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cathy
cathy, Mental Health Professional
Category: Mental Health
Satisfied Customers: 1436
Experience:  MS., MS.Ed., 30 years clinical and administrative experience in psychiatry and mental health
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Why is determining abnormal behavior or a mental disorder so

Customer Question

Why is determining abnormal behavior or a mental disorder so difficult when applying principles and methods of identification?
Submitted: 3 years ago.
Category: Mental Health
Expert:  cathy replied 3 years ago.

cathy :

Hi and thanks for writing JA

cathy :

Medicine is an art and not a science so that in and of itself makes diagnoses more or a "rule out" than a definitive diagnoses realm and psychiatry is such that behaviors or rather patterns of behavior over time are what play into the differential diagnosis. Does this help or can you be more specific on this?

Expert:  cathy replied 3 years ago.
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Customer: replied 3 years ago.
This is not informative at all to me. I have a type "A" personality and require complete and thorough answers to questions to be satisfied. I would like more indepth analysis of my question with some possible examples. Information such as, there is a book with diagnostic criteria, isn't there? Why, with the existance of such a book, are there misdiagnosises or why is it so difficult to properly diagnose a mental disorder. What makes a psychiatrist so sure of there diagnosis? What are the principles and methods of diagnosing someone with a mental disorder such as myself? What are the challenges involved in such identifications?
Expert:  cathy replied 3 years ago.
Yes there is a book called the Diagnostic and Statistical Manual of Psychiatric Disorders and that is the bible of all in the psychiatric community and has been for decades. You wont like this book though at all so don't read it. It will tell you that there is no such bona fide diagnosis of Type A Personality and that will upset you so best not to consult with that manual which all mental health professionals use daily. Best to do some online research in the "alternative" diagnoses not recognized.
Customer: replied 3 years ago.
Can you answer the other questions in my last post?
Expert:  cathy replied 3 years ago.

You know I have answered them but you are not happy with my answers so I am not sure what I can do for you.

 

1. Medicine is not a black and white/cookie cutter service. The human body is a complicated organism and so more often than not we know first what something is not and then through the process of elimination can determine what is.

 

2. Mental illnesses are not isolated incidents but rather patterns of behaviors. Therefore no isolated incident can conclusively be diagnosed.

 

Finally most diagnoses are accurate. It may not be the case in your instance but most cases are properly and appropriately diagnosed with the exception of bi polar diagnosis which is over diagnosed by 65 percent and usually for reasons not at all helpful here. Most of us can only be as sure of a diagnosis as what a client tells us. If the client is honest and forthcoming we can usually make an accurate diagnosis fairly early and if not we cannot. I have no idea what your diagnoses might be so I cannot answer that question and again

the biggest single challenge in making a diagnosis is the veracity and honesty of the client. Let me know if I can guide you further on this. Cathy

Customer: replied 3 years ago.
Your most recent explanation was more helpful and I appreciate your patienence with my curiousity. If you can be any more specific with the following information, I will be completely satisfied; I have been diagnosed with Bipolar Disorder, Borderline Personality Disorder, and Anxiety/Panic disorder. All of which manifested after I suffered a massive stroke 7 years ago. My symptoms have been depression, mania, self-mutilation, attempted suicide - multiplule times, suicidal ideation, crying fits for no appearant reason, inappropriate uncontrolled fits of anger, obsessive behaviors as to a clean house, organization or objects and thoughts as well as how things are to be done, racing thoughts, and perfectionism to name a few. I know you cannot give a diagnosis, but can you be more specific to my questions as far as the additional information contained within this message?
Expert:  cathy replied 3 years ago.

HI and first I would have to ask how old you are?

 

50? and that is far too late for onset of true bi polar disorder and unlikely that you have undiagnosed borderline personality disorder. I would have to leap to agitated depression which would account for suicidal ideation, labile mood, irritability and poor impulse control but none of which would lead me to bi polar, ocd,bpd. I think this is a very common Depressive episode that often comes after cva that would very much lend to irritability, poor impulse control and even some of your ruminating thoughts and behaviors.

The botXXXXX XXXXXne is that we do not treat diagnoses we treat people and it does sound to me as if you have had appropriate treatment. I would think one mood stabilizer, an anti depressant and an anti anxiety might do the trick, but also in many many cases like this I have seen a good anti depressant along with a good anti anxiety med do the trick. Tell me what is going on for you in therapy which is actually the best medicine for all that you describe. Let me know. Cathy

Customer: replied 3 years ago.
I have been forced to endure 5 years of group therapy which did not help me at all, and I have had a private therapist for 7 years. At first, I felt like we were getting somewhere, but the last few years I don't think we have accomplished anything. Now my symptoms are getting worse again and I have begun to self-mutilate again. My psychiatrist has been changing my meds around, but it's now helping. I am currently taking Cymbalta, Invega, Klonopin, and doxipine. I know when my psychiatrist finds out I'm cutting again, she will want to put me in the hospital. All of my past hospitalizations have ended in disaster as far as my medical health is concerned. My last hospitalization of two months caused my luekemia to take a dive and I required a complete blood transfusion, then 1 month later, my kidneys shut down and I had to be catherterized for the next 3 months. This happens because the ward M.D. won't listen to me about my medical conditions and does not speak to my medical doctors before making changes. This causes me to want to really die! So, hospitalization is not the answer for me. What would you suggest I try?
Expert:  cathy replied 3 years ago.

Was the group therapy DBT? Dialectical Behavioral

Therapy? Let me know..

Customer: replied 3 years ago.
Yes. I believe so! My current therapist works a little differently than group therapy but not by much.
Expert:  cathy replied 3 years ago.

Okay then so if that is the case it means you probably do have BPD or some strong Borderline traits or at very least problems with emotional regulation. Which begs the question why are you cutting when you have your dbt skills to use?

 

I think you might have bpd or borderline traits and the best way to work on this with the dbt treatment. Can you get back into a group where you live? Hard illness to treat but does so much better with dbt. Let me know. Cathy

Customer: replied 3 years ago.
I do have access to group therapy, but it requires attendance 3 days a week for 7 hours each time. This is a major disruption in life and really puts a damper on the rest of my scheduling for other obligations. Why isn't my private therapist able to deal with this? Is there anything I can say to her to provake the correct treatment needed? Are all of my symptoms related to BPD?
Expert:  cathy replied 3 years ago.

You know BPD is just that kind of disorder that responds best to group therapy, its just the way it works. I think though that seven hours is so far out of line. Three hours maybe but seven hours is outrageous. Really.

The other thing you can look into is a classical Freudian analysis which does not work as well as DBT but works and the problem with this is that it is five days per week and an hour a day.

I would look around for an Advanced DBT group that meets twice a week for three hours a time. And stop cutting yourself so you stop getting such a bad rep with admitting docs at hospitals. Use your dbt skills and dont self mutilate. Use a warm line for heavens sakes but dont play into the game that all bpds are pains. You need to be smart about this. Use those skills girl.

I have no idea if all your symptoms are related to bpd but now that we have it on the table I would say yes. probably all.

You need to work your skills and get past all the pain. It is time now to do that. and also that will help you to get off so many meds. Two stones killed with one bird I think.

Let me know where you wish to go further on this and you have my attention.

Cathy

Customer: replied 3 years ago.
I have utilized skills such as visual imagery, possitive self-talk, and the other techniques I have been taught, but they do not seem to work for me right now! I can't explain why, I don't even understand why I am cutting! I just know it gives me a sense of relief from all the stressors in my life and keeps me from thinking about suicide so much. My personal attendant keeps threatening me that she is going to call my Psychiatrist about the cutting if I don't stop it right now! This is just adding more stress. Do you have any immediate suggestions to help me avoid this behavior until I can obtain theraputic help? Or suggestions on how to keep my psychiatrist from putting me in the hospital over this behavior? Are you still there? I haven't heard from you?

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