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Doctor Blake
Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience:  Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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Can depression be misdiagnosed as a cluster B personality disorder

Resolved Question:

Can depression be misdiagnosed as a cluster B personality disorder? I had a very rough year where I felt hopelessly upset and suicidal, however when I sought help from a therapist, they told me that I had prominent cluster b personality traits and adjustment disorder. Is it possible that I was misdiagnosed? Are the two similar?
Submitted: 7 years ago.
Category: Mental Health
Expert:  Doctor Blake replied 7 years ago.

Good morning and thanks for writing.


I'm sorry that you're having a difficult time right now. I'm glad that you have seen someone to address your concerns and hope that it was helpful. Before I provide an answer, please understand that it would be inappropriate (and unethical) to diagnose over the internet... that being said:


Cluster B Personality Disorders refer to four Axis II disorders of the DSM (Diagnostic and Statistical Manual of Mental Disorders):

- 301.7 Antisocial Personality Disorder

- 301.83 Borderline Personality Disorder

- 301.50 Histrionic Personality Disorder

- 301.81 Narcissistic Personality Disorder


First of all, you indicate that your therapist said you had "prominent cluster b personality TRAITS" - which suggests that s/he did not diagnose a personality disorder per se. S/he also diagnosed an adjustment disorder, reflecting that s/he took into account the "rough year" you had previously.


Without refuting his/her diagnosis, it is possible that your behavior/feelings could be categorized in a number of ways. More specifically:


You should know that Personality Disorders in general are somewhat controversial. You should know several things about the field of psychology/psychiatry:

1. The "big book" used for diagnosing mental disorders is the Diagnostic and Statistical Manual of Mental Disorders... and has undergone a number of revisions and changes over the years.

2. While there are still discussions and arguments about the material contained in the DSM, none is more controversial than those disorders located on Axis II (so-called "Personality Disorders").

3. You should understand that there are licensed mental health professionals who do not believe in the concept of "personality" and do not, therefore, believe that a personality can be disordered.

4. Even for those who find sufficient evident for "personality," the disorders listed on Axis II can be controversial. Besides difficulties with diagnostics, if personality is an immutable trait of an individual - how can one treat it? If one were to diagnose an individual's entire personality as "disordered," what could one do to "re-order" it?


To add to this conundrum, you're a relatively young man at only 23... and probably only 21-22 during treatment. If there *is* such a thing as personality - is it already "set in stone" by such a young age?


Simply put, most licensed mental health professionals would likely find other diagnostic categories to describe your behavior. Certainly an Axis I disorder (such as Major Depression) would be "more treatable" with a better prognosis than an Axis II disorder. Axis I disorders also tend to be better researched and have better developed treatment protocols (either medication or therapy).


So, let's take Major Depression, as you suggested...


Research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for a majority of Axis I disorders. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention.


A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Referring to a psychiatrist for medical treatment is appropriate if you are interested in pursuing this approach.


Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of Axis I disorders... it actually exacerbates the condition(s). So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.


SO: I will return to an adage I learned during my residency... "If you hear hoof beats bearing down upon you, it's far more likely to be a horse than a zebra that's coming..." The same is true with mental health disorders. Personality Disorders are highly controversial, relatively rare, and some would argue, untreatable. A host of other disorders (that *are* treatable with good prognoses) could explain the very same behaviors used to describe the personality disorders.


I would encourage you to work with licensed mental health professionals who specialize in horses, rather than zebras. You deserve solutions to your problems... and I believe the first step you might take is getting an objective, scientifically-based evaluation from a licensed mental health professional - preferably someone with a CBT background.


Thanks. I hope you're well and that this was helpful.


* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.


Customer: replied 7 years ago.
This was very, very helpful. Before I accept this, I just would like a straight answer as to whether or not depression could be confused with cluster b.
Expert:  Doctor Blake replied 7 years ago.

Oh, sorry if that wasn't clear enough.


I wouldn't say "confused with..." but it's possible two different psychologists could look at a bunch of behaviors and psychologist A would say "Oh, that's Cluster B" and psychologist B would say "Oh, that's Major Depression."


So, there can be significant overlap!


Hope you're doing well.

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