I have not asked for my diagnosis. I sought treatment for depression and anxiety. I can experience both several times or more a day, have a calm peaceful day once in a while. I think my diagnosis would be some kind of personality disorder based on quizzes I've taken and that medications for depression or bipolar or anxiety or depression & anxiety did not bring consistent relief. I am now seeing a psychologist for psychodynamic therapy and I think this is what I need. I know it is what I want.

So, if I am right then meds aren't helpful. It will be a long haul from what I've read. That is okay with me as I am lucky to have private insurance and I am committed to paying for it myself if necessary. It is what I wish to invest what little extra money I have in right now.

It scares me that the things that scare me are the things I have to face and find new perceptions for. I am new (several months) to this therapy and it has been quite an adjustment for me. I trust the therapist and like her a lot. I've had to call her several times after sessions, which I never did before because there was never that option; I feel so immature when I do that, but I am usually very distressed and I need to hear her voice to calm down. She is very supportive and when I apologized this past week for calling (3rd time) she was very non-judgemental, very matter-of-fact that she is perfectly fine with it and said twice that she doesn't mind. I love her for that, but will still try to not have to call her. She even gives her cell phone number on her office phone's answering machine. Many times I just call the office number, listen to her voice on the recorded message, and that is enough to help me feel calmer and safe again. I told her I do that and that was okay too. I feel funny about it, but I am doing my best to be totally honest with her because I am so serious about making this work. I have been in therapy several times before but did not understand the process or the importance of total honesty, even about the embarrassing things. (a good site for understanding the therapy process is www.guidetopsychology.com , particularly the question and answer section).

So things are going well for me, but sometimes I wish for a simpler diagnosis, even though I realize I am diagnosing myself here. Am I wishing for that because I think it would make it easier to get better? I don't know. Somehow a personality disorder seems more of a stigma to me, that I failed to mature or something. There is some bit of shame attached to it that hangs out at the edge of my thoughts sometimes.

Do you ever with for a different diagnosis?

How is your therapy going? What are important things to let the therapist know about?

Thanks for listening to me and for any replies!

ECHOES

Hey. I think that labels are of limited utility. Of limited utility indeed. I suspect that the driving force behind the proliferation of labels endorsed by the American Psychiatric Association is partly a function of how much money they make off sales of the DSM and partly a function of political agenda with respect to legitimating distress (e.g., post traumatic stress disorders for war vets) and most importantly channeling funding into treating and researching such conditions.

What does this mean?

The driving force isn't science. There aren't different labels because they have found 'different kinds of people' with similar aetiologies, inner causal mechanisms, treatments that work, and course of illness.

As such... Diagnostic categories are of limited utility with respect to their predictive power of how someone is likely to respond to treatment and what course their illness is likely to take.

Ian Hacking talks about a phenomena that is distinctive to people. It has a paralell in physics, however called a 'paradox of observation'. The notion is that when we are categorised in a certain way (by other people or by ourself) then this causes us to behave differently. The very act of diagnosing a person can alter their behaviour so they conform to the stereotype that we have of their diagnosis. This is known as the 'categorisation effect' or 'self fulfilling prophecy'. It is like if you are repeatedly told (or if you repeatedly tell yourself) 'I can't do math I can't do math' then you will stop trying to do math and you won't be able to do math. If you instead told yourself 'I think I can get a lot better at math if I work hard' then you will work hard and get a lot better at math.

If you tell youself you have a severe and chronic condition and there will be many years before you improve...

What are the likely consequences of that?

Sometimes people find the labels validate them. Labelling yourself as having a personality disorder might help you not blame yourself for not having improved in a way you would have liked. But there are other things you can do with respect to that without condemning your future...

I was diagnosed with borderline personality disorder. I read about how it is fairly much a lifelong way of interacting with the world. About how people often show improvement later in life but how there wasn't really a great deal to be done about the whole way of interacting...

I'm 28 now and when I was 26 I was told I no longer met criteria for borderline personality disorder. Instead of putting me down as someone who was borderline who got better they put me down as a case of initial misdiagnosis. Talk about altering the data to suit the theory!

I think labels are harmful for the most part. They provide something to run away from but they don't really provide anything to work towards. I've found it really helpful to put the diagnoses to one side as much as possible (not internalise them, see them as political agenda and don't take them on board) and instead... Work towards being the kind of person I want to be...

[lostson]

Oh God yes, I wish I had different diagnoses. I wish there was one for really messed up in the head that would be cool. Then again like Alexandra K said it’s really just a label.

My therapy is stable nothing really to write home about other than starting EMDR again which I can say I’m afraid to do. Lots of bad memories come up for me.

The most important thing I ever told my therapist was that I wanted to change. Second was my past every gory detail. She can’t fix me if she doesn’t know what’s wrong and how it got that way.

Lostson

[jbug]

I wish I didn't have all the stuff that is wrong with me. But then again I think it makes me interesting as a person. I don't like being on disability cuz I can't work right now but it also gives me the time to work on me. I'm able to go to therapy twice a week....if my T was there every day I'd probably be there everyday. It also gives the opportunity to go to school. I wouldn't be able to afford it but since I have a mental problem I'm able to get my schooling paid for by the state. So on one hand I wish I didn't have these things wrong with me but on the other hand I don't mind it so much.

Jbug

[spiritual_emergency]

<blockquote>
ECHOES: Many times I just call the office number, listen to her voice on the recorded message, and that is enough to help me feel calmer and safe again. I told her I do that and that was okay too.

I used to do something similar except in my case it was an online recording of Pema Chodron speaking about Tonglen (meditation) practice. I found tonglen to be helpful when I was in a lot of pain, but there were times I found it especially soothing simply to hear another human voice. I would deliberately seek out the audio version of the online article for that reason. That little audioclip made a handy addition to my personal toolbox because I could use it for self-soothing. It sounds as if you're using your therapist's voice for essentially the same thing.

alexandra_k: Ian Hacking talks about a phenomena that is distinctive to people. It has a paralell in physics, however called a 'paradox of observation'. The notion is that when we are categorised in a certain way (by other people or by ourself) then this causes us to behave differently. The very act of diagnosing a person can alter their behaviour so they conform to the stereotype that we have of their diagnosis.

You're probably also familiar with the Rosenhan study...<blockquote>In 1973, academic psychologist D.L. Rosenhan sent himself and seven friends and colleagues to the psychiatric emergency rooms of 12 different hospitals. Each told ER workers that for several weeks he or she had been distressed by voices saying "empty," "hollow," and "thud." The testers gave false names and occupations but otherwise accurately reported their histories, which did not include mental illness. In all 12 instances they were admitted to a psychiatric ward. At that point, they stopped pretending to have symptoms. Nonetheless, they were held for an average of 19 days (their stays ranged from seven to 52 days) and were all released with a diagnosis of "schizophrenia, in remission," or something like it. Rosenhan titled his study "On Being Sane in Insane Places" and argued that psychiatric diagnosis has more to do with the presumptions of clinicians, and their tendency to treat ordinary behavior as pathological when it occurs on a psych ward, than with a rational assessment of symptoms.

Source: Take the Shrink Challenge</blockquote>
The difficulty of reliable and consistent diagnosis has been an ongoing problem for those practicing within the field for a number of years...<blockquote>In 1949, the psychologist Philip Ash published a study showing that three psychiatrists faced with a single patient, and given identical information at the same moment, were able to reach the same diagnostic conclusion only twenty per cent of the time. Aaron T. Beck, one of the founders of cognitive behavioral therapy, published a similar paper on reliability in 1962. His review of nine different studies found rates of agreement between thirty-two and forty-two per cent. These were not encouraging numbers, given that diagnostic reliability isn’t merely an academic issue: if psychiatrists can’t agree on a patient’s condition, then they can’t agree on the treatment of that condition, and, essentially, there’s no relationship between diagnosis and cure.

...

Another study, whose primary author was Spitzer’s wife, Janet Williams, took place at six sites in the United States and one in Germany. Supervised by Williams and some of the most experienced diagnostic professionals in the world, the participating clinicians were given extensive special training before being split into pairs and asked to interview nearly six hundred prospective patients. The idea was to determine whether clinicians faced with the same client could agree on a diagnosis using the DSM. Although Williams claims that the study supported the reliability of the DSM, when the investigators wrote up their results they admitted that they “had expected higher reliability values.” In fact, Kutchins and Kirk point out, the results were “not that different from those statistics achieved in the 1950s and 1960s—and in some cases were worse.”

Source: The Dictionary of Disorder</blockquote>

alexandra_k: If you tell youself you have a severe and chronic condition and there will be many years before you improve...

I have absolutely no doubt that if I had presented to an emergency room in the state I was in, I would have received a diagnosis in line with "schizo-something". I consider it to have been an act of extremely good fortune that I didn't discover the "name" for my experience in this culture until more than a year had elapsed. At the point that I did discover that name, nearly everything I read told me I would never recover, that I would never get better. Fortunately, I was already well on my way to recovery by then. I don't think I'd have gotten there if I'd been told earlier in that process that I'd never get better -- that there was no hope for me.

Hey. I agree with much of what you say but I would like to add something of a cautionary note.

The studies you cite are indeed important, often cited, and fairly notorious for casting doubt on psychiatry.

It is important to note, however, that the studies were done a fair while ago now (1974, 1949, 1962).

It is correct that there are still a number of disorders in the DSM that haven't been validated. Supporters would say something about now about how across the board validity is improved with each edition and hence each edition is getting closer and closer to carving nature at its joints.

I'm not too sure how they measure 'validity'. I get a bit muddled up with the relationship between 'validity' and 'inter-rater reliability'...

Everybody might agree that the caloric fluid flowed from one object to the next (in the good old days of alchemy) but that doesn't establish that there is any such thing as caloric fluid ;-)

[AlteredState01]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
What are important things to let the therapist know about?

</div></font></blockquote><font class="post">

EVERYTHING!!!! If you don't want to waste our money or your time, then just be COMPLETELY HONEST - ABOUT EVERYTHING!!!!

If you even tweek a thought, even to make yourself seem less "vile," for lack of a better word, right how, it can skew what your therapist may conclude and/or assume.

Complete honesty, no matter how embarrassing, is the only way to get a diagnosis. Even when you are in the midst of an incredibly irrational moment - let them see it!!!

I know so many indiviudals that spend so much time, effort and money, yet fail to tell their therapists the truth, and all I see them doing is going 'round and 'round in circles, including being diagnosed incorrectly and taking meds that do them more harm than good - all because they are too embarassed to tell them the truth.

Someone, at some point, has to hear the bare-bones truth about what is going on inside - even if it is repugnant to yourself and to society. But denying such will only mess things up further and will delay healing.

A good therapist will know when you are "out of sorts," but that is all part of what they need to see.

I spent 5+ years with the same therapist (wonderful guy) who never judged (from what I could tell) what I had to say. He just took it all in! When he retired, it was then that I ask what he thought I suffered from.

He gave me, what I believe, is the most accurate diagnosis I had ever had before - and believe me, I've had lots!!!

Again, the point that I am trying to make is.... I TRIED MY BEST NOT TO HIDE THE TRUTH ABOUT WHAT I WAS FEELING, THINKING AND DOING!

Maybe I was very fortunate in the therapist that I was able to see, but I know that being honest with him made the difference between all the other psych people I had seen.

Even when I thought I was deluding myself, I let him know... because, deep down inside, I believe we all know when we are trying to "hide" certain things...

So, if there is one thing that you can do for yourself is this:

BE SO FREAKING HONEST THAT IT HURTS!!!!

AS

Thank you so much!! I'm sorry I am late responding to you but I thought the thread was dead and hadn't looked at it.

You are so right about saying everything. I have learned a bit since I posted that. In fact, I have changed therapists, now paying myself for one who is analytical and who CAN and does indeed take anything I tell her. I know she can but still know I am holding back. It's hard to make yourself look bad when you spend so much of your life trying to not look bad and trying to keep the things in that you need to really get out in therapy. I think we're doing good, working well together even with my holding back and the overwhelming shame I feel that makes me look at the floor and ties my tongue and dulls my brain. I trust if I keep at it, it will get better. I won't quit this time. If all I can do is show up for my appointment, then that's what I'll do.

I don't care what the diagnosis is anymore. However I am pretty sure BPD is it. Browsing at the bookstore today I found a book that really resonates with me so I bought it. It's called "Understanding the Borderline Mother" I posted about it in psychotherapy.

Thanks so much AlteredState01 for your reply ! xoxoxo

[Fuzzybear]