Sloppy Psychiatric Diagnosis

Many of you know that I am not a fan of psychiatry and struggle very much to see the benefit the profession brings as it currently is. I was pleased to come across an article today in the Toronto Star that spoke to something I noticed as a teenager and recently, again, as an adult and demonstrates how far psychiatry still has to go in order to serve us better. The article, “Be wary of sloppy psychiatric diagnoses” by Jowita Bydlowska, speaks to the countless diagnostic errors given to people by psychiatrists. There are multiple reasons for this, but I feel it simply comes down to the fact that there is very little science in the diagnostic process.

But, let me organize myself a little bit to explain my thoughts on this article.

Since being diagnosed with Dysthymia (chronic depression) at age 16, I also had psychiatrists toss around Bipolar and Post Traumatic Stress Disorder. My Borderline Personality has been labeled as a disorder and then as traits. While only two of these diagnoses stuck with me I am bothered at how different psychiatrists can come up with different diagnoses (as seen in the research paper, Being Sane in Insane Places) based off of what I feel is nothing. While I greatly value anecdotal evidence and a person’s unique narrative, when it comes to providing myself with a label that can greatly alter the course of my life I would like more to be done than an hour long chat.

I often find myself becoming upset when I read research on Borderline Personality Disorder that says when the brain scans of someone with BPD and someone without BPD are compared it can be seen that the BPD brain is more Brain imagery helped Assistant Professor Anthony Ruocco untangle the neural circuitry underlying bordeline personality disorderemotionally on and has difficulty shutting off than the non-BPD brain (as seen, in research done by the Univrsity of Toronto). If we have seen this then why is brain imagery don’t a part of the diagnostic process?! I know this probably has something to do with “needing more research” but psychiatrists have already made so many diagnoses not based on these scans that I think adding it to the process wouldn’t hurt much. I’m sure cost comes into play as well, if not being one of the largest motivating factors for not providing it as an option. I WANT THE SCAN! I trust that.

The other part that I found interesting in the article is that the author talks about how certain diagnoses seem to be “in”. I noticed this when I was newly diagnosed. Many of my classmates seem to be getting diagnosed with some for of depression or bipolar disorder. I have a distinct memory of thinking, “How can everyone have depression?” Then, as the author mentioned, I noticed a few years ago that a lot of my friends were being diagnosed with PTSD or trauma language was being used a lot to describe their experiences. This past year, in the house that I live in, various occupants wondering, “Do I have ADHD?” and asking me for resources to receive a diagnosis (child and adult). As for 2015, I have noticed a great surge in BPD diagnoses. “BPD is so hot right now,” as I commonly say. It baffles me that these trends can exist. What is going on?

My final point is based off a comment in the article made by Dr. Andrew Lustig from the Centre of Addiction and Mental Health (CAMH, Toronto). He says, “the clinical picture of diagnosis can change over time as person develops in their illness, so sometimes a diagnosis that a person gets at one point (early) isn’t accurate at another point as the condition progresses.” This is cited as a reason for misdiagnosis and it is valid, but, I feel it is a tad weak. Aside from still coming from a patient-blaming perspective that ceases to acknowledge the systemic flaws of psychiatric, it ignores the fact that some diagnoses are not given out for certain reasons (age, gender, potential stigma etc.) or that a diagnosis is usually made after a 1 time visit that usually lasts an hour. Let me use myself as an example.

By the time I was 14 years old, I believed I had BPD. I displayed 8 or the 9 criteria (5 criteria are required at the minimum) but because I was still a teenager I could not receive the diagnosis and was given dysthymia instead. This meant that I was treated for depression which as I see now as an adult was very ineffective. If psychiatrists had looked at BPD as a potential option, seen that I had the traits, regardless of my age, then maybe I could have received treatment that actually helped me. My diagnosis of depression and BPD traits were made after a 1, 1-hour session with a psychiatrist. I was also prescribed medication during this session. I would think there is a lot of room for error if you are going off of your very first (and sometimes only) meeting with someone.

As always, my message is to be your own advocate. If you do not feel like you can step into that role yet or your doctor/psychiatrist will not listen to you, then find someone you trust to support you in having a conversation with your professional. You have to live your life and be comfortable in it.


18 thoughts on “Sloppy Psychiatric Diagnosis

  1. Yes. Last year I was diagnosed as having BPD while in hospital. A few months later, I had an assessment from a personality specialist who said BPD traits. When I was in hospital & googled there was very little, if I google now it’s everywhere. Totally agree that it’s the in diagnosis to have, I thought it was my imagination.
    The hospital diagnosed me after just a few mins. I’ve never read the diagnosis & then referral from them, but other professionals have been shocked by the poor quality of it & lack of content.

    • The second last psychiatrist I spoke with (who was from CAMH as mentioned in the article) told me I should be happy to have a Traits diagnosis because having the Disorder is horrible. I think I just politely smiled to keep from raging on him. It was such an offensive and dismissive statement. He was totally useless.

      It’s not your imagination. A friend of mine is a social worker that works with families of individuals with mental health issues. Maybe half of his clients have a BPD diagnosis. It’s unbelievable! Have we all been hiding? I once read the BPD is the diagnosis a psychiatrist gives you if they don’t like you. Is there truth in this? We prove to be willful so must have BPD?

      Read your psych evals with caution. Mine was decent but it’s awkward to read what they write about you or I guess in your case what they do not when they should have.

      Thanks for your comment!

  2. so true most of humanity could be diagnosed with something these days – and lets face it with the world the way it is, thats not surprising. its pretty hard to remain full of light and love when so many people are angry, hurting, hurtful and our governments are doing everything they can to make our lives miserable and hard! nice words! thanks! xx

    i think in the west as well we are so cut off from nature and being totally stewarded towards robotic living – interaction through computers and all activities related to inside stuff… we need more interaction with nature, with true life, with growing food and things like that – simple things in life… but that doesn’t make profit, so they’d rather keep us ill, detached separared from our neighbours and brothers around the world, and then ill with mental health problems and pilled up… so we all need to take positive steps for our own well being… and that will help SO much !!!

    • I agree with you! Happiness is also becoming mandatory, but it is actually an emotional state that comes and goes! Sadness, anger and frustration are just as valid and have a lot of value in what their experience can bring to our lives.

      I have found it interesting that many of the distractions we are taught to give ourselves involve nature and being away from what we recognize as civilization. I know I feel great when I’m out in nature.

  3. i have nothing good to say about western medicine except for emergencies. i do believe we can heal ourselves through exercise and nutrition, but it requires a lot of support, education, and dedication.
    have you read the China Study? this book talks about diet, and all things health (planet, mental,

    recently, i was close to death because the many docs i went to see would not listen to me. i told them i had nausea every day, had lost 30 pounds, was weak, underweight (normally chubby), and i was in horrid stomach pain, they saw me only as a person who wanted drugs. they treated me like i was in their way, like a mangy dog.
    until we get doctors and nurses to see us as whole, sentient, human beings, then we will never get help from them.

    btw, the warning on the labels of all drugs is available when you get your pills and there is so much information on line, but when we read these labels, we do not think we will get something. well, i did, i now have a painful autoimmune disease from taking Imitrex. the price we pay for migraine relief.

    there is a place for western medicine, like broken bones, but psychiatric is still too barbaric for me.

    great article as usual 🙂 thanks!

    • I have not heard of the China Study! I will have to google!

      The whole medical system just seems to be based on mutual distrust. Professionals and patients do not trust each other or the professionals have more power. We should be a team!

      Thanks for your comment Dee!!!

  4. When you add Alzheimer’s to the mix things get even more sketchy. Failure to diagnose All literally puts family through he’ll and innocent bystanders in danger.

  5. I prefer psychologists over psychiatrists, i find they work with you more as a team and because they are not covered by healthcare system in Canada, they can spend time with you and they are not overwhelmed with patients like psychiatrists tend to be.

    My last psychiatrist wasn’t bad, she was the one who figured borderline, she never outright said it and I had to push her to tell me what was going on, but her evaluation was based on 2 months of in patient care, we met daily for an hour, plus the nurses several times a day, and were very in depth, how the doctors can even say a diagnoses like some do in like an hour, I have no idea and doesn’t seem possible.

    My wife is bipolar, but it took several months and a couple in patient stays before her doctor at the time came to a diagnoses, we have no reason to not think it’s wrong for her, the medications work and she is stable, if she goes off within 3-4 months she becomes manic and paranoid and just not good, so I guess they got her diagnoses right.

    I don’t even go to psychiatrists anymore and have stopped even dealing with the public health care system for mental health, and now go to a private DBT center, I see a master degree level (working towards Phd) in Psychology and will be doing a 26 week group program there as well, and so far have nothing but good things to say, totally different then what is experienced with psychiatrists, but in Canada psychiatry is done so differently then what I experienced in California where my psychiatrist also acted as a counselor and the appointments were 60 mins long.

      • I’ve only seen 1 social worker and it was in a hospital setting and wasn’t the best, so can’t really say anything about social workers, I wont try and form an opinion based on 1 experience, wouldn’t be fair to the profession.

        Social workers in mental health here are only used for the most severe cases, people who can’t function on their own, have trouble with day to day tasks and activities and so on.

  6. My original about me speaks of all the diagnoses I’ve had in my lifetime. My last therapist had an hour to diagnose me. Insurance reasons. During our last session, I asked her to write down what she had come up with. I was impressed, but she also had 25 years experience with people like me. Had I come on a different day though, she may have come up with different stuff. I have never understood how one can be diagnosed in an hour. It all depends on which hour.

    • I’ve only had 1 psychiatrist take more than one visit to diagnose me. On our third and final visit (I stopped seeing him) he was still only speculating, asking me what I thought about Borderline and PTSD. It also bothers me that I could have a say in the diagnosis lol if I didn’t like it would he have given me something else? 😛

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