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I think I'm with Dinah

Posted by Racer on March 20, 2004, at 1:08:24

In reply to Re: personality disorders/fair? terrics, posted by Dinah on March 19, 2004, at 18:32:43

You know that I've been struggling with this damned therapist about which personality disorder I have -- since she's convinced I must have one -- and we had a bit of a run in over it the other day. She kept saying, "we all have personality traits, dear, and we have to face up to it when we have diagnoses in order to get better." I told her that, being a middle aged woman, NOT having a personality would be pathological, but having personality traits was a sign of HEALTH. I went on to say that she was welcome to explore any diagnosis she wanted, but if she wanted to help me it might be nice to talk a little bit about -- maybe? -- my emotions, perceptions, etc?

Needless to say, that did not go over very well.

Anyway, as you know from above, I printed out the stuff that Jane linked to, and I've been going over it all piece by piece. I can see things that do apply to me -- but I can also see things that might LOOK as though they apply to me if you didn't look closely. Here's an example of what I mean:

From the Borderline criteria:

"(1) Frantic efforts to avoid real or imagined abandonment."

OK, now let's examine this. Frantic efforts to avoid abandonment may not be pathological. Let's try this scenerio to show what I mean:

We're in a car, you're driving, I'm in the passenger seat. You pull up in front of my house, and tell me to get out. If I then throw a fit to try to keep you, that's weird and fits into a disordered world. Especially if I'll see you again tomorrow.

Now let's get back into that car. You drive this time way out into the boonies, on a little road in the middle of nowhere, someplace I've never been before. Suddenly, you pull over to the side of the road and tell me to get out. If I thow that same fit again now, that really doesn't seem so strange to me.

Does that make sense? Some of the criteria are so context sensitive that it makes me wonder about the usefulness of using diagnoses at all. Then again, I know from statistical studies that you do need to have a way to catagorize patients for larger studies, and I can see how it would be great when you have to be able to communicate with a collegue about referring a patient, and I also know that insurance companies really don't react well to notes saying, "I gotta see this chick three times a week, on accounta she's Froot Loops." Aside from those aspects, though, I cannot see a unique funtional benefit to a patient in using the diagnostic criteria as the be all and end all.

And I'm very suspicious of any stigmatized mental disorder that is more often diagnosed in one gender or the other. Yes, for every female borderline, there's a male antisocial, but that makes me nervous. I tend to think that the underlying pathology may be the same, while the outward manifestation is sexually dimorphic. And the fact that borderline is so heavily stigmatized, while antisocial is considered more a behavioral constellation, really makes me question its validity.

That said, I also agree with Dinah: a lot of therapists and doctors may not know what else to say. It's kinda like multiple personality disorder: the greatest indicator of your likelihood of being diagnosed with MPD was going to a doctor who had diagnosed someone else with it. So, some doctors come back to the same handy dandy vaguery of one disorder or another, rather than dealing with the amorphous whole.

There. Them's some of my opinions. You want more? I got plenty of 'em. Heck, I gots so many I gotta give 'em away!




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