[Chopin99]

I got to thinking. How does your T feel about diagnostic labels?

My first T diagnosed me with GAD, depression, and OCPD. The Pdoc I saw at the same time added bipolar and borderline. I took those Dx's to my GP. After two years of therapy and getting off a couple of meds, GP said there was no way in hell I was bipolar or borderline, so they got dropped.

My second T and I never addressed anything but OCD. She said I was definitely not OCPD. After treatment with her, my OCD symptoms were practically cured.

My GP says current official Dx's are GAD, depression, and OCD.

Current T hates diagnostic labels. The only thing she has Dx'd me with is adjustment disorder. She says I have OCD and borderline "traits" but I am neither OCD nor borderline. She said the bipolar Dx was ridiculous (which it is...I argued with it when I received the Dx). She once stated she could parade 100 people through her office an hour at a time and figure out how to diagnose 98 of them as borderline.

I'm not asking everyone what their Dx's are; it's not my business. I just want to know where on the continuum your T falls in handling the diagnosis of disorders; is he/she trigger-happy with Dx's like my first T/Pdoc, or he/she eschew them altogether like my current T, or fall somewhere in-between?

[rainbow8]

My current T doesn't like labels so she didn't try to diagnose me at all. She didn't believe I have BPD but I think she changed her mind. My former T never stopped thinking of me as my diagnosis. The previous T's begrudgingly told me I had BPD but they didn't want to discuss it with me. One decided I also had dysthymia so that's what she wrote for diagnosis. I think my current T writes "adjustment disorder" on the insurance forms. I think I have OCD too but no one ever diagnosed me with it. (I know you said you didn't have to know diagnoses, but you know me. TMI as always.)

[sunrise]

My T is not big on diagnoses so he would be at one end of the spectrum. I don't think he's really given me any diagnosis over several years. When we first started working together, we did trauma work, so I think if he had to give a diagnosis, it would have been PTSD. Then we did a lot of work on my marriage so it would have been a "V code" diagnosis such as relationship troubles. We're not working on trauma or my marriage anymore, so I don't know what he would give me today if someone twisted his arm. I just go to therapy and work on healing. I don't think having labels would help us any in our healing work.

[di meliora]

Over the decades I have had many different labels. None of the the therapists seemed to pay any particular attention to them. The meds stated they were for depression and anxiety. The types of therapy seemed to me to be more eclectic than adhering to a particular school of thought. Whether the type of therapy was intended to address a particular disorder is something I assumed but was not a topic of discussion.

My T uses severe depression as my diagnostic code for insurance. He has a great deal of diagnostic training and experience, so he also says ptsd and bipolar but mainly as a point of reference, not officially on paperwork for insurance. His assessment is the same as my pdoc, but my pdoc actually uses bipolar as my diagnostic code. Insurance doesn't seem to care that there is a difference.

I'd say for the most part the diagnoses are a point of reference for treatment and monitoring.

[BlessedRhiannon]

Since I'm not filing insurance claims, there's no official need for a diagnosis from my T. The only thing she's ever labeled is OCD, and I was fully aware of that one. She hasn't given me any other labels or diagnosis, and it's not really important to me. I'm sure she has some in her notes somewhere, but I've never asked.

My T seems reluctant to label or diagnose beyond recognizing my anxiety and depression. I was the one who brought up BPD, and she agreed to me having what she described as a 'modicum' of a personality disorder, but that she disliked the term. She did say she doesn't think depression and anxiety explain everything I'm going through, though. I think because there is no insurance requirement or whatever, she maybe doesn't see any advantage to putting me into any particular box, and I think she worries about me getting hung up on the diagnosis or the negativity around it. She always seems to want to accentuate the positive, you know?

[SoupDragon]

My T doesn't do labels, he says we are all a little bit of this or that from time to time.

[Elli-Beth]

Mine has only used them to help me see I'm not alone. He'll pull out the DSM and turn to the symptoms for the dx closest to me as reassurance that others have gone through the same struggles

With DID my diagnosis is kinda hard to miss Gotta know it to treat it effectively I think. I'm glad she is involved in getting to know about it because it can be really hard to treat.

For my clients, I'm not big on diagnosis, only do it cause I have to for insurance. I tend to do very "low level" diagnosis (depressive disorder nos, anxiety disorder nos, adjustment disorder). I usually use diagnostic information to dispute what parents feel their child has. Most often they feel their child has bipolar. The way I was trained, you do NOT diagnose bipolar until 18, and I stick to that unless there is very apparent evidence to the contrary. So I often use my "lower level" diagnosis to talk with parents instead of them self diagnosing their kid because bipolar is the "fad diagnosis" now.

[CantExplain]

My T despises diagnosis. And since I'm seeing her privately, she is free to do so.

As an Aspergic (my diagnosis of myself), I like to put things into boxes, so the lack of diagnosis used to bother me. But not any more.

I yam, what I yam, I'm Popeye the sailor man!

[healed84]

T and I have never discussed anything of specfic diagnosis.. So, I don't think that he is really big on assigning them, then again, I have never asked.

[Eliza Jane]

Originally Posted by stormyangels

With DID my diagnosis is kinda hard to miss Gotta know it to treat it effectively I think. I'm glad she is involved in getting to know about it because it can be really hard to treat.

For my clients, I'm not big on diagnosis, only do it cause I have to for insurance. I tend to do very "low level" diagnosis (depressive disorder nos, anxiety disorder nos, adjustment disorder). I usually use diagnostic information to dispute what parents feel their child has. Most often they feel their child has bipolar. The way I was trained, you do NOT diagnose bipolar until 18, and I stick to that unless there is very apparent evidence to the contrary. So I often use my "lower level" diagnosis to talk with parents instead of them self diagnosing their kid because bipolar is the "fad diagnosis" now.

Are you familiar with www.jbrf.org? While I agree that pediatric bp is over diagnosed, it is also often misdiagnosed, leading kids to be put on the wrong meds for years. The site has lots of good info, backed up by continuing research. It also inludes an assessment tool that can be used for free by the parent and brought into the diagnosing clinician. Also, clinicians can buy access to the measures if the would like to administer them in the office. The measure also pays special attention to the differential diagnosis between ADHD and BP.

The other thing I wanted to throw into the mix are the benefits, yes benefits, of a more severe diagnosis when dealing with an insurance companies. Because of parity laws, many insurance companies cover biological diagnoses at a greater level than the nonbiological diagnoses you mentioned. For example, my insurance company covers dysthymia for 20 sessions per year. Major depression, being a bio dx, earned me unlimited visits. It's not right, but it is what it is.

Food for thought.

EJ

[Perna]

My T and I only discussed a dx once, in passing (GAD). I think she decided on what general "approach" to take and that was that. The dx's are for the T's, for them to decide what to treat and in what order perhaps. I was originally dx's borderline, way back in the 70's when it meant something slightly different than today (wasn't a "fad" yet :-) and my therapist at that time (a psychiatrist did the diagnosing after a one-time interview) was a student and an idiot and went on and on about how well I fit it, etc. I learned a lot from that therapist but did not get any therapy out of him :-)

[precious things]

my dr.doesnt believe in labeling people so we don't use them.

[Eliza Jane]

Originally Posted by precious things

my dr.doesnt believe in labeling people so we don't use them.

There is a difference between labeling people and labeling symptoms. For example, a person is not a Biploar, they are a person with symptoms consistent with the illness of Bipolar disorder.

Of course, not all professionals get that.

EJ

Labels can be vital when dealing with certain diagnoses. A person who is bipolar, but who is mistakenly treated for depression can be thrown into mania if only treated with anti-depressants. So, I suppose while it may not matter so much whether a T uses a diagnosis or not since he/she won't be prescribing medications, clearly a diagnosis is very important when being treated medically for a mental illness.

Also, my T needs that bipolar diagnosis so he can monitor my symptoms. People with certain diagnoses display some pretty clear warning signs when we are headed into an episode. The sooner a T can help a client recognize that something is going awry, the sooner intervention can happen to hopefully lessen the impact of that episode. My T's willingness and ability to recognize those symptoms as indicators of a bipolar episode has saved my life many times over the years.

So, I think the whole diagnosis issue is really dependent on what kind of diagnosis you are working with. I would be personally very wary of a T who basically blew off my diagnosis as not important to his handling of my case.

[sunrise]

Originally Posted by farmergirl

So, I think the whole diagnosis issue is really dependent on what kind of diagnosis you are working with.

Agreed. I think some disorders would be very important to have a stated and accurate diagnosis for--bipolar and schizophrenia, to name two (but not the only two). Even though my T doesn't give a diagnosis to me, I think if I had one of those disorders, he might, or would communicate more closely with a pdoc about a diagnosis and treatment plan.

[skysblue]

Well, if my T needed to give me a diagnosis, and she doesn't have to because I'm self pay, it would probably be "whiney self-indulgent personality disorder".

I don't know how he feels about them. I know getting the ones I got was a relief because it explained a lot and I found it helpful because I know what I'm dealing with and I agree with the diagnosis 100%.

[critterlady]

The only diagnosis I've ever been given was depression, but that one was fairly obvious. I have no idea if my T has decided on any other diagnoses or not. I haven't asked and he hasn't volunteered the information. I don't think i want to know and it probably wouldn't do anything but bother me to have a label.

[lostmyway21]

Originally Posted by farmergirl

Labels can be vital when dealing with certain diagnoses. A person who is bipolar, but who is mistakenly treated for depression can be thrown into mania if only treated with anti-depressants. So, I suppose while it may not matter so much whether a T uses a diagnosis or not since he/she won't be prescribing medications, clearly a diagnosis is very important when being treated medically for a mental illness.

Also, my T needs that bipolar diagnosis so he can monitor my symptoms. People with certain diagnoses display some pretty clear warning signs when we are headed into an episode. The sooner a T can help a client recognize that something is going awry, the sooner intervention can happen to hopefully lessen the impact of that episode. My T's willingness and ability to recognize those symptoms as indicators of a bipolar episode has saved my life many times over the years.

So, I think the whole diagnosis issue is really dependent on what kind of diagnosis you are working with. I would be personally very wary of a T who basically blew off my diagnosis as not important to his handling of my case.

I totally agree with this. I am pretty sure this is why my T changed my primary dx to bipolar from PTSD. Once I had the appropriate dx, it felt like my treatment plan changed right away. He handled situations differently because it's a whole different set of reactions. Once he recognized I rapid cycle a lot, he did his best to get me out of it, and it helps. Even though I was really mad after he first changed my dx.

[Chopin99]

Thanks for all your replies!

In my own case, the Dx's were actually helpful for me in a practical sense; they allowed me to get the help I needed at the time without much hassle from insurance companies. I find this to be true also with my clients; without the Dx's, Medicaid and Medicare Part D don't want to pay squat toward medicines my clients need simply to function on a daily basis. The Dx's also help us formulate good treatment/behavior/crisis plans for them.

About 8 years ago when I was diagnosed bipolar and borderline, I needed anti-psychotics and mood stabilizers just to get me to the place I could function enough to go through therapy. These meds would have been harder for the Pdoc to prescribe without the Dx's...they usually aren't prescribed for anxiety and depression. Do I think I have these disorders? No...I have some borderline traits, but the unhealthy situations I had placed myself in at the time caused me to act as if I did. To a Pdoc seeing me for the first time, I looked bipolar and borderline. Once I got out from under the unhealthy situations and made progress in therapy, I no longer needed either mood stabilizers or anti-psychotics. Therefore, the Dx's dropped off.

That being said, my T hates diagnostic labels. She doesn't even have me Dx'd with GAD, OCD, or depression, all of which I know I have. My Dx with her is adjustment disorder. She said she uses that for almost everyone because other Dx's are stigmatic.

My final word is this: Dx's, just like almost anything else in life, are fluid. A Type II diabetic on insulin can (but not always) eat healthier, exercise, and lose weight and have his/her diabetes symptoms abate. I look at therapy similarly; as kind of a "health plan for the mind."

Feel free to disagree! Just one gal's humble opinion.

[stopdog]

"because, without labels, the world would have no shape, my prince"
Becket
Jean Anouilh