[nervous puppy]

Okay, so I've been in therapy for a long time now. Going on 14 years now. 13 years with one T and the past year with a new T.
Just the other day, the subject came up about my diagnosis. So I asked what mine was.
I always wanted to ask, I just never did. I was too chicken to ask. I know it's irrational to be afraid to ask a question that I have every right to know the answer to, but that's me. Always afraid.
Anyway, I only had seen what the pdocs had in written and it was always GAD and MDD in partial remission. I can accept that. I was upset with my GP when she changed the partial remission to recurrent, but that was when I suddenly lost my previous T.
Sorry, back to the diagnosis answer. What I thought I heard her say was "avoidant personality". That was quite overwhelming for me to learn that. I chewed on that for a day and read everything I could dig up on the internet. It seemed to fit. I wasn't sure that "avoidant" was what she said. So before I went flying off the deep I emailed T for clarification.
She had me down for adjustment disorder with mixed emotional symptoms. With the stressor being losing T1 suddenly. That's much more benign, I think. T also went on to say that she doesn't use a diagnosis to treat a client or let it affect her approach.

I guess it shouldn't matter to me what the "label" is, but it does.
I am wondering if anyone else knew right away what their diagnosis was, or not, and whether or not it affected your self-perception.

I've always known what my diagnoses were. I wouldn't have it any other way personally. That said, my diagnosis has changed somewhat over the years, and that is okay too since my earlier diagnosis was MDD but as I aged and finally was able to see a pdoc and therapist for a much longer period of time they were able to finally get a better handle on what was going on with me. Proper diagnosis can be vital with certain disorders because certain treatments have a better track record with certain diagnoses and/or can cause serious problems for others (particularly when dealing with meds).

I haven't found knowing my diagnosis affected my self-perception; rather, if simply gave me a framework for better understanding what I was dealing with and what I needed to do to manage my symptoms. I would have found not knowing my diagnosis and just kind of nebulously dealing with issues without definition pretty anxiety-making. I'd much rather know what I'm dealing with so I can educate myself and advocate for myself as needed.

[ChipperMonkey]

One should always know their current diagnosises.

Why the need for secrets?

[nottrustin]

For me it is important to know my diagnosis so that I can be as knowledgeable as possible about it. Pcdoc had me as bipolar 1. I never believed it because of mania. I have never felt manic. T had me as PTSD that has caused me to also suffer from depression. Recently I brought the subject up with pcdoc. She said bipolar was what she initially had but asked what T had as a diagnosis. When I told her, pcdoc agreed that T had the correct diagnosis and switched it in her files. Right now I am working at better understanding my ptsd with it triggers and effects on my life.

[The_little_didgee]

Definitely. I had the PD label that never described my experiences follow me for years. Therapy was pointless, because the therapists always focused on the PD. This made it nearly impossible for me to share my inner experiences which was frustrating. I ended up quitting therapy and staying away from psychiatry for years, because they weren't helping. They were trying to kill my spirit.

My breakthrough in therapy occurred after I was thoroughly assessed and given a few diagnoses that were explained to me. It made so much sense and for the first time ever I agreed with a clinician. She decided to take my case and offered to do psychotherapy. After that I started to see or feel results that others noticed too and gain insight into my issues. My way of being and history finally made sense. I finally had validation that allowed me to start healing.

Autism spectrum disorder is very different from personality disorder.

[ScarletPimpernel]

I had my ex-T and my Pdoc assess me at the same time. Their conclusions were similar. One said BPD, the other said BPD traits. One said GAD, the other said anxiety disorder nos.

For me, I wanted a diagnosis because it showed that I not crazy. In the past, people told me I was faking my mental health problems. They said there had to be csa, but there wasn't any that I could remember. I told them I was neglected, but back then it wasn't bad enough to get a diagnosis.

I'm also happy to have a diagnosis so that I know how it's "treated". I understand why my docs do x,y,z.

[nervous puppy]

I feel pretty stupid for not knowing and not asking in the first place. I never asked previous T. I guess since current T has the files, she could look and find out, IF I asked.

I guess I have been operating on the GAD/MDD/ with some PTSD (due to CSA) for what seems like forever and to hear something different was unsettling to say the least. I wasn't expecting it.
I can be a little slow when things like that hit me and I need time to digest it. About 2 days before I emailed T to get the details straight.

I'm still trying to reason this out in my head and grasp/understand what it means so I can move on. It shouldn't be so hard. So I'm getting down on myself for not "getting it" sooner.

[Freewilled]

Who says it shouldn't be hard? I never asked my previous T. I just couldn't get the question out, probably because I was scared to hear the answer. Plus diagnosis can be soooo subjective. It's more about symptom relief for me.

Many therapists truly don't like to "label" or diagnose their clients on paper, meaning leaving a mental health paper trail that can come back and bite a person on their butt. But they are forced to provide an official diagnosis based on the DSM. They have to commit that diagnosis to paper when or if they file for payment through the client's insurance (thus the reason people who can afford it, will pay cash rather than using their insurance). The diagnosis put on insurance documents becomes part of the client's file, and once it's there, it doesn't go away.

Some therapists get around this by putting down "Adjustment Disorder". This is a relatively benign term that simply indicates that the client is "adjusting" to something in their life and needs help with this adjustment through therapy. Putting down that a person has a Personality Disorder is more serious--people usually look at personality disorders as lifelong and in some cases untreatable (not necessarily true but a belief that has hung on in both the mental health community and in the general public). It's a terrible bias and that's why some therapists won't put it in insurance documentation.

What some will do, however, is put down "Adjustment Disorder" in the record and on the insurance paper, but then they will talk openly and frankly with the client about what he/she really thinks is going on--ie. a personality disorder etc. Knowing one's diagnosis or what the heck seems to be going on in one's life mental health wise is important. If you trust the therapist (or have a relatively solid degree of trust in your therapist's skill and knowledge), talking about what he/she thinks is a good thing. The more we understand about ourselves is a good or at least I tell myself that!

[ruh roh]

I think they should definitely say what they're thinking, because they could be headed down the wrong path. Very early in my therapy career, my first therapist labeled me with a pd and used my therapy to hammer home personal responsibility--she was disrespectful and distancing, never once addressing the very serious trauma I had been through, and I had only touched on it because she just wanted to focus on the positive. It took decades to find a therapist who would work with me on the effects of past experiences and it has made all the difference in the world. When someone has been through life threatening events that don't get resolved, relegating symptoms to a category of personality traits is very damaging.

[Chummy]

It helped me. I knew my diagnose after 2-3 years of seeing different T's. When I wanted to start a intensive grouptherapy, they first wanted me to take lots of test and that resulted in a diagnose. Avoindant personality disorder and social anxiety disorder. It helped me to know what I had and that other people also have it. Those 2-3 years were really hard for me, not knowing what was wrong with me. I felt like there was something so wrong with me. And knowing what I had could help me find the right therapy to treat it. Not that that grouptherapy has helped me. If the T's aren't good or understand what you have, then they're useless to you. But after that and another useless T (most therapy I've had told me they treated anxiety disorder, including social anxiety), I finally found a good T that was able to help me.

Maybe knowing my diagnose sooner would have helped me better. I don't know. I was 15 when my problems got really bad. I didn't knew much about therapy. I trusted the T's, the adults. That was stupid. Just because someone is a proffesional doesn't mean you can trust them.

[vonmoxie]

It can be helpful in theory and in practice, but the process itself is riddled with logistical inefficiency. For one thing, there's as much misdiagnosis that occurs as there is accurate diagnosis. The degree of positive prognoses and available treatments differ widely among diagnoses. Practitioners can themselves have varieties of cognitive distortion about various disorders that can corrupt the potential for helpful treatment. Then where there's differential diagnoses, the question of a practitioner's talent for accurately prioritizing needs and treatments adds another level to the process. It's a bit of a crap shoot, really, at least that's my personal opinion. But I've experienced far more (far more) disruption to my process by way of professional intervention than I have experienced anything helpful. Had I been lucky enough to have somehow known how crucial it would have been to have gotten a genuine advocate to navigate the process with me, at times when I was truly vulnerable and at the mercy of the skill set of practitioners whose help I enlisted, I might not have been so severely derailed by the process at those times when I most could not afford further trauma. I don't know how I could have known though.

If I found myself at another juncture in time in which I felt that vulnerable again, I still don't know who I could enlist to be that advocate. I'm hopeful it won't happen again; these days I'm as vigilant about not letting myself become vulnerable to the mental health system as I am about not letting myself become vulnerable to severely compromised mental health. Luckily, I suppose, the two work well in tandem together, however.. realistically I cannot fully control either outcome.

In my own case, I've been far better at accurately diagnosing myself than anyone I've seen. It is possible. Just a matter of finding a way to let go of ego for long enough to be able to look at oneself plainly enough to be objective, and comprehending the breadth and relativity of diagnostic parameters. A ton of work, certainly, but for me it's been the only way through the maze.

[ruh roh]

Originally Posted by vonmoxie

Practitioners can themselves have varieties of cognitive distortion about various disorders that can corrupt the potential for helpful treatment.

Yes. This is a real factor that, sadly, is hard to identify when you're in distress (let alone prove if you do suspect it). I asked one potential therapist if she had worked out her own issues and she shot back with a vengeance that it must be hard to be so smart, hard to be me, etc. The toxins just poured out of her. I won't do that again, even though her behavior gave me my answer. It took too much of a toll.

It felt like such a big acknowledgement of my suffering when I first read somewhere I had PTSD. Before that people had always just called it 'trauma'. But the PTSD diagnosis made me feel understood. That people realized that what I went through wasn't normal and wasn't OK.

It has helped me to know what the doctors think I have and what not to say and or do if I am taken to the hospital so they won't try to hurt me.

[iheartjacques]

Mine is depression and anxiety. I asked if I had anything else. He said borderline traits but a lot of positive things to outweigh it and wouldn't stand up in court to say I had bpd.
I think we have to know so we can deal with it. We can't fix r manage what we don't know.
Hugs.

[Serzen]

I was relieved to find out my dx. I thought I had something much worse.

Now I can openly talk about it. I would even dare to say I'm proud of my awkwardness.

[Lauliza]

I consider diagnosis a part of the service a psychiatrist is paid to provide, so I asked mine in the first session. I asked my T too, and they pretty much had the same things - GAD, MDD and ADD. My pdoc also had phobic disorder at one point. Many clinicians don't like to mention personality disorders since they stigmatize people and aren't very helpful when dealing with insurance companies. Insurance doesn't always cover much in the way of services for PDs, so Ts need to be careful.

[ruh roh]

I do think it's important if they're thinking pd, especially if they adjust their approach according to how therapists are taught to treat people with a pd. Imagine looking up a treatment they've been suggesting, or a tactic they've taken, and discovering it's for people with bpd. I think it would feel worse to have not been told. If a therapist withholds information like that, then they're the one perpetuating the stigma.

[NowhereUSA]

I don't really fret about it nor care for the most part. I have depression (though it's in remission because we finally found something that works). I have anxiety. I think it's written as MDD and GAD somewhere on some paper. My T has one pdoc in the clinic he works at that likes to hand out personality disorders like candy. He can't stand the guy and won't work with anyone who sees that particular pdoc because he doesn't like having to constantly argue with him.

In that regard it makes me wonder about how subjective these diagnoses are and how helpful they can really be. I think there's a broad benefit in maybe helping narrow down treatment but then treatment is very individualistic - we see that in everything from the medications used to the therapy options available.

[Lauliza]

Originally Posted by ruh roh

I do think it's important if they're thinking pd, especially if they adjust their approach according to how therapists are taught to treat people with a pd. Imagine looking up a treatment they've been suggesting, or a tactic they've taken, and discovering it's for people with bpd. I think it would feel worse to have not been told. If a therapist withholds information like that, then they're the one perpetuating the stigma.

I don't mean withhold from the client so much as use it as the main diagnosis for the insurance company (or even note it at all). Treatments traditionally used for bpd, like DBT, can be used in other circumstances, so the use of it doesn't indicate the presence of a full personality disorder. Plus I think the borderline PD is used too loosely and too frequently by clinicians based on the presence of certain traits.

I was unaware I was sick and all the diagnosis has done is ruined my life by medicating all my personality out. Though me T says we can discover who the real BPA is....I doubt it

[Gavinandnikki]

Originally Posted by eden1515

It has helped me to know what the doctors think I have and what not to say and or do if I am taken to the hospital so they won't try to hurt me.

Well..... That should get you good help, eh? Making sure not to tell them what you're thinking or feeling. They may try to give you medication or something.

[Permacultural]

HIPPA changed everything in the US. Now a patient has the right to know their diagnosis, and not be taken on a ride by their T just for asking.

That being said, there is a great deal of personal nuance that the diagnostic criteria fail to capture. I think it is helpful for someone to know their diagnosis AND know what research shows will actually help. I think just knowing a diagnosis can be potentially demeaning.

I've heard horror stories of young people with a very mild social anxiety, with no other difficulties, going to therapy weekly for years.