Diagnosis - kind of...

Hi everyone,

So I sort of pressed my psychiatrist for her opinion re my dx and she said:
"Well, you don't have a coherent sense of self. It's fragmented."
Me - "So what's the difference between that and DDNOS?"
"Yes, some people would call it DDNOS. Others would say you have a borderline personality structure."

I've just emailed her asking what she would call it?? An obvious question, but I'm hopeless at thinking on the spot so I didn't ask it at the time.

So I don't know, I kind of think I have both, but maybe I am more BPD with dissociative symptoms - but not severe enough to be a DD. I know there's a lot of overlap. But then tomorrow I'll think just the opposite!

Any thoughts?
Zel.

You could self-administer Paul Dell's Multidimensional Inventory of Dissociation (MID) and give a copy to your T for her to get it scored. Scoring the MID is complicated, and involves a spreadsheet. Your T might take weeks to find another T who can score it for her, or to join ISSTD (if not already a member) and download the scoring spreadsheet from the member area of the ISSTD website. Among other features, the MID supports differential diagnosis of dissociative disorders vs the schizophrenic and personality disorders.

DID Forum: Check in: Multidimensional Inventory of Dissociation

This post is weird, it started in the ASPD forum and ended up grated into a post into the the dissociative forum.

Anyway, interesting information about the differential analysis.
BPD has overlaps in dissociation, so it is a judgment call from your psych. The actual reality does not change, no matter what she decides to call it.

Black Widow wrote:This post is weird, it started in the ASPD forum and ended up grated into a post into the the dissociative forum.

Yes. Some kind of database glitch.

Black Widow wrote:BPD has overlaps in dissociation, so it is a judgment call from your psych. The actual reality does not change, no matter what she decides to call it.

Well, some but not all people who have borderline personality disorder also have a lot of dissociative symptoms. Some but not all people who have DID have one or more alters who have borderline symptoms or even borderline personality disorder. It is not a judgment call, it is a matter of clear diagnosis. Therapists are not all equally adept at diagnosis.

I don't know much about the grey areas.
I know I was diagnosed schizotypal PD and there are overlaps there as well. They take my dissociation as a symptom of what I have. Which may be true.
But the reality, for me, is not different than someone that would have some sort of DDNOS, I suppose. Derealization for sure.
But for me, subjectively, I think more like I am multiple people than one with some fragments. Especially since I do not have a sense of "I".
Not sure if it makes sense.

Black Widow wrote:I was diagnosed schizotypal PD and there are overlaps there as well. They take my dissociation as a symptom of what I have. Which may be true.

The overlap is in symptoms, not in underlying pathology, which means the treatment is different too. It's like having a fever (symptom) due to infection. Is the infection a virus or a bacteria? Antibiotics treat bacterial infections, not viral infections.

What I was told though was that they had no clue about the underlying pathology. They only go with the overt symptoms. Not saying there are no theories, but it seems still in the theoretical stage.
They have no resources for dissociation where I am anyway. It seems something they do not know much about, aside from movies.

Black Widow wrote:What I was told though was that they had no clue about the underlying pathology. They only go with the overt symptoms.

This sounds like they are trying to treat the symptoms. Please look for more experienced help. This could take the form of someone who visits to train your therapists, or offers a short course, or has written materials for training therapists.

Una+ wrote:You could self-administer Paul Dell's Multidimensional Inventory of Dissociation (MID) and give a copy to your T for her to get it scored. Scoring the MID is complicated, and involves a spreadsheet.

Thanks Una,
I've printed that out. I don't think my psychiatrist would be interested in scoring it, she seems to be discouraging me from taking too much interest in diagnoses etc.
She said that both conditions (BPD & DDNOS) are treated the same anyway. ie psychotherapy.

I might have more luck with my psychologist.
Am I right in thinking that these days BPD is thought to be an outcome of abuse / trauma in childhood?
Some things I've read suggest that it's interchangeable with C-PTSD.?

Thanks, Zel.

ZeldaZonk wrote:She said that both conditions (BPD & DDNOS) are treated the same anyway. ie psychotherapy.

She actually said that? Oh dear. High cholesterol and gout are treated the same way too: long term medication. But the medications are different.

ZeldaZonk wrote:Am I right in thinking that these days BPD is thought to be an outcome of abuse / trauma in childhood?

These days there is a theory that all the personality disorders can be caused in part by traumatic abuse and neglect in childhood.

ZeldaZonk wrote:Some things I've read suggest that it's interchangeable with C-PTSD.?

Like DID and DDNOS, C-PTSD is a dissociative disorder plus there are attachment issues. Borderline PD is a personality disorder, so necessarily includes attachment issues; dissociative symptoms might or might not be present. Treatment for all is psychotherapy, but there are significant differences.