To all who may be interested,
My brain is not working well today, but if it were I would have much more to say. However, much would agree with what you have already written. So instead, I will just pose a few food for thought comments:
1. The diagnostics categories and axes are ever evolving and highly debated in whatever form they exist. They are at best based on the current available body of 'reliable knowledge' and 'concensus agreement' of 'declared experts' at the time of printing, hence the delay in releasing DSM-V. Yet before, during, and after such printing there is still much debate among professional. In fact, it is hard to find three professionals who can agree upon a diagnosis, let along four or more.
2. As you also accurately wrote, the conditional backdrop behind any properly assessed personality disorder is that the individual is at least 18 and the the pervasive traits were evident in childhood/adolescence. Well, statistically speaking, many if not most consumers are not seen/assessed by a psychiatrist or psychologist until adulthood. So in order assess whether any pervasive trait existed in childhood/adolescenc, a professional must often times rely on the testimony of others (unless clear legal documents exist), which is clearly an interpretive judgment call. And again, it is hard to get two professionals to agree.
3. Now another conditIonal backdrop for diagnosing (as you clearly indicated) is that a personality disorder can only be applied when there is NO other "condition/disorder that better accounts for the consumer's symptoms". And I do not contest this at all, personality disorders should only be used if no better medical or axis I disorder exists. Now what follows next is my opinion, but at least a worthy food for thought. Taking into account the fact that I have severely rare autoimmune disorders that attack my entire body, produce great pain, steal my energy, and alter my view of the world based on the limitations it imposed on me, I have had MANY licensed and credentialed psychiatrists label them as some somatoform disorder simply because they refuse to believe the "proof" in light of my past.
And in that same vein, I strongly believe that many consumers with PTSD get in incorrectly diagnosed with borderline or avoidant or obsessive compulsive or other personality disorders when the syptims are better explained by PTSD. This seems especially true when early childhood trauma/abuse exists. One has to ask would the, for example, black-and-white pervasive thinking of BPD or pervasive avoidance of AvPD or the compulsive need for perfection/order of OcPD exist if a child had experience such complex trauma or was not in a fight for their own survival almost since birth? Who knows what traits that child would have developed, if not exposed to such trauma.
4. In line with that, there are a boatload of unqualified professionals, who rather than take partial credit for the successes and failures in a therpeuatic alliance, choose to "blame" the consumer instead of admitting that they were not truly qualified to work with a particular diagnosis and person. How many PTSD sufferers have be first labeled 'defiant', 'resistant', 'unamenable to change', or 'unwilling to accept tx recommendations' or 'aggressve' or 'uncooperatve' and so on, when often times this is more areflection of the professional's skillset, projection, or insecurities?
To make a simply analogy in an effort to clarify (but one I recognize is not 100% accurate - too tired), in the case of one who is repeatedly exposed to early onset, prolonged, brutal, manipulative, and life-threatening child abuse, many professionals often (and in secrecy or while li) assess the sole diagnostic label of BPD, when in my view such cases are likely labeled that when it should more accurately be PTSD. As in (PTSD - Trauma ~= BPD) but with much more stigma from the medical and mental health communities here in the states.
5. And one last comment which I am sure will come out not as clear as I see it in my head (damn brain). Part of me (not that I have more than one identity or anything *smile*) wants to tentatively say that the only diagnoses we as consumers need to get correct are the ones we have been diagnosed with, one of which being PTSD - the reason we are here, sufferers and supporters alike. Please try to delay forming any opinion/reaction yet until I can get the rest out. And I would like to approach from two angles, if possible.
I believe that diagnostic criteria are always in flux, and today's understanding is not tomorrow's understanding. There is as much agreement as there is disagreement and new diagnoses and criteria and classsification are being proposed every single day. So is it so wrong for a layperson/member to use C-PTSD to describe what they feel better fits their systems when it is part of the 'proposed body of knowledge'? I myself find it helpful to me when many standard tx models work from the premise that "one can somehow how get back to their pre-trauma life after the trauma has been dealt with in therapy. But, take me for example, I have no pre-trauma life to refer to, since my life was in jeopardy since the very day I was born. In addition, many critical developmental phases were affected (language development for one) by my longstanding and intertwining abuse/neglect trauma. And that makes it more complex than was the DSM refers to as "single incident trauma". So again helpful for me to use that description.
And then there is the question of using descriptive terms, which may overlap with diagnostic one, to expound on our perceived experiences with another. For example, sociopathic is not a diagnostic code in the DSM, but ASpD is. Also narcissistic and histrionic are not diagnostic labels either unless you specifically add 'personality disorder' to them. However, they all have a cultural and a descriptive meaning to them apart from the specific psychological meaning. And I know "sadistic" and "bio bitch Barbie" have no value/place in any diagnostic tool, just like 'vermin', 'whack job', 'f*ing bastad', 'crazy ass lunatic', 'puppet master', 'monster', 'hostage taker'', 'exploiter', and so. But, for me, because of the cultural meaning of antisocial (a little socially awkward) and narcissistic (a little self-centered), my mother being diagnosed as having either (depending on the professional she deviously met with while stalking me night and day) a NPD or ASpD never fully described to me or to others less psychologically knowledgeable the breath and depth of the 'soul murder' that she was to me. But I felt more validated and others did relate better to my lived experiences when I would refer to her as a 'my sadistic narcissist mommie' or my 'sociopathic bio bitch Barbie'. I certainly do not care about my mother's various diagnostic labels, I just care about depicting how "I experienced her" and about how I wished she never had the label of "my mother".
I have many more thoughts and questions, and these were most assuredly not presented as clearly or as correctly as I would have wished. However, I have to work with my brain the way it is now (many losses). Yet I do sincerely hope that I made some on here question their own assumption as I have about how trivalized the words trauma and abuse have become, and how very difficult it is to speak to our experiences in the language of finite words when so much of our experiences take place on the nonverbal plane.
And just to reiterate, I am not presenting this to argue or debate or challenge anything, just my little spin on 'descriptive labels and depiction' from my unique perspective. Ponder or question or discard as you see fit.
I'd eat humble pie, but only just ate my first ICU meal in almost three months - so I doubt "pie" is on the menu anytime soon. :)
Warm Regards,
Alex
