is even one of the most difficult. I can think of many others pdocs would consider more difficult to treat.

Suffering is in the heart of the beholder. For some people the flu is barely more than a cold and for others it is deadly.

[ultramar]

To toss them together/add on because of overlap issues would only confuse the issue because it suggests probable/assumable symptoms that the person doesn't have*.

You say some really interesting things here and I generally agree --but what does the above mean (probable/assumable symptoms specifically) -can you explain?

[Anika.]

Sometimes the emotional turmoil from bipolar symtoms is enough to have anxiety and other issues outide of the episode itself. Anxiety is a common and natural response, it is a warning signal that can run ammuck to the point of disorder or dysfunction, so it would seem natural to me that you suffer emotional turmoil and other issues (many people do just because life is messy) that things like anxiety could become unregulated, or to put it another way... become reprogramed as a first response to any sort of stress.

That's just how I see it anyway, or how I saw it in myself.

I think it's unhelpful to have many labels especially if they have overlap. An example I can think of is when people say they are dx'd with Major Depression AND Bipolar. Or Bipolar and S.A.D., ect. Anxiety is another good good example in my opinion as well as OCD. Sometimes maybe it is warrented and often perhaps it's not. Often our issues are interwoven and there is a cause and effect, domino effect, or symptoms secondary to the root cause or other symptoms.

I have an autoimmune disease that causes many many symptoms, I don't need a seperate dx for each one even tho each symptom does have a name. The symptoms do not always come in the same flare, it can come in any order, some linger through remission others don't. Some symptoms lead to other symptoms. Residual symptoms and I guess I see a lot of mental illnesses the same way, as well as issues we face outside of mental illness.

Originally Posted by ultramar

To toss them together/add on because of overlap issues would only confuse the issue because it suggests probable/assumable symptoms that the person doesn't have*.

You say some really interesting things here and I generally agree --but what does the above mean (probable/assumable symptoms specifically) -can you explain?

Basically two circles with an area of crossover. Since each circle basically has its own set of symptoms, even if one is simply in the merged area, having both "circles" dxd, tends to "imply" the person has other symptoms than what they actually deal with. That's probably even more obtuse(!) Lol. Clarifies? Probably just a little... (?)

[cashart10]

Originally Posted by ultramar

My old pdoc said that whether you are BP or BP and GAD, etc is determined by whether or not the other symptoms subside after your BP episode is finished (I hope I said that clearly enough).

Thanks for this, I had never thought of it this way. As I've said before, one way in which I personally conceptualize bipolar is that, between episodes, you are just 'you' (your 'normal,' your 'baseline'), if that makes sense. In other words, you're not bipolar between bipolar episodes, you are who you are (with all of your psychological issues, personality characteristics, quirks, etc.).

In this context, what you say above makes a lot of sense to me. So if you suffer from a great deal of anxiety between episodes, then it's likely you suffer from a co-morbid (or separate) anxiety disorder -do you think this is what your pdoc was saying?

About psychosis, since you're diagnosed BP I and psychosis can be a component of this, maybe it's encompassed within the bipolar diagnosis? As someone said, there is a psychotic disorder nos, but if it occurs during your episodes, I would think it would be the BP? What does your pdoc say?

Yes, that is exactly what he meant and I thought it explained a lot also. Thanks for the info too. I haven't asked my pdoc about it. I am bad about just letting her take the reigns (she's good at it) and not asking a lot of questions. I do it with most doctors actually, trying to ask more though.