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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by deerock on April 27, 2009, at 12:32:18
i asked my therapist to tell me my diagnosis. she wouldnt tell me, she just kept asking questions. finally i wrote her a letter asking her to tell me my diagnosis and also told her a few things that were bothering me.
in her response to me, she wrote "dysthimia, anxiety,and some axis two features."
I have no idea which axis two features she is referring to. This really pisses me off though. I feel like she is telling me there is something wrong with me. Personality disorders cannot be fixed as far as I have read.Why is she telling me I have axis two features? Its not enough to say I have a mood disorder? She has to say there is something *else" going on?
I will speak to her about my concerns. This really makes me feel judged.
Can anyone relate to this? What the hell does that mean, even, "axis two features." such a pain in the butt hearing this stuff.
Posted by Amelia_in_StPaul on April 27, 2009, at 13:01:21
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
that's rather vague of her, but perhaps she doesn't want to scare you, since it's clear axis II disorders scare you?
it's not true that personality disorders can't be fixed. they represent a longstanding pattern of maladaptive coping mechanisms, yes, but longstanding isn't the same as intractable. that's whay your therapist uses the term "features"--she's not saying your whole personality is a problem, or even that your coping mechanisms rise to the level of a disorder--just that there are some problems there (and who in therapy doesn't have problems; who in this world, for that matter, doesn't have problems?).
I have features of a personality disorder; I have a loving spouse, a fantastic brain, creativity, and some good sources of support. It's not the end of the world, trust me.
Therapy is really the best way to deal with personality disorder features and I am finding that I am learning to deal better with hurts in this world through therapy.
But a person has to to trust their therapist in order to let the process begin. That may be why she is reluctant to give you the whole dx--there is a stigma associated with these diagnoses, in full evidence here, and she may not want you to think she is burdening you.
As well, the landscape of what personality disorder presents itself may not be clear to her yet. She may just suspect that something is there.
Give her a chance; if she won't talk to you about her process and her thinking, then maybe it's time to see a new therapist. But please don't get hung up on the diagnosis. It's the symptoms that matter.
Posted by deerock on April 27, 2009, at 13:26:40
In reply to Re: axis two features, posted by Amelia_in_StPaul on April 27, 2009, at 13:01:21
thanks amelia. thats helpful to hear your perception of what i described. ill def give the therapist a chance. thanks again. have a nice day.
rock
Posted by pegasus on April 27, 2009, at 13:37:17
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
A lot of therapists don't like to give diagnoses, because they don't really believe that our system of diagnosing mental disorders is accurate or helpful. Maybe that's why she was reluctant to tell you how your symptoms would be interpreted in that system.
People tend to look at mental diagnoses the same way they look at physical diagnoses, and they're really very different things. With physical diagnoses, they generally point to a particular physiological cause and mechanism for all of the symptoms that you see. Mental diagnoses don't. It's almost the other way around: certain clusters of symptoms tend to occur together, and so we give them a name and call them a diagnosis. But they could be caused by different things in different people, so that diagnosis doesn't necessarily tell you how to treat someone, or what their prognosis is, etc.
hope that helps
Peg
Posted by Phillipa on April 27, 2009, at 13:53:35
In reply to Re: axis two features, posted by pegasus on April 27, 2009, at 13:37:17
Personally I feel it's the pdocs job to discuss diagnoses as please correct me if wrong but doesn't a doc have to diagnose not a therapist. They can guess but not diagnose? Phillipa
Posted by deerock on April 27, 2009, at 13:55:40
In reply to Re: axis two features, posted by Phillipa on April 27, 2009, at 13:53:35
the therapist in question is a PsyD. thats a doc. not an MD, but still a doc.
Posted by alexandra_k on April 27, 2009, at 14:48:30
In reply to Re: axis two features, posted by deerock on April 27, 2009, at 13:55:40
I guess they might have felt a little like they were between a rock and a hard place. On the one hand you feel frustrated / angry that they won't tell you what they are thinking with respect to a diagnosis, on the other hand you feel frustrated / angry when they do tell you what they are thinking with respect to a diagnosis...
I guess we tend to have a view of personality as being, well, personal or about the person. Something intrinsic and invariant that doesn't alter without, well, altering who you are as a person. The psychologists notion of a 'personality disorder' or of 'personality traits' is a little different. It isn't supposed to be personal so much as a description of behaviors. There is much controversy over how invariant they are or how much these characteristics of behavior can be altered over time and / or as a function of therapy.
Posted by deerock on April 27, 2009, at 15:12:50
In reply to Re: axis two features, posted by alexandra_k on April 27, 2009, at 14:48:30
what you are saying is what my concern is.
if my behaviors are a result of a personality disorder, they are either much harder to change or not likely to change.
if its a result of depression, thats highly treatable. so in effect, she is telling me what i have is hard to treat. and some others might say its not treatable.
Posted by fleeting flutterby on April 27, 2009, at 15:19:26
In reply to Re: axis two features, posted by alexandra_k on April 27, 2009, at 14:48:30
---I agree with what alexandra said here:
> I guess they might have felt a little like they were between a rock and a hard place. On the one hand you feel frustrated / angry that they won't tell you what they are thinking with respect to a diagnosis, on the other hand you feel frustrated / angry when they do tell you what they are thinking with respect to a diagnosis...
>----there's a saying goes something like-- "If you can't handle looking at what's under a rock, then don't lift it up"....
----seems to me you asked a question and were given an honest answer and now you're pissed??.....
----I have several personality disorders and I don't feel I'm a dead end! I'm working hard and making progress, if I do say so myself. (it might not be noticeable to most people but it is to the therapists I've seen and to myself and a few others in my family.)
----people with personality disorders don't have to be stuck-- it's in their control-- they just have to realize that.
flutterby-mandy ps.....-- I don't think I am, or anyone else with a personality disorder, is a lost cause. argh!
Posted by alexandra_k on April 27, 2009, at 15:50:22
In reply to Re: axis two features alexandra, posted by deerock on April 27, 2009, at 15:12:50
I dunno how 'highly treatable' depression is. Some people with depression do the rounds with all kinds of medications and don't find much relief. If one has depression then does medication 'cure' or 'fix' things or is it like having to take insulun for a condition like diabetes? I dunno. Just saying that one could make a case that axis one disorders (or traits) are just as invariant as many peoples conception of the nature of personality.
There are many effective interventions for altering axis two traits. Depending on what those traits are many of them have significant overlap with axis one traits anyway. Treatments have developed well for borderline personality disorder etc etc. Many people 'grow out' of the behaviors that they find problematic when they hit their 40's. Many people recover much faster with therapy etc. I don't know of anybody who thinks that axis two traits are untreatable (except possibly sociopathy). I don't suppose she would spend time working with you trying to help you if she thought it was pointless...
Posted by deerock on April 27, 2009, at 15:55:10
In reply to Re: axis two features, posted by fleeting flutterby on April 27, 2009, at 15:19:26
<<<----seems to me you asked a question and were given an honest answer and now you're pissed??..... >>>
am i not allowed to ask a question and be pissed at the answer? im not sure i understand why you asked that.
to me, her thinking i have a personality disorder tells me as much about her, as it does about me. i mean this in the sense that many therapists i have seen have never dx'd me with such a thing.
its hopeful to hear you say you dont feel its a dead end to have a personality disorder. good~!
Posted by garnet71 on April 27, 2009, at 16:41:13
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
Forgive me if I said anything repetitive since I didn't read the other posts.
Get a full copy of your medical/therpay records - there will contain all the diagnosis codes.
Having a diagnosis of a personality disorder CAN affect job opportunities (esp. if you work in public service), court custody situations, etc., later down the road. Hence, it's important to find out. Unless those situations will never apply to you, you might want to just blow it off getting the records. Still, I think it's important to be proactive. I have a personal issue with future employement, knowing any mental health treatment at all affects my opportunities for the career fields I am considering for the future. General anxiety disorder. Any and all mental health treatment is investigated and considered for some career fields.
But it doesn't sound like she gave you a diagnosis; she said you had traits? Everyone in the world has some traits of personality disorders, and some only from time to time as a result of environmental factors. Just about everyone. Say a patient must meet 10 out of 15 criteria to be diagnosed w/the disorder-maybe you have 2 of the symptoms...for example. Big deal.
Overall this whole thing is bizarre-I've never heard of a therapist/dr not give a diagnosis. Plus, it's in your record. It's YOUR record-and you have a right to know what's contained in there. Therapists can be supenoed for records by the courts...
But what traits is she referring to? Say you tend to blame others for all your problems and don't take responsibility for things you've done-that's a sign of a personality disorder, just one example. Do you have an example of some of the traits T is referring to?
Personality disorders can be referred to as character disorders and are ingrained in one's behavior. You're right-they are very difficult to treat, but not impossible. All the better reason to find out what's up. There's no excuse for your T not being straight up with you, imo. What she labeled you with is followed by a trail of paperwork that may not go away. Get your records.
Posted by MollieQ on April 27, 2009, at 17:09:34
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
You need to distinguish traits or features from disorders. Most of us have axis 2 traits. If you have separation anxiety, does that mean you have borderline personality disorder? It only becomes a personality disorder if the traits cluster in particular areas as defined by the DSM-IV.
I don't know any T's who would put such a thing down in writing anyway, especially for insurance purposes. Most just put anxiety or depression etc.
Posted by alexandra_k on April 27, 2009, at 17:20:38
In reply to Re: axis two features, posted by MollieQ on April 27, 2009, at 17:09:34
It sounded like she was reluctant to engage in the diagnosis thing but ended up doing it because the person wanted to know. Similarly, asking for some kind of written report or official notification means that one has a formal record of a diagnosis. Personally... I'm not sure such things are helpful.
What are the problems that you want assistance with? What are the things that your therapist thinks might be problematic? I don't see what is to be gained by focusing on the issue of diagnosis rather than these latter two questions.
Posted by Amelia_in_StPaul on April 27, 2009, at 18:17:03
In reply to Re: axis two features, posted by alexandra_k on April 27, 2009, at 14:48:30
There is often a false dichotomy in thinking about Axis I and Axis II diagnoses--the thinking being that Axis I is biochemical in origin (sometimes circumstantial)and Axis II is not. But, for example, exposure to trauma can create biochemical changes in a susceptible person that leads to borderline personality disorder.
Another, related point is that Axis II traits are, as I said before, maladaptive ways in which the person has learned to cope in the world. That is NOT the person's fault. It is a mixture of environment and genetic susceptibilities.
I abhor any notion that these ways of relating to the world are intractable. I know what the literature says, but I have seen over and over again that changes in circumstance (yes, sometimes personality disorders or their traits are exacerbated by circumstance) and hard work in a therapeutic relationship can make a difference.
> I guess we tend to have a view of personality as being, well, personal or about the person. Something intrinsic and invariant that doesn't alter without, well, altering who you are as a person. The psychologists notion of a 'personality disorder' or of 'personality traits' is a little different. It isn't supposed to be personal so much as a description of behaviors. There is much controversy over how invariant they are or how much these characteristics of behavior can be altered over time and / or as a function of therapy.
>
>
>
Posted by Amelia_in_StPaul on April 27, 2009, at 18:26:31
In reply to Re: axis two features, posted by deerock on April 27, 2009, at 13:26:40
No problem, Rock. Keep your chin up. Don't let it all get to you. You are still you--therapy is about making your way in the world a peaceful one. The only thing we can change about the world is ourselves--and it's NOT impossible. You have a nice day too!
> thanks amelia. thats helpful to hear your perception of what i described. ill def give the therapist a chance. thanks again. have a nice day.
>
> rock
Posted by BayLeaf on April 27, 2009, at 18:29:51
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
look at the list of features for all the personality disorders and you'll find bits and pieces of everyone you know.
bay
Posted by deerock on April 27, 2009, at 19:08:38
In reply to Re: axis two features » deerock, posted by garnet71 on April 27, 2009, at 16:41:13
thanks for the input garnet. yeah, see, this is my concern. im starting school for social work next fall. i dont want a paper trail following me around.
axis II features may not be a diagnosis of personality disorder. it may just be fluff that she put into what she gave me. i asked her for something in writing that outlines her treatment plan.
id love to find out what will follow me around.i may want to work for the prison system, i may want to apply for fellowships that may want to know my mental health history.
i feel stupid for having even asked her this because when i asked her straight out she would only ask me questions and when i finally asked for it in writing, she put down "dysthimia, anxiety. temporal lobe irregularity and axis II features."
my whole concern is to not have a huge paper trail.
Posted by deerock on April 27, 2009, at 19:10:57
In reply to Re: axis two features, posted by alexandra_k on April 27, 2009, at 17:20:38
most of my issues deal with low self esteem and behaviors like cigarette smoking and unhealthy eating to deal with difficult emotions that stem from self hatred. i dont care what the diagnosis is. i know whats wrong.
BUT, i wanted to know what shse used for a diagnosis because it helps me understand where she is coming from and what is going down on paper. now im thinking what i did was really stupid because now the letter she wrote me is in my file.
Posted by Dinah on April 27, 2009, at 19:11:36
In reply to Axis I vs Axis II -- a false dichotomy, posted by Amelia_in_StPaul on April 27, 2009, at 18:17:03
I totally agree.
Posted by alexandra_k on April 27, 2009, at 23:56:14
In reply to Re: axis two features))garnet, posted by deerock on April 27, 2009, at 19:08:38
If you don't want her to create a paper trail then why do you ask her to write things down?
Posted by Garnet71 on April 28, 2009, at 0:28:27
In reply to Re: axis two features))garnet, posted by deerock on April 27, 2009, at 19:08:38
It would depend upon the scope of the background investigation. The letter you asked for isn't the issue here, it seems. Do you know some therapists write notes after your leave? Some even audio record the sessions (though I'm not sure if the laws dictate whether or not they have to tell you). What do you think happens when the doctor leaves an exam room-they summarize the visit, including your behavior, in a tape recorder-it is later transcribed in placed in your record/file.
To comment about what others have said-Just because someone uses depression/anxiety codes for insurance purposes, does not mean that the therapist doesn't write notes about your issues and places them in a file.
I don't know about the field of social work-I only know about my particular field; in some cases, they would want to read all those 'notes'. I have no clue about the scope of investigations social work employers conduct. But know your hippa rights; always keep copies of your records. They can come back to burn you.
Someone I knew a few years back was a electronic records investigative consultant for law firms; he said, and I don't know if this is still the case today, there is one single place in Atlanta, Ga, that has all your medical infromation. Despite that, i'm really surprised at the lack of concern I always come across-lack of concern for what's in your med records. It's like your credit report but worse, in some cases.
There's also a data house that keeps track of any insurance medical claims you've filed. If you apply for worker's comp, or file an auto insurance claim, for example, it's like pulling a credit report-of our medical history.
I wouldn't worry too much about that letter, you were't diagnosed, only traits were mentioned (which like we all say everyone has from time to time), but if I were you I'd find out what exactly the corrections system investigages and then accordingly check your records if needed. And check the HIPPA laws if you run into a problem. Good luck!
Posted by deerock on April 28, 2009, at 8:23:41
In reply to Re: axis two features))garnet, posted by alexandra_k on April 27, 2009, at 23:56:14
Your question is answered in my original post.
Posted by pegasus on April 28, 2009, at 9:17:17
In reply to Re: axis two features » deerock, posted by garnet71 on April 27, 2009, at 16:41:13
>I've never heard of a therapist/dr not give a diagnosis.
Oh, I know lots of therapists who won't make any diagnosis unless it's required for some reason, like insurance reimbursement. I had a therapist once who didn't diagnose in general, and who also took virtually no notes. In my file he would mark down when I'd seen him, and any medication change I reported (he wasn't my pdoc, so if I didn't report it, he didn't know), but that was it. I guess he must have had some bad experience with having his records subpoenaed for a lawsuit, and having his notes not be helpful for his client. So he mostly stoppped taking them.
Seems kind of dangerous, from a self-protection point of view. For example, if I'd tried to sue him for malpractice or something, he'd have had nothing to defend himself with. But he was a really great therapist, and I wonder if he had decided to take on that risk for himself, in order to better protect his clients. Or maybe he was just naive and overly trusting. But I digress.
Peg
Posted by deerock on April 28, 2009, at 9:20:09
In reply to Re: axis two features))garnet, posted by Garnet71 on April 28, 2009, at 0:28:27
thanks garnet. i appreciate your insight. have a nice day.
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