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Dr. G.
Dr. G., Psychologist
Category: Mental Health
Satisfied Customers: 1525
Experience:  Licensed Psychologist.
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My psychologist and psychiatrist disagree on my diagnosis.

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My psychologist and psychiatrist disagree on my diagnosis. Who do I believe? Does it matter?
What are they saying?
Customer: replied 7 years ago.

So, all three of us agree that I have generalized anxiety disorder. The psychologist who I started seeing a year ago thinks that I have borderline traits that are only exhibited in certain relationships (with female mentors in a certain age group), though she doesn't think I come close to meeting the full criteria for borderline personality disorder.

The psychiatrist, whom I've been seeing for a few years thinks that the psychologist is wrong and that what I have is traits of dependent personality disorder.

I've looked up the criteria for both on my own. The only one of the DSM criteria I see for the borderline traits is the first one that talks about fears of abandonment, but I think two of the ICD-10 criteria for dependent personality disorder are right on the money- "preoccupation with fears of being abandoned by a person with whom one has a close relationship" and "limited capacity to make decisions without excessive advice and reassurance."

Both my psychologist and psychiatrist are well qualified, kind professionals, who have known me for some time, and the fact that they're not in agreement makes me nervous. On the other hand, maybe if no one thinks that I meet the full criteria for any disorder, I'm worrying too much.

You are worrying too much. In this profession there will be disagreement but that doesn't mean either one or wrong. There is such a diagnosis as Personality Disorder NOS which is used when there are several traits but not one specific diagnosis. Now I just confused you more. I say don't worry about it and as long as you feel you are getting good treatment from both then continue what you are doing. What's in a name anyway????
Customer: replied 7 years ago.

I don't think personality disorder NOS would help the process along much... It's not so much that they're describing different traits, but rather one is labeling the overdependency as a borderline trait and the other is labeling it as dependent trait. The problem is that I do care about the name--- "borderline" has such a huge stigma attached to it, within both the general and medical communities.

And the psychiatrist feels that even though I'm not depressed and the anxiety is improving, that adding prozac would be helpful because it tends to lessen traits of dependent personality, but if the psychologist doesn't think I have that, then I might as well skip a medication that causes weight gain in a significant number of people.

Who in the community is going to know your diagnosis? And what process are you talking about? You work on the symptoms and problems that you present with. Just because you are borderline or dependent personality doesn't mean there is a specific treatment for each one. As far as the meds go, it will be trial and error to see if it relieves your symptoms. Lessen personality traits??? Never heard of it.
Customer: replied 7 years ago.

I just meant that personality disorder NOS doesn't really resolve the issue of whether the dependency is more characteristic of BPD traits or DPD traits. Some state boards do require you to disclose if you've ever been treated for mental illness, but "traits" aren't actually approved diagnoses, so it wouldn't actually go anywhere in my records. It's more that I don't want my treatment providers thinking of me as "borderliney."

Some psychiatrists believe that Prozac at low doses can alleviate some personality traits; the book Listening to Prozac is apparently one that espoused that view.

The anxiety is the only symptom that is troubling me as the dependent relationship ended about a year ago. And SSRIs in the past haven't helped with the anxiety, so I wouldn't try the med unless I thought it was going to help prevent me from forming those overly dependent relationships again.

Why does it matter if it is BPD traits or DPD traits? The only thing that matters to you is what people think about you as if one diagnosis is better than the other to have. I think you are moving away from the issue of getting treated for your symptoms and more towards your facade.
Customer: replied 7 years ago.

I think that having the correct diagnosis is an important first step to treating any medical disorder, including psychiatric conditions. I was hoping you could provide a tie breaker vote, but that's probably unrealistic for an online question asking service. Thanks for your time.

No tiebreaker here because I don;t know your whole history. Just a side note about your comment on right diagnosis.... how is the treatment different for each one?
Customer: replied 7 years ago.

BPD and I'm assuming borderline traits tend to be treated by DBT, while DPD tends to be treated by more traditional CBT (I realize DBT is a modified form of CBT, so the distinction isn't completely clear cut). Also, apparently, my psychiatrist feels that Prozac has a positive effect on dependent traits.

The prognosis also differs between BPD and DPD, so I was assuming that it would also differ between BPD traits and DPD traits.

Ok so you have done some homework. But my point is that no matter what we will call the mental illness (i.e. depression, anxiety, narcissism, etc) I will work to help the person relieve whatever symptom is bothering them. SO if I am off on the diagnosis but I am helping the person with whatever problem they have then I consider it good. I hope you are getting the help you want and not getting bogged down in specificities. Remember, psychology degrees are B.A. bachelor of art...not science. There is some wiggle room in our field unlike the medical field where a broken knee is easily diagnosed. You get the picture. Good luck to you.
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