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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Dinah on January 11, 2004, at 11:46:53
My therapist, who is a LMFT or whatever (I might be missing a few letters), has told me that he thinks I have a couple of things that I've never been diagnosed with by a psychologist or psychiatrist. This may be because (and this has proven true in the past) my therapist is rather loose in his interpretation of DSM IV criteria. Or it may be because he knows me better than anyone else.
When he's said something along those lines, I've replied "But I've never been diagnosed as xxx or yyy" and he agrees.
So if anyone asks, do I have to admit these as diagnoses? He's never written it down or anything. And sometimes he just uses the word "traits", rather than the formal diagnosis. One, for example, is borderline personality disorder. My various pdocs have ruled that one out, because honestly I only really show that aspect of myself to my therapist. You'd never guess it from my life or social history, and it didn't show up on my personality testing. Everyone else sees me on the schizoid/schizotypal cluster.
While I don't personally think there is anything wrong with the diagnosis, and in fact think it should be listed as a mood disorder rather than as a personality disorder, I must confess that I am reluctant to have to declare it because there is still, unfortunately, prejudice out there.
Ditto with the other suggestion he has.
Posted by gardenergirl on January 11, 2004, at 12:23:58
In reply to What constitutes a diagnosis?, posted by Dinah on January 11, 2004, at 11:46:53
Dinah,
I think diagnosis is an inexact science at best. The DSM-IV is there to try to make it more objective, but it is still being interpreted by individuals with subjective ideas of what the objective criteria mean. Certain disorders are much less objective anyway, especially the personality disorders. So you may be given dx A from one person and B from another, both of which make sense depending on how they explain their thinking.Another important question. What does diagnsosis really mean? Will it change the way someone's problems are treated with meds or in therapy if they have dx A versus B? Sometimes.
But you are absolutely right about the stigma and prejudice associated with certain diagnoses, especially borderline traits or disorder. Do you agree with one or more of the diagnoses given to you? Do you have to disclose, whether you agree or not? That depends on you. I tend to disclose my depression, including the atypical aspects of it in order to reduce the stigma of mental illness. I am also surrounded at work with people who are studying to be or who already are psychologists, so disclosure at work is a very safe thing to do. I still don't think most of my family "gets it", but I figure that anyone who sees that I am a good, valuable, strong person who also uses an AD and goes to therapy is learning something about people with mental illness. (At least that is my hope. Some people will likely never get it.)
But disclosing something like a personality trait or disorder with such stigma is a very different deal, unfortunately. There is such stigma even among helping professions that I really feel for you. Only you can decide whether to disclose or not in any situation.
Good question!
g
Posted by badhaircut on January 11, 2004, at 13:07:25
In reply to What constitutes a diagnosis?, posted by Dinah on January 11, 2004, at 11:46:53
> So if anyone asks, do I have to admit these as diagnoses?
Who would ask? Outside of a health insurance application, who would be in a position to ask for your traits or diagnoses?
-bhc
Posted by Dinah on January 11, 2004, at 13:22:42
In reply to Who would ask about it? » Dinah, posted by badhaircut on January 11, 2004, at 13:07:25
I suppose I'm thinking of the EMDR therapists, or any future mental health professionals. And internists and my headache doctor asked for psych diagnoses as well. I took the position that I haven't received a diagnosis of those things.
Posted by badhaircut on January 11, 2004, at 14:10:08
In reply to Re: Who would ask about it? » badhaircut, posted by Dinah on January 11, 2004, at 13:22:42
Ah, disclosing a diagnosis to another provider...
A person can be honest and complete in answering questions about what she does and what she thinks and how she feels and about her family and so on, while simply not volunteering any info about her other providers' opinions -- unless she feels comfortable doing so.
If new providers ask, "What have you been diagnosed as?", she could honestly reply, "I'd be more comfortable getting *your* uninfluenced opinion. That's part of why I wanted to see *you*. We can compare diagnostic notes at a later visit, if you like."
They all have access to the same intake questionnaires and the same DSM guidebooks. Make 'em earn that fee! Besides, therapists are often notoriously non-respecting of each other's work.
Warning: strident opinion coming. ;)
(I think the DSM is a silly, therapeutically useless, unsupported, dehumanizing billing device, anyway.)-bhc
Posted by Dinah on January 11, 2004, at 14:15:27
In reply to Let 'em figure you out for themselves. » Dinah, posted by badhaircut on January 11, 2004, at 14:10:08
Posted by Elle2021 on January 11, 2004, at 22:59:58
In reply to What constitutes a diagnosis?, posted by Dinah on January 11, 2004, at 11:46:53
> So if anyone asks, do I have to admit these as diagnoses? He's never written it down or anything.
I wouldn't.
>And sometimes he just uses the word "traits", rather than the formal diagnosis.
Isn't that irritating. My pdoc does the same thing. He says, well you have all the traits of bpd, but then he won't come right out and say, "your borderline." I read an article that said pdocs don't like to label their patients... Well, I prefer they do.
>Everyone else sees me on the schizoid/schizotypal cluster.
Can you explain what those dx's are please. I am somewhat familiar, but not really.
>I must confess that I am reluctant to have to declare it because there is still, unfortunately, prejudice out there.
I wouldn't go about admitting to them either, to other doctors that is. Let the other doctors come up with their own dx.
Elle
Posted by fallsfall on January 12, 2004, at 8:08:45
In reply to Re: What constitutes a diagnosis? » Dinah, posted by Elle2021 on January 11, 2004, at 22:59:58
When I was interviewing new therapists the first thing I told them was that I was diagnosed Borderline - but not typically Borderline. I had to know if that would scare them off, or if they would make assumptions that weren't true. So I think I used the shock value to collect information.
My understanding is that "traits" means that you have some of the criteria, but not enough to get a full blown diagnosis (like the diagnosis says you need 5 out of 9, and you have 4). I could be wrong. Or different doctors could use the word differently.
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