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Dr. Bob is Robert Hsiung, MD,
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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.
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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.
Posted by 10derHeart on April 28, 2009, at 9:56:10
In reply to Re: axis two features, posted by pegasus on April 28, 2009, at 9:17:17
My T. (psychologist) of 4+ years never even mentioned a dx. I don't think it seemed relevant to either of us. He took notes for maybe the first year - sporadically - but then stopped after I'd mentioned a couple times how distracting it was, and never took any since then.
I did see what he'd used for insurance once, and we had a little talk about that - it did bother me some because he hadn't told me, not that I disagreed with it. He was really surprised the way I reacted, not understanding it felt like a impersonal label, or like him doing something behind my back that made me into more of a dx than a person. (He'd also thought he did tell me - a little memory issue there, but I forgave it in time...) A small rupture, but a good learning experience....
I guess there are a few different approaches out there.
Posted by fleeting flutterby on April 28, 2009, at 11:14:04
In reply to Re: axis two features fleeting, posted by deerock on April 27, 2009, at 15:55:10
> <<<----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.<<
---flutterby: What I was trying to get at is, the therapist was put in a NO win situation-- she was condemned(you were pissed) if she didn't give you the diagnosis-- and -- she was again condemned(you were pissed) for giving you her diagnosis.......
wonder if you put people in no-win situations when you're stressed?(not pointing a finger at you negatively-- just trying to figure things out, is all)
> 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.<<--flutterby: Maybe she's the only one you've been working with that uses axis II in diagnosis, or maybe she's the only one you've come across with courage to be honest and open with you......
like someone once said here(sorry I can't remember who)... "one can go to 5 different therapists and come out with 5 different diagnoses"-- psychiatry is NOT an exact science..... hmmmmmm.. is it even a science?? *scratches head*...
>
> its hopeful to hear you say you dont feel its a dead end to have a personality disorder. good~!<<---flutterby: Of course it's not! :o) It's not easy but it's not a dead end. There are many many thought approaches/processes I've had to re-learn(and still am), as I taught myself and -- being I was a child, and didn't have an adult knowledge-- I have had to unlearn(start from a *blank*)underdeveloped approaches....which is extremely difficult-- and then learn a healthier approach..... like I try not to jump to conclusions as much and I try(this is a very hard one for me!) to not get defensive, when someone disagrees with me.
anyway-- wish you the best :o)
flutterby-mandy
Posted by deerock on April 28, 2009, at 11:19:44
In reply to Re: axis two features » deerock, posted by fleeting flutterby on April 28, 2009, at 11:14:04
yeah...when ppl disagree with me...boy do i get upset :)
Posted by Garnet71 on April 28, 2009, at 16:57:48
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
It sounds like you might want to read up on narcissistic personality disorder
Posted by alexandra_k on April 28, 2009, at 17:47:46
In reply to Re: axis two features, posted by Garnet71 on April 28, 2009, at 16:57:48
Kohut has some interesting stuff on narcissistic personality. He thinks it results from lack of empathetic attunement. Basically, when we didn't receive the nurturing, empathy, and care that we needed as infants. Many therapists consider narcissistic personality / borderline personality / hysterical or hysteriod personality to be very similar. Theorists differ with respect to how much they focus on ego and counter-transference reactions rather than empathetic attunement and environmental experiences. It is interesting that many people who are nowdays regarded as anxious-depressed or neurotic are (according to Kohut) narcissistic...
Posted by alexandra_k on April 28, 2009, at 17:49:12
In reply to Re: axis two features, posted by alexandra_k on April 28, 2009, at 17:47:46
Posted by Phillipa on April 28, 2009, at 20:04:20
In reply to Re: axis two features))garnet, posted by Garnet71 on April 28, 2009, at 0:28:27
Garnet what if the records were prior to Hippa laws? Phillipa
Posted by raisinb on April 28, 2009, at 22:35:05
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
I have kind of a funny aside to this thread. When I went in for my session Thurs, my therapist said "I finally figured out how to open the window!" I looked over and the DSM-IV was holding it up. I laughed and said "it's doing good service! What if you need to diagnose somebody?" She laughed and waved that away.
I think what I'd say is that diagnosis can sometimes be a negative influence in therapy. It creates distance between therapist and client, and those "Axis II" etc. features almost never make a client feel heard, not to mention feeling unique and special.
We are all so complicated, rich, and individual. Diagnoses might be a tool for your therapist to begin with you, but I don't think they are particularly helpful in a deep, transformative therapy. To accomplish that, you and your therapist should be in a place of deep relationship, in which acceptance without judgment and labels (I think) is a prerequisite. This might be why your therapist was reluctant to share it.
Don't worry about the labels. They were written by people trying to formulate a coherent theoretical structure in a field that is young and unsure. And, in a field that deals more with inchoate, individual, emotional conflicts. Not that they can't be useful for sending in forms to your insurance company. But for your relationship with your therapist, I doubt they are. Relationships aren't build on labels. They're build on deep understanding, which is the opposite.
Posted by raisinb on April 28, 2009, at 22:38:01
In reply to Re: axis two features, posted by alexandra_k on April 28, 2009, at 17:47:46
I love Kohut, partly because he seems to theorize the exact kind of therapy I need.
"Narcissistic disorder" I think isn't the same as having NPD to Kohut. To him, I think it's about addressing fundamental defects in the self, which can manifest in a lot of different ways--self-effacement, self-aggrandizement, or attachment to another or a goal as a substitute for a real, internally directed self.
Posted by softheprairie on April 30, 2009, at 2:15:10
In reply to Re: axis two features, posted by Phillipa on April 27, 2009, at 13:53:35
> 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
I'm pretty sure that the state license that allows a therapist to provide mental health treatment, even if at just a master's degree level, also legally allows them to diagnose mental problems.
Posted by chumbawumba on May 8, 2009, at 16:05:45
In reply to axis two features, posted by deerock on April 27, 2009, at 12:32:18
I'm not sure it matters really except maybe when it comes time for insurance to deny coverage.
When I took abnormal psych I was taught that the only personality disorder that had any validity or reliability was the antisocial personality disorder.
I wouldn't give it a further thought. You're you, infinitely more complex than any label some therapist or insurance company puts on you. What matters is what are you going to do to become a better, happier, stronger you?
This is the end of the thread.
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