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Diagnonsense…

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This post is inevitably going to be very long. I have been thinking about what to say for days now and I just haven’t been able to force myself to do it. I need to write though as I must get this straight in my head.

I seem to have writers block. I sit down here with the intention of writing and making sense of everything and I can’t do it. I try to put all of these thoughts down onto the screen and I can’t. There are too many conflicting worries. Too many fears. I know what I have to say, but I am scared. I am scared of writing for making it real.

As you may have read, there was talk about changing my diagnosis when I was first admitted. I was a little surprised and worried about this to say the least. It was hard enough getting a firm diagnosis the first time, let alone having to go through it again. I had accepted the Bipolar II diagnosis and was felt it was accurate. I’ve not found any other diagnosis that describes my experience as well, although I do accept there are so many overlaps between psychiatric diagnoses that it is possible to get things wrong or mixed up.

I am uncomfortable with the idea that Dr M seemed to decide I didn’t have Bipolar Disorder in about 10 minutes. She referred me to Dr S, who is a consultant psychiatrist specialising in psychotherapy. She’s involved with the EDT team that I have been waiting on since last year.

Dr S assessed me over two, hour long appointments. Dr M wanted someone with a therapeutic background to assess me and provide input on my diagnosis. Dr M was obviously considering a personality disorder, although amazingly it seems not the one I thought she was (BPD). I am starting to wonder though how much Dr M influenced Dr S’s assessment.

Dr S asked me about all sorts of stuff. We did the usual history thing and she dug deeper on some things. She asked me a lot about my mood. One thing I was uncomfortable with was the constant assertion that my experience of high moods, could just me not recognising normal moods because I spend so much time depressed. I don’t agree with this. It is not normal to be working 16 hours a day, hardly sleeping yet not tired at all, running around your office doing a million and one things, laughing and talking constantly and generally not being able to concentrate on anything.

At the end of our second session, she told me what she thought. She agreed that I had “some form of mood disorder” but wouldn’t commit to anything. She told me that she was leaning towards recurrent or chronic depression rather than Bipolar II disorder, but wouldn’t dismiss that completely. She also mentioned “personality traits” (mainly perfectionism and high standards) that she said perhaps made me more susceptible to mood episodes, but she also said she didn’t think there was enough to suggest a full personality disorder diagnosis.

So what did Dr M think? I tried to find out, but she kept avoiding the subject. With regards to mood, she did mention dysthymia at one point, but surely by definition dysthymia would never be severe enough for hospitalisation? There were times when she even questioned whether or not I was, or had ever been depressed, which seemed bizarre.

When asked about the personality side of things she said she  “didn’t want to open any boxes that can’t be closed”, implying that it could be dangerous to give a diagnosis without being certain. She said there were personality traits which she was concerned about, particularly focussing on “high standards”, but she didn’t feel any were severe enough to consider a full PD diagnosis. She would also tell me that labels weren’t important and that we should focus on trying to “change the way I see the world”.

I saw Dr N a couple of weeks ago and he said my diagnosis had been changed on the system. This sparked my curiosity because I couldn’t get Dr M to commit to anything. I asked him what it said and he looked it up. It just said “moderate depression” and “personality disorder”. Nothing more specific than that. I think we were both curious as to what PD, although I think he suspected borderline too. After all, he had even suggested it back when he first met me, but it hadn’t been mentioned again since.

I saw Dr M again last week. We got through pretty much the whole appointment before I eventually found an opportunity and the courage to ask about my diagnosis. She had to look back through my notes to find it, which is a little scary. You would have thought she’d know what diagnosis she had given me.

It states clearly:

  1. Moderate Depressive Episode
  2. F 60.8 Other Specific Personality Disorder.

I have issues with the first diagnosis, but didn’t express them because I was so surprised and concerned about the second point. I didn’t know what F60.8 actually said, so I asked her what PD she referred to and she mentioned Narcissistic, which I was surprised about. Of all the PDs I had considered she might give, it was not that one. I told her this and she just said that she “felt the signs were there” and that Dr S agreed with her. I told her what Dr S had said to me; that there were some unhelpful personality traits and that I accepted those, but also that either of us didn’t think any constituted a full personality disorder diagnosis. Dr M then tried to justify her decision by saying it was not the primary diagnosis, but that if she thought it was there it should be documented. Somehow she seems to have decided to open the box after all.

I wanted to question how helpful any personality disorder diagnosis would be, let alone an inaccurate one, considering there aren’t any specialist services or extra treatment available here, but we had already gone well over my time and I didn’t have the fight or words to argue.

I want to argue though. I want to fight. The more I have read and the more I think about it, the more unhappy I am about this diagnosis. It doesn’t seem accurate and really doesn’t seem helpful.

I am less concerned about the depressive episode diagnosis, although that has its problems, but the personality disorder diagnosis is really concerning me. I find myself offended and ashamed by it. No one wants to be considered self-serving, unempathetic and arrogant. I think the shame has actually been one of the barriers to posting about it. I don’t even want to put my name near the diagnosis I’m so unhappy about it. The fact it is written in my notes for posterity is disconcerting to say the least.

So what is wrong with this diagnosis?

Firstly “Moderate Depressive Episode”.

If you consider the ICD-10 explanation of this diagnosis, F32.1, you have to note that by referring to a depressive episode you are implying that it is the first episode of depression. For me this is far from the case and I don’t like that my diagnosis neglects to consider any past mood episodes. It is almost as if she doesn’t believe I have been depressed before.

I also question the severity, but I understand that this can be subjective. Many people would go off my BDI score, which is still above 40 (severe depression is considered 30+). I do have more than four of the ICD-10 listed symptoms, but I would also suggest that some of these symptoms are marked and distressing, making it severe. Actually attempting suicide would surely put the suicidal ideation into distressing territory? Worthlessness, guilt etc are all pretty marked too. The thing is I still function reasonably well so people can be forgiven for thinking I am better than I am. It also doesn’t matter. The treatment for a moderate episode varies little from a severe one and it doesn’t make much difference whether it is my first episode or 10th.

What about the lack of acknowledgement of hypomania or high mood? The treatment for Bipolar II Disorder is different to that of Major Depression. I have responded much better to the introduction of Lamotrigine as a mood stabiliser than I did to any antidepressant to date. What if they try to take me off this? Would I respond better to a different one and will they ever try it? Usually antidepressants make me agitated and unstable. I have been okay with the Reboxetine so far, but it doesn’t seem to have lifted my mood at all, so what will happen if they change it? What if I am given an antidepressant that sends me skyward? It worries me.

At the end of the day though I am depressed at the moment and that’s the important thing. It’s the other diagnosis I’m most concerned about.

So – F60.8 “Other Specific Personality Disorder” (Narcissistic).

The ICD-10 does not give individual diagnostic criteria for the disorders listed in this category, so I will assume that the DSM-IV criteria is what Dr M is referring to, after all she had a copy of the DSM on her desk when I saw her.

The criteria for Narcissistic Personality Disorder is as follows:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  4. requires excessive admiration
  5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
  6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
  7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
  8. is often envious of others or believes others are envious of him or her
  9. shows arrogant, haughty behaviors or attitudes

It is also a requirement in the ICD-10 that any specific personality disorder diagnosis meets the general diagnostic criteria for personality disorders.

According to ICD-10, the diagnosis of a personality disorder must satisfy the following general criteria, in addition to the specific criteria listed under the specific personality disorder under consideration:

  1. There is evidence that the individual’s characteristic and enduring patterns of inner experience and behaviour as a whole deviate markedly from the culturally expected and accepted range (or “norm”). Such deviation must be manifest in more than one of the following areas:
    1. cognition (i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others);
    2. affectivity (range, intensity, and appropriateness of emotional arousal and response);
    3. control over impulses and gratification of needs;
    4. manner of relating to others and of handling interpersonal situations.
  2. The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e., not being limited to one specific “triggering” stimulus or situation).
  3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to in criterion 2.
  4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
  5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F00-F59 or F70-F79 of this classification may coexist with, or be superimposed upon, the deviation.
  6. Organic brain disease, injury, or dysfunction must be excluded as the possible cause of the deviation. (If an organic causation is demonstrable, category F07.- should be used.)

I guess you can draw your own conclusions from reading the criteria and what you know of me from reading here. I guess others may have a different opinion of me, but I hope they can see that this is not what I am like.

I have decided to go through each point of the NPD criteria myself to see if I can work out what does and doesn’t fit.

1. Self Importance

has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

I really don’t think this is the case. I often downplay my achievements, because I can actually find it hard to admit them, even recognise them. I was bullied at school for being clever and a “swot”, so I am not really comfortable with admitting my successes to people. Yet when I’m assessed by mental health professionals I do of course have to talk about my achievements and talents, so I guess they can be forgiven for not realising this. It’s hard not to talk about these things when you are asked to give your life story. I have a good job, which I have been successful in, I got a 2.1 at university, I got 3 As at A Level, I got 11 GCSEs including 4A*s and 4As. These are facts though, not exaggerations.

I don’t believe I am superior, certainly not to anyone with equivalent achievements. Most of my colleagues at work have a similar background to me and I certainly don’t consider myself superior to them. Yes, my academic record is superior to someone who left school with 3 Cs at GCSE, but that doesn’t make me superior; just better at school.

I think this is hard when you have been generally successful. You can seem like you are bragging when you are not, it’s just the truth. I remember during the assessment with Dr S there was a lot of focus on my achievements and suggestions that considering my age I had done well. I generally agreed with her, but now I almost wonder if she was fishing for this.

2. Grandiose Fantasies

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

I don’t even believe in unlimited success or ideal love so how I can be preoccupied by fantasies of these things, I don’t know. When Dr M and Dr S had been talking about high standards, they actually seem to mean in this sense, rather than the perfectionist sense, which I didn’t realise until this diagnosis was made. So I’ve been agreeing with them when I actually disagree. They seem to think I expect to be highly successful and powerful. I don’t. In the past I had been fairly ambitious, expecting to do well at school and going on to get a good job, but I don’t expect “unlimited success”. Anyone with a good academic record starting out on a career similar to mine has similar expectations. This is usually something to be considered positive and not out of the ordinary. Now of course I’m depressed and even the most simple tasks seem ambitious, which would suggest that these thoughts aren’t pervasive either, therefore not meeting the diagnostic criteria.

There was a short period fairly recently where I had thoughts of going into politics as I wanted to make a difference and there was a lot of focus on diversity in politics and increasing the number of women in parliament. I can be passionate about issues and want to do something about them. I guess I may have been fantasising a little at the time, but even still this is not an unrealistic ambition. I have been interested in politics for years and often considered it as a future career option, but not because I want to be all powerful.

I have had the odd grandiose moment when my mood has been high though and I have admitted this. Of course they question whether or not I’ve ever experienced hypomania, so will put this down to personality rather than symptoms of a mood disorder.

3. Special Status

believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

This is one that I guess I can identify with, although I am not sure it is correct. I do not believe I am special as such, but I guess I do feel more comfortable with people that have a similar background or interests to me. I think everyone does though to some degree and it is not like I will not associate myself with other people. I try to judge people on their merits and will talk to anyone.

I can see why they may think this is true though. During my assessment with Dr S she asked me about my regrets regarding me degree choice. She asked about how I chose my course and one of my considerations was choosing a respected university. This consideration was mainly to keep my career options open as opposed to anything else. There are plenty of graduate employers that only recruit from top universities. I guess this could be seen as wanting to be associated with “high-status institutions” though, so they may well use this as an example when diagnosing me.

4. Admiration

requires excessive admiration

Erm. I don’t know how to reply to this. I cannot deny I can have difficulty responding to criticism and that I like praise, which I guess may come under this category, but I don’t require or seek excessive admiration. If someone likes me that’s a bonus, but if they don’t then fine.

5. Entitlement

has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

A sense of entitlement? I expect fair and reasonable treatment, but I don’t expect favourable treatment over others. I am a strong believer in equality and a sense of entitlement would go directly against this.

I can at times be stubborn and this could be misconstrued as expecting compliance with my expectations. I will compromise, but I try to be assertive as well. I don’t see this as entitlement though. We are usually encouraged to be assertive when in therapy, so it would be wrong to judge this as being narcissistic.

6. Exploitative

is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

It is criteria like this that makes me so uncomfortable about this diagnosis. I don’t want to be considered self-serving. I don’t take advantage of others in order to get ahead and I find it horrible when people do. Some of examples given are things such as dressing provocatively to get your own way. Ignoring the fact that if I dressed provocatively people would run to the hills, I would never do this. I hate the idea on too many levels.

7. Lacking Empathy

lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

There are two sides to this for me. In many ways I am often considered too empathetic. I consider other people’s needs often to the detriment of my own. I was told off repeatedly by the therapists at The Priory for considering everyone else first, for listening to the others and offering them advice and support, but for not giving myself the opportunity to speak and receive that support back. I would like to think that I understand how others feel and that I am sensitive to their needs. I certainly try to be, so I am not unwilling.

Yet, I know occasionally my bloke finds I have a lack empathy towards him. He says I don’t realise how much the things I say and do hurt him or recognise how he is feeling. I think our relationship is an isolated case though, because there are many ways in which I act different with him than I do with others – lack of assertion is another.  I also don’t think depression helps matters much. I guess a suicide attempt could be seen as not taking other’s feelings into consideration, but if you knew how much I worried and obsessed over this beforehand you would realise it is not.

8. Envy

is often envious of others or believes others are envious of him or her

I think everyone gets jealous now and again. I can be envious of others that have recovered from illness, because I wonder why I have not. I can be envious when someone gets better grades than me at school. I can be envious when I see people having a great time when I am depressed. I wouldn’t say it is often though and certainly no worse than most.

I really don’t believe anyone is envious of me. There would be no reason to be. I’m depressed. My life sucks!

9. Arrogance

shows arrogant, haughty behaviors or attitudes

I hope I don’t, but I guess at times I can be a bit of a snob and I’m guilty of generalisations. I am not exactly appreciative of chavs and I can sometimes be a bit rude towards people that watch rubbish on TV, but I’m not alone on this. I don’t think I’d go as far to say that this is a major problem or that I was particularly bad at it. I certainly know people who are worse than me!

_______________________

Anyway.  I’m going to post this now. It’s not really complete. There is plenty more I could say on the matter, but I’ve been at it for hours and if I don’t post it now it may be days before I do finish it. Maybe I will edit this post, or maybe I’ll add another. We shall see. This is well over 3500 words long now and I have spent quite a few hours on it.

Does anyone have any ideas of what to do next? I just feel a bit lost and trapped. I’m worried that if I question the diagnosis, it will come across as narcissistic! That is the biggest problem with personality disorders. Questioning it is just further evidence of the disorder and can all be seen as part of the problem.

34 Responses

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  1. I’m shocked and I really don’t know what to say… apart from I am truly shocked! I knew you were dealing with a new diagnosis but this is ridiculous…

    Okay I only know you via the internet and we’re met twice and talked on the phone twice (see who has a good memory!) but I wouldn’t say you have a Narcissistic Personality Disorder, what planet is this Psych on? You certainly don’t lack empathy…

    I have a male friend who is DX with Narcissistic Personality Disorder now he on the other hand says he doesn’t think he has this personality disorder… but knowing him, how he behaves, how he acts… I would personally say his DX is right! It tends to be more males than females that are DX with it I think anyway…

    The whole high mood thing was why the NHS would never DX me with Bipolar II because they never witnessed the ‘High Moods’ but no offence to the NHS, I never really felt like presenting to the NHS when I was blowing £500 in the Trafford Centre or travelling around Europe… the last thing on my mind was thinking of turning up at A&E and claiming ‘Hey I need a psych, I think you guys need to witness this high moment in my mood’, it’s absolutely f***ing crazy… they should go off the person, what we say, what our family say… we can ourselves determine our moods, look how off the scale mine was I was living life on a rollercoaster until Dr G gave me Topiramate took a while to get to a good dose but the mood swings are pretty much stable now!

    I really don’t know how you can handle this DX, apart from query it with this Dr S, get her to review it again, if you’re not happy ask for a second opinion, you are entitled to that. Consider getting PALS involved.

    You know where I am if you need to chat or email! Hang in there, take care… xxx

    Alison

    Tuesday, 2nd March 2010 at 6:24 pm

    • *hugs*

      The NPD diagnosis is frustrating because I feel trapped by it. Challenging it could seem like narcissism! I have contacted an advocacy service, but not sure they can help me really. Don’t know about PALS. Suspicious of them as they are NHS related!

      The high mood thing is frustrating. When I was first admitted to the ward I felt quite high – agitated, barely sleeping but not tired, writing lots but not making much sense, talking too much and too fast, running around my room jumping between activities, texting a million and one people etc. The thing is I told her I felt quite high and she said I didn’t come across as such because I was too coherent during my ward round and the nurses hadn’t observed me to be high. The fact was I was hiding in my room because I didn’t want to drive everyone mad. I wasn’t saying I was completely manic, just a little higher than could be considered normal! It seems that she now thinks that any description I can give of my mood is inaccurate.

      Take care xx

      intothesystem

      Thursday, 4th March 2010 at 5:51 pm

  2. My immediate thought is how much the criteria for NPD are like those of a hypo/manic episode. Do you think they assessed you on how you were at the time (seem to remember you were racing a lot when first in hospital) and not taking into account these are episodic periods associated with the ‘up’ end of your mood disorder rather than a long standing ‘stable over time’ personalty disorder? (one would hope not if you had 2 hour long assessments but…)

    Hope that makes sense – I have trouble putting things into words. Fight the PD dx if you feel it’s wrong. Don’t accept it.

    Helen (previously silent reader of your blog but not associated with your trust & don’t know you, if that helps!)

    Helen

    Tuesday, 2nd March 2010 at 7:48 pm

    • I was racing a lot when I was first admitted, but they did not seem to believe me at all because I was apparently too coherent during ward round and they had not “observed me to be manic”. The fact I was hiding in my room and trying not to draw too much attention to myself was ignored. They wouldn’t acknowledge that I’d slept barely an hour or two each night and that I was wide awake and not tired. I explained that I felt agitated and giddy. I was writing literally hundreds of pages in my diary, which when I read it back I realise it doesn’t make much sense. I knew I was higher than what would be considered normal, but apparently my opinion doesn’t count.

      If they won’t acknowledge the hypomania it is impossible to get them to realise that the odd grandiose moment is an episodic thing down to my mood.

      Apparently the narcissistic alarm bells were ringing during my first ward round (when I was a little high!). I wanted to make sure they realised how scared I am about doctors and that I hated to be patronised, but I am not sure I chose my words very carefully. It seems they thought I was arrogant for suggesting that they might patronise me in the first place.

      It’s frustrating. I have been diagnosed based purely on 2 assessments and a couple of ward rounds. The person giving the diagnosis didn’t even do the assessments so she could take from the notes what she will.

      I am going to try and fight but I’m scared about it.

      Thanks. x

      intothesystem

      Thursday, 4th March 2010 at 6:08 pm

  3. OK, I don’t really know you very well, but based on reading this blog for several months and following your Twitter feed, I have to say that a diagnosis of NPD sounds like complete and utter horseshit! For what it’s worth from what you’ve written your depression also sounds severe to me, but as you say at least the treatment is similar for moderate.

    Can you get a second opinion? If the NHS are unco-operative, is there any way you could consult another private psychiatrist? Or you could try contacting Rethink’s advocacy service and see if they will liaise with Psychiatry and tackle the unlikelihood of this diagnosis.

    I think you’ve pretty eloquently summed up here how this is a very improbable diagnosis. You live with yourself 24 hours a day; these twats have made this “assessment” on the basis of a few hours. If they won’t listen to your own concerns, I do hope you’ll be able to discuss this with an advocate or similar.

    Good luck, and big hugs. xxx

    Pandora (Serial Insomniac)

    Tuesday, 2nd March 2010 at 8:42 pm

    • I have written a letter for my consultant. I see her on Monday.

      I am going to ask about the possibility of a second opinion. I actually saw a private psych for a year and as far as I am aware she never mentioned NPD, despite the fact she is a personality disorder specialist. I wanted to know what she thought, but as I am not longer her patient it’s probably not possible.

      Thanks for the luck. I think I need it!

      intothesystem

      Thursday, 4th March 2010 at 6:10 pm

  4. “I find myself offended and ashamed by it. No one wants to be considered self-serving, unempathetic and arrogant. I think the shame has actually been one of the barriers to posting about it. I don’t even want to put my name near the diagnosis I’m so unhappy about it.”

    Regarding personality disorders, i can empathise completely. Although i’d love to know whether they have handed me that as a diagnosis, or whether it was written in my notes for fun! I have become rather adept at reading upside down in a subtle manner!

    Like you though, i fear if i bring the subject up and react against it then this will give them more evidence to state their case.

    I think it was CBTish who commented on a post i wrote regarding diagnoses, labels & PDs – It went something along the lines of the fact that a diagnosis is only really of any use if it give you access to the correct help/treatment.

    take care.

    xx

    Susie Belle

    Tuesday, 2nd March 2010 at 9:03 pm

    • Yeah CBTish has commented with that below, as if summoned like a genie.

      I talked about it with my GP today. I said I’m scared of bring it up and he replied “because doing so might seem narcissistic”. So at least he recognises my dilemma. Doesn’t make it any easier though.

      intothesystem

      Thursday, 4th March 2010 at 9:43 pm

  5. The most important thing is, as you mentioned at one point, how helpful this is in your treatment — how does it change things? If it makes no difference then it’s not worth worrying about.

    Or, to put it another way, what do you think would help you most in treatment? And does this new diagnosis give you any leverage in obtaining it? I’m surprised that the psychotherapy specialist didn’t put it in those terms.

    cbtish

    Tuesday, 2nd March 2010 at 9:09 pm

    • It has been put to me in those terms, but as far as I can see the new diagnosis is going to make no positive difference and if anything it will make things worse.

      I was on the waiting list for long-term therapy anyway and this diagnosis will not speed up that process. It also means that they are diverting attention away from other treatment for the depression, because there is an assertion that if I have a PD then the only way I can get better is to treat it with therapy.

      Not to mention the stigma attached with such a label and the barriers that can bring.

      intothesystem

      Thursday, 4th March 2010 at 6:13 pm

  6. Really sorry to hear about this. I can relate a lot, as I was also diagnosed with Narcissistic PD, I suppose a couple of years ago now. This was my a Clinical Psychologist, who I don’t really know how to describe. Certainly very arrogant. One day I had an appointment with the psychiatrist immediately before seeing her, and so when I saw her she asked how it had been and what he had said, and when I told her she insisted I must be wrong, and said ‘No, he can’t have said that. We discussed what he should say before your appointment, and I didn’t tell him to say that. I will have to speak to him about this.’ She seemed to have a bit of a god complex. I am now under a different CMHT, and no longer have the Narcissistic PD diagnosis – it was changed to Borderline, which whilst I don’t like because of the stigma associated with it, I can at least relate to. My CPN can’t believe I was diagnosed as Narcissistic – says it is absolutely nothing like me, can’t see how any of the diagnostic criteria could relate to me, and thinks the whole thing is pretty ridiculous, particularly as I have very low self esteem, which seems a complete contradiction with a Narcisstic PD diagnosis. This seems to be the opinion of everyone I know, apart from this one Psychologist. Receiving that diagnosis really upset me though – it made me feel like I must be a horrible person if I had no empathy for others, and used people to get what I wanted etc. I also had the same fears about questioning it – I didn’t know how I could do so without being seen as Narcissistic – a real catch 22. I would suggest asking for another opinion perhaps, or as Alison said, consider getting PALS involved. I would also check if they are planning to change your medication, and say that you feel like the Lamotrigine helps you more than any anti depressant has etc. I am really sorry you are in this situation – misdiagnoses are horrible. x

    Bippidee

    Tuesday, 2nd March 2010 at 9:35 pm

    • This scares me quite a lot due to the number of parallels.

      I get the impression that Dr M (my consultant) influenced Dr S (psychotherapy consultant) quite a lot before she assessed me. Thinking about it now I can see that a lot of her questions were geared towards narcissism.

      I too have pretty low self esteem, although I vaguely remember that being used to justify something about “high standards” at one point. There has been so much rubbish said though I can’t remember what is what.

      intothesystem

      Thursday, 4th March 2010 at 9:50 pm

  7. I only know you online, but I can not see how this diagnosis applies to you. You are very empathetic, and your empathy gives you very helpful insights into others’ situations.

    Some of the other traits seem to me if anything to possibly come out of low self-esteem, like the needing praise thing. I have a hard time responding to criticism, not because I feel I don’t deserve it, but because I automatically think that people hate me if they criticise me. I respond better to praise. This is something I need to work on, self-esteem, confidence, etc., but it does not mean that I require admiration because I think I’m so wonderful.

    And other traits, if you have them, can come from hypomanic episodes.

    Grrrrr. Could you respond in writing, based on this post? That is what I have been recommended, when I can’t communicate verbally.

    When do you next see a doctor?

    Karita

    Wednesday, 3rd March 2010 at 10:11 am

    • Thanks hun.

      I think it’s not even that I seek praise, but I guess like everyone, it’s nice to get it once in a while. I do struggle with criticism though and you are right, it’s not usually because I disagree with them, but because I can be a perfectionist and I end up beating myself up for it.

      I saw my GP today and I see Dr M on Monday. I ended up emailing a letter to Dr M’s secretary. I have felt sick to the stomach since.

      intothesystem

      Thursday, 4th March 2010 at 9:53 pm

  8. Also knocked for six.

    Reading down that list, who hasn’t felt envious or arrogant or any of those things at one time or another? But you really (really, really) don’t come across as consistently envious, arrogant, exploitative etc. Not at all. It would never have occurred to me to use those words to describe you in a million years.

    la

    Wednesday, 3rd March 2010 at 11:32 am

    • Thanks.

      You are right that these are all normal personality traits and yes, I have experienced some of them. We all have. That is the problem with PD diagnoses – at what point does normality become a disorder? If you wanted you could easily find a few examples and give someone a diagnosis, but I don’t see how they can suggest a pervasive and enduring pattern of behaviour with a couple of hours of assessment.

      intothesystem

      Thursday, 4th March 2010 at 9:57 pm

  9. Hello Inthesystem,

    I greet you from Cork Ireland. Found your blog post via a Google Alert I have for this sort of stuff.

    All I have to go on is this single post. But you may be interested in another view. I admire you for writing such a long sustained post. You present the story in a way I found captivating and horrifying. Captivating because I wanted to read to the very end. (to be continued)

    Paul O'Mahony (Cork)

    Wednesday, 3rd March 2010 at 7:25 pm

  10. i literally felt like crying when i read this blog. i’ve been checking in for a couple of weeks now to see if you expanded on the whole diagnonsense issue. i think it was the explanation of the shame you felt regarding the diagnosis that got me. i think you’re really brave for talking about it despite this. i think all mental illness can be stigmatizing but somehow PD is such a horrible title for what is probably one of the most difficult diagnosis to live with.
    as for your psych- well! it sounds like she’s failed you on several instances. some of the advice on how to approach this seems helpful.
    thank you for writing about this. i hope you can move forward in a way that is helpful and kind to yourself.

    starrunner

    Wednesday, 3rd March 2010 at 9:11 pm

    • Thanks.

      It does feel like much more of a personal slur than any other diagnosis would. I don’t even object to the personality disorder side of things so much, it’s the narcissistic side that I find so shameful and embarrassing.

      intothesystem

      Thursday, 4th March 2010 at 10:00 pm

  11. Ouch, it’s never nice to be buried in a sea of confusion and frustration that I’m sure this turn of events has bought on.
    xx

    Phoenix177

    Wednesday, 3rd March 2010 at 9:49 pm

    • Thanks. It’s not. I feel genuinely ill over it all.

      btw – going off twitter your name is the same as another mentalist I know, but she lives up here! Very weird!

      intothesystem

      Thursday, 4th March 2010 at 10:04 pm

  12. Forgive me for the wry smile, it’s aimed at the system, System, not at you. It’s amazing how that PD label gets wheeled out like it’s a Happy Bonus! Well done, congrats, have a lifetime of stigma….what, why aren’t you happy?

    I’d be gutted too.

    It’s the way it’s applied, like a bully applies chewing gum to an unsuspecting classmate’s hair on the bus to school.

    “Ignoring the fact that if I dressed provocatively people would run to the hills”

    Doesn’t seem very Narcissistic to me, huh? Maybe I misunderstand the diagnosis, but surely you should have an inflated sense of self esteem, not a deflated one in terms of self image? I dunno, seems a bit fishy. How can someone be depressed enough to consider themselves worthless, want to kill themselves because life isn’t worth living, but also consider themselves Better, Entitled, and Special? That makes little sense to me. I also thought I read somewhere that a PD should be a primary diagnosis?

    Lola x

    PS Sorry, don’t hate me, but how much input has your Bloke had with the team recently? If he has been pissy with you about the blog/the mentalosphere, could his input have been misinterpreted?

    Lola Snow

    Thursday, 4th March 2010 at 6:35 pm

    • I don’t hate you, but my bloke probably will!

      I don’t think anything he’s said will have contributed to this. He hasn’t had much contact with Dr M anyway and I think she’d already made her mind up before she even met him.

      He disagrees with the diagnosis as well, despite the occasional accusation that I’m not empathetic towards him, so I don’t think it is that.

      I think I’m actually going to let him come with me on Monday to see her. I’m usually so reluctant to have anyone there, but I think if I go on my own I will just end up backing into a corner or breaking down completely.

      I too find it hard to believe that I can be considered narcissistic when I generally think so little of myself. Maybe she thinks I wanted to kill myself *because* I’m special. I dunno.

      Not sure about a PD being a primary diagnosis, but it does have to be enduring and not limited to episodes and the symptoms can’t be explained by other diagnoses (e.g. grandiosity resulting from mania).

      intothesystem

      Thursday, 4th March 2010 at 10:12 pm

  13. I’ve been reading your blog for a while now and whilst I don’t know you, this diagnonsense really doesn’t sound right from other things you have written. I am diagnosed with Bipolar and like you I never seek help when I am having a hypo/manic episode. I am on top of the world with no insight that there is anything wrong, why the hell would I ask for help?! So like you, the professionals have never witnessed a full blown manic episode, they have seen me hypomanic but that is it. My psychiatrist though seems happy with my diagnosis of Bipolar and it has been commented that I show some BPD traits but not enough for a dual diagnosis. I agree with the others who have commented in that if you know this diagnosis is not right then fight it all the way and get a 2nd opinion. Nobody wants to be treated for a condition that they know in their heart they don’t have. I am also on Lamotrigine and compared to the other mood stabilisers they tried me on, and compared to anti-depressants alone, Lamotrigine is proving to be a lifesaver for me. In 3 months I have been far more stable than the last 3 years. I really believe that if a mood stabiliser is stabilising you, then it is far more likely that you have a mood disorder. Sorry for such a long comment, I wish you the best of luck in fighting this diagnonsense you have been given x

    mycrazybipolarlife

    Thursday, 4th March 2010 at 6:37 pm

    • Lamotrigine hasn’t been a life saver for me, but it has certainly helped.

      I said this to my GP today and he said it can’t have helped too much if you still end up in hospital after a suicide attempt, but I think he’s forgotten how unstable I was before. I may still be very depressed, but I’m not agitated and all over the place like I used to be. I’m a little surprised that he didn’t acknowledge this, but never mind.

      intothesystem

      Thursday, 4th March 2010 at 10:16 pm

  14. >>Apparently the narcissistic alarm bells were ringing during my first ward round (when I was a little high!). I wanted to make sure they realised how scared I am about doctors and that I hated to be patronised, but I am not sure I chose my words very carefully. It seems they thought I was arrogant for suggesting that they might patronise me in the first place.

    So they’re pathologising their opinion of you? And that’s all it is – an opinion. You can argue it’s a medical opinion, but arrogance isn’t a medical condition. I can say so and so is a bitch, doesn’t mean she has a personality disorder.

    la

    Thursday, 4th March 2010 at 9:41 pm

    • As far as I can tell that is exactly what she is doing. She practically told me before I was discharged that she didn’t think she would get on with me very well.

      It seems like she pretty much made up her mind from that one ward round when I was very nervous and agitated, had just tried to kill myself and wasn’t exactly behaving normally.

      intothesystem

      Thursday, 4th March 2010 at 10:24 pm

  15. This whole not witnessing hypomanic episodes annoys me so much and I brought this up with Dr G yesterday, (and something I intend to blog about shortly) it was part of the reason the NHS didn’t want to diagnosis me with Bipolar II because they didn’t witness episodes, but as I stated to Dr G I’m not likely to present to A&E or a Doctor or Shrink when I was hypomanic and she fully agreed with me, in her words ‘No you’d be off travelling having a good time…’

    I urge you to fight this diagnosis, I was thinking about you a lot last night and I’ve re-read this post today and the more I read this what you have written the more annoyed I get with the NHS!

    Alison

    Friday, 5th March 2010 at 7:47 am

  16. I left a comment yesterday but I was just thinking something about your situation. I’m not sure how much this applies to you, but I was thinking that if my diagnosis ever got changed then I would be ever so slightly annoyed that I had been given “poisons” to put in my body for all these years, then suddenly someone comes in and says “oh actually you don’t have that diagnosis after all”.

    But essentially what is most important is that this new diagnosis is challenged. I wonder if the professionals would admit to giving you “unnecessary medication” for x amount of time if they are so sure all of a sudden that you aren’t bipolar.

    And as I said before, mood stabiliser drugs are most effective for mood disorders, not personality disorders. Therefore if mood stabilising medication is beneficial and making a noticeable difference, whilst I’m not a doctor, common sense would say that surely there is a mood disorder to treat if mood stabilising medication makes a difference.

    Anyway, again best of luck in getting this all sorted as soon as poss :)

    mycrazybipolarlife

    Saturday, 6th March 2010 at 1:38 am

  17. I was talking about you yesterday to the MH Advocacy services at the hospital {obviously no names mentioned} I’m applying to volunteer there and they were absolutely disgusted at how you have been treated by the NHS and how they came about your DX when I explained to them about your time in The Priory, treatment etc… I was talking to them about me, how we had Dr G in common why I went private and it seems it’s a very much common occurrence of people being very unhappy at not getting the right medication at MY hospital, but not everyone is in a position to go private! The woman I was talking to actually remembered me from the ward last year as I volunteer my services last year but just never followed it through, and yesterday popped in after my appointment and she said ‘Yes I remember you, the college girl’ I couldn’t believe it!

    Alison

    Saturday, 6th March 2010 at 10:48 am

    • Aww thanks for thinking about me.

      I know what you mean about private care. I am sad that I had to leave The Priory. I do find things have only got harder since I left Dr G – I don’t really trust anyone involved with my care any more.

      Cool that the woman remembered you. Always a good sign. xx

      intothesystem

      Wednesday, 10th March 2010 at 2:00 pm

  18. I’ve been reading your blog on and off for a while and felt compelled to reply to this post because I think that for you to be given such a diagnosis is frankly disgusting.

    Would you be able to make a one-off appointment with your psychiatrist from the priory for a second opinion?

    Jessica

    Saturday, 6th March 2010 at 11:20 pm

  19. Ugh, I’m really sorry that they’ve put that label on you, and similarly rather baffled – from reading your posts it doesn’t seem to apply to you at all. Do try and fight it, I hope things go well with Dr M on Monday. Take care x

    thesunshinediaries

    Sunday, 7th March 2010 at 4:28 am

  20. […] a comment » I am still finding the whole story of my diagnosis pretty distressing. Every time I think about it I feel like shit. More often than not I start […]


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