Important Psychiatric Disorders: Personality Disorders I Have Known In Private Practice and Adjunct Therapy

Normalized Rorschach Ink Blot #8 out of 10.
Normalized Rorschach Ink Blot #8 out of 10. | Source

Introduction and the DSM-V

In Spring 2013 came the release of the fifth edition of the diagnostic manual of the American Psychiatric Association, called the DSM-V. It replaced the DSM-IV-TR and included changes for a number of psychiatric conditions and added additional mental health disorders to its contents and description classifications.

This Hub will does mention the names, locations, or dates of contact with the following examples of Personality Disorders that were diagnosed under the DSM-IV-TR by competent, licensed psychiatrists. These cases were referred to a range of facilities in which I worked in the services of 1) medication reduction or withdrawal, 2) pain and stress management, 3) Workers Compensation Rehabilitation programs, 4) support group activities, 5) relaxation and talking therapies, and 6) exercise classes, and others. In fact, the persons in these examples are now deceased.

An upsurge has occurred in the discussion of mental health diagnoses and treatments among the general population during the 2010s. With the advent of the DSM-V and changed criteria for diagnoses, it is easier than ever for untrained lay diagnoses to be incorrect and harmful. If concerned or interested in your own or others' behaviors that may be unhealthy, please see some effective, legal, and ethical steps to take in my article How to Questions a Doctor's Diagnosis. Professional intervention is more important than ever.

To our confounding, many mental health conditions overlap in symptoms. There is a protocol for determining which symptoms take priority for diagnosis that must legally be followed, but the general public do not usually have access to these..

Reaching a definitive diagnosis requires interviews, personal and family behavioral and medical histories, observations, psychiatric testing, and soon, even DNA analysis in some upcoming cases. The total process is much more complex than some understand it to be. See the required steps at How to Do A Mental Health Assessment.

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Aggressive Personality Disorder - Questionable

In the late 1980s, during the use of the DSM III-R, I was presented with a case for evaluation of a 5-year-old male with an accompanying report (sketchy) that listed a diagnosis of only "Aggressive Personality Disorder", but no mention of Axis designations. This was confusing and not standard practice. Additionally, at the time, diagnosis of children with adult mental health disorders was not encouraged. Having never heard of this particular personality disorder, I found that it was not listed in the DSM-III-R, or Diagnostic and Statistical Manual, version III-Revised, of the American Psychiatric Association. This was interesting.

The child might have been diagnosed ADHD, because as soon as he entered the room, he ran around the floor in a circle and three steps up the wall -- Perhaps he had been watching Fred Astaire movies.

He also brought with him a history of climbing into extremely high places, unless strictly controlled by his parents. This included railings on the back of the highest bleachers in gymnasiums, tall trees in state recreational areas, roofs, pieces of construction machinery parked near his home, and other examples. Luckily, I was not looking for a new diagnosis, but only evaluating the child for which adjunct physical activities might channel energy in a postive way. Rock climbing and wall climbing were perfect. His parents chose soccer, judo, and karate.

Before losing touch with this nuclear family of two parents and one child, I eventually discovered some interesting background. Firstly, in general, each relocation of home in early childhood and into the early elementary school years tends to produce a regression of maturity of a full year. The child in this case experienced three moves already by age 5 years, 6 months.

The son was also left at home alone on workdays from 3:00PM - 5:00PM after the preschool bus brought him home. At age 5 years, this is illegal treatment as well as inappropriate. The child reported that he was also always hungry and was not always fed every day, and this information was passed through proper channels.

Eventually, the appropriate care systems discovered that the child had been placed on a "point system" from birth. He was to be quiet for a certain number of minutes and exhibit other required behaviors for specific time intervals in order to earn 1) being picked up, 2) being talked to, 3) being fed, and other "rewards." I was stunned at the report.

IMPACT OF THE INFORMATION: CAUSES

A team of two psychiatrists that specialize in brain mapping and whom I admire have satisfied themselves that personality disorders and some other mental health conditions form within the first three months of life after birth, through the interference with the psychoneurological development of the infant by psychologically unhealthy individuals in the environment of the child. From my own experiences in a private practice, counseling, education, and adjunct therapy, I find myself agreeing.

I cannot find a disorder called "Agressive Personality Disorder", but one called Passive-Aggressive Personality Disorder does exist. I do not see that the latter diagnosis fits the child above, but I did not participate in the full psychological diagnosis and I do not think one was completed.

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Borderline Personality Disorder (BPD)

A segment of mental health professionals tell us that all teenagers possess Borderline Personality Disorder (BPD), yet should not be so diagnosed. They feel that chronological maturity brings the youth out of the symptom sets associated with BPD. These practitioners feel that the BPD symptom sets "come with the territory" of the teenage years.

At the same time, increasing numbers of teens are receiving adult mental diagnoses in the 2010s and this is disturbing. This information will go into a national medical database forever, once that system initiates. The database may unfortunately function almost like a criminal system in these cases, because of the stigma still attached to psychiatric diagnoses in our culture. The stigma gives rise to prejudices and assumptions that may be incorrect. This may also put into place a sort of "type casting" in which an individual wears a label and is administered treatments long-term that are not entirely effective.

A SPECIFIC CASE

A war veteran was diagnosed in the1980s with "a cyclical mood disorder", Somatoform Disorder (in short, focused on physical problems), and Borderline Personality Disorder (BPD), in addition to physical injuries of war.

In summary, the client did not exhibit enough of the symptoms of BPD to justify that diagnosis. The cyclical diagnosis was dropped, but BPD was retained. Thus, he reportedly possessed BPD, Somatoform Disorder, and physical injuries that included injuries in a military vehicle collision and head and neck cancer from dioxin exposure.

In further interviews, it was found that the client was in the middle of 7 male and female siblings, one of each gender being molested by the male parent. The parents both died and the siblings were separated into different adoptive households. The client, however, suffered long-term physical abuse from the adoptive mother, coincidentally in the same areas injured by the wartime vehicle injury that worsened over time. In fact, the same areas of the body were injured a third time in occupational tasks. Post Traumatic Stress Disorder might have been diagnosed as well, given the PTSD symptoms also present, but the psychiatrist did not consider it.

IMPACT OF INFORMATION

This is a sad case. The few Borderline Personality Disorder symptoms demonstrated by the client probably began with his Family of Origin and were reinforced by 1) adoptive-parent physical abuse, 2) wartime injury at the same anatomical sites, and 3) workplace injuries at the same anatomical sites.

The BPD symptoms present were 1) outsized anger and 2) inability to maintain relationships - Except that he held onto to two close relationships for totals of 25 years and 10 years at his death. One needs 5 symptoms to qualify, as it were, for this personality disorder.

I THINK WE NEED A FIELD OF FORENSIC PSYCHIATRIC DIAGNOSIS

I believe that no one ever read the entire file and interview notes, or connected up the history of injuries to the same anatomical areas three times, or noted the foundation of physical abuse suffered and sexual abuse witnessed early on. Various files were in too many places in too many offices for a reconstruction.

This case history may have led to some BPD symptoms, but it started with child abuse and three severe long-term injuries that reinforced it, all in the same anatomical areas. The client also had a range of heart conditions that can and did manifest as psychological symptoms. I think some practitioners missed that connection in this client as well. He was killed gradually by abuse and injuries, mentally and physically, while he coped (sometimes in odd ways) until he died. This is more than BPD in my view.

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Comments 12 comments

Lord De Cross profile image

Lord De Cross 5 years ago

Probably an uncle had BPD but we never knew the diagnosis. My next point is: how many of our war veterans that live among their 'fellow men' have certain disorders of this and other types. Thanks Patty. Voted up as usual..Any future reports of Jobs in Arizona?

LORD


FloraBreenRobison profile image

FloraBreenRobison 5 years ago

I remember information in my Psychology 101 and 102 courses had to be free of technical jargon so that the layperson could understand the textbook. This leads to what is commonly referred to as First Year Medical Student's Disease. Regarding personality disorders being diagnosed at all- I remember learning multiple personality disorder does exist in rare cases -like Eve in The Three Faces of Eve. But as a general disorder it doesn't exist- it mostly turns up in accused serial killers trying to avoid the death penalty. I studied Psychology because I found it fascinating and thought it would help my writing. But I get no end of comments from people I know when they first learn that Psychology is my major wondering why I am not a therapist or why Major in Psychology if you aren't going to be a therapist. I don't think I could handle what you do.


Cardisa profile image

Cardisa 5 years ago from Jamaica

First of all Patty, I must tell you how much I have learned from you since joining HP.

I am always interested in mental or personality disorders for some reason.....maybe being diagnosed with depression and at times displaying obsessive behavior might be the reason.

The above cases you mentioned make me think that the diagnosing psychiatrists may have been hasty with their diagnoses. Being misdiagnosed is a major problem with many physicians as with my case when I had endometriosis. My personal physician told me I had an ectopic pregnancy which delayed the actual prognosis which almost cost my life. I read the hub on how to question your doctor's diagnosis and have to agree with that one too.

Thank you for such wonderful insight into the world or personality disorders.


Erin LeFey profile image

Erin LeFey 5 years ago from Maryland

Very interesting hub with lots of information. Great examples added as well for a couple of psychological disorders. well done.


Phil Plasma profile image

Phil Plasma 5 years ago from Montreal, Quebec

I think that this kind of disorders are terribly difficult to diagnose and treat. There is still so much we don't know about the brain. That you feel there should be better forensic diagnosis makes terrific sense. Well written hub earning you a vote-up and interesting.


Patty Inglish, MS profile image

Patty Inglish, MS 5 years ago from North America Author

Thank you for these insightful comments. Diagnosis is difficult and if TV's House MD were a psychiatrist, we'd need him in this type of work.

We once had a case of a woman with two personalties. One was an office worker and one was a cocktail waitress at night. Each thought she had a roommate and their two bedrooms had completely different wardrobes, etc. The one woman was working 16 hours a day and each personality wondered why she was so tired. After a time, the lead psychiatrist in the practice was able to help the one woman see the two personalities she was exhibiting and helped her to become one personality with one job.

As for our vets - they need more thorough care overall and it makes me sick to see them under-treated.

I'd like to see how many BPD DX's are apllied to people that have been abused in childhood.

{I'll be sure to look into Arizona jobs as well :)]

Thanks, everyone!


breakfastpop profile image

breakfastpop 5 years ago

Terrific and informative article. It brought me back to college when I minored in Psych!


Internetwriter62 profile image

Internetwriter62 5 years ago from Marco Island, Florida

Fascinating article, although it is very sad to know that parents could abuse their children to the point of making them dysfunctional. I found this hub very informative. Voted it up.


Ms Chievous profile image

Ms Chievous 5 years ago from Wv

Aggressive personality disorder? This is very questionable especially in a five year old. I believe for the most part children should not have any mood disorders put upon them. I have worked with children for years...

BPD is one of the most difficult diagnosis to understand and treat! Only after being around people with BPD have I begun to understand the diagnosis just a little.


Angie Jardine profile image

Angie Jardine 5 years ago from Cornwall, land of the eternally youthful mind ...

Thanks for this informative hub, Patty ... I am never totally comfortable with labelling behaviour. I suppose it makes it easier but really I sometimes wonder if all unusual/socially awkward behaviour is just one person's way of dealing with the lousy hand life has dealt them ... how do we really know what normal behaviour is? Is there any such thing? Or are there only strategies and coping mechanisms when one is in emotional, physical and/or mental pain?


Hello, hello, profile image

Hello, hello, 5 years ago from London, UK

Thank you for giving such an easy to understandable insight of a normal life distroying disorder.


trosiev profile image

trosiev 5 years ago

I agree with your findings and thank you for a great hub. I was diagnosed with BPD ten years ago, although I was always high functioning; I have never had an addictive personality or suicidal tendencies. I have been through individual and group therapies, DBT workshop, spiritual retreats, journaling, etc. I have come so far in recovery with a lot of hard work uncovering the layers of the onion. I was committment phobic for years and am now ready to find the right partner and settle down. I take long breaks from men, especially when a love rlationship ends. The last serious relationship was the first in five years and showed me that I am ready to give as a partner; ironically, the other person was not ready to be happy and was afraid. He was a mirror of my older self. It lasted less than a year, but I have barely dated at all in almost two years. I am going to write a hub on this, and come out so to speak. Thanks again. I am inspired to share...

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