hi, well i have a problem, it seems that going to a Psychologist has got me thinking that i wasn’t who i thought i was. i thought i was antisocial, but then i realized i had guilt so i wasn’t that, i was recently in the ER for spontaneous suicidal tendencies. so i’m seeing a psychiatrist for meds for depression and anxiety, i was released and now i feel empty i feel like i don’t know who i really am, i do have symptoms of antisocial,paranoid,borderline,schizotypal -schizoid, narcissistic. but i cant really nail any "one", of them. my therapist isn’t really giving her thought on the whole thing and i feel i am left to go insane. my dad has mood swings, my mom was suicidal and drank and smoked a lot and as a result died at 36, she was on meds for a few things-unsure of what that was. my uncle on my mothers side was a fire starter. so with a mouthful said can you lend some insight? thank you.
- Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
- Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
- Questions submitted to this column are not guaranteed to receive responses.
- No correspondence takes place.
- No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Dombeck to people submitting questions.
- Dr. Dombeck, Mental Help Net and CenterSite, LLC make no warranties, express or implied, about the information presented in this column. Dr. Dombeck and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
- Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
This doesn’t sound like identity confusion so much as diagnosis confusion. Even if you have a diagnosis or two, these would not need to define you as a person. A person is a much bigger and more important thing than a diagnosis.
It is entirely normal to want to know what is happening to yourself with regard to diagnosis though, so I will do what I can to help you understand with what limited information you’ve provided.
I think in this case, my "big insight" is that you may be, in part or in whole, barking up the wrong diagnostic axis. Mental health disorder diagnoses are made using five axes or separate diagnostic components. The terms you are slinging around such as "antisocial", "narcissistic", "paranoid", "borderline", "schizotypal" and "schizoid" are what are known as personality disorders. These are diagnosed on the second diagnostic axis (known as Axis II) and describe lifelong rigid personality styles and tendencies that people may have. The first diagnostic axis (Axis I) is where significant but non-lifelong conditions are described, such as Major Depression, Bipolar Disorder or Schizophrenia. Axis III is used to describe pre-existing medical conditions which may affect behavior. Axis IV is used to describe any social or economic conditions which may affect behavior. Finally, Axis V is used to make a 0 to 100 rating of how well the person is functioning (with 0 being dead and 100 being absolutely healthy and good).
It is entirely possible that the problems you are experiencing are best described on Axis I rather than Axis II. If you’ve been hospitalized for being suicidal, there is at least a mood component of your condition, which would suggest the diagnosis of depression or a related mood disorder such as bipolar. This is especially likely given that you’ve described your parents as showing mood symptoms, and depression tendencies are in large part heritable.
It’s hard to know what to do with your feeling of emptiness. This is a common complaint among people diagnosed with personality disorders, but it also fits people diagnosed with mood disorders and often times, people diagnosed with psychotic disorders. If there is a bit of psychosis happening for you, it is possible that the accurate diagnosis would be schizoaffective disorder, which combines characteristics of mood disorder with some of the psychotic features characteristic of schizophrenia. You aren’t talking about hallucinations or delusions it doesn’t seem, and your ability to construct an email is intact, so if you have a psychotic disorder, it is an organized one, and not as heavy as it could be. There really is no telling though, given that we just don’t have a lot of information to go on.
You should be aware of the NOS category that exists, built into most of the diagnostic categories within the mental disorders. NOS stands for "not otherwise specified". It is certainly possible for people to meet partial criteria from a number of different personality disorders without meeting full criteria for any of them. In such a case, until the diagnostic picture becomes clearer, a person usually gets a "Personality Disorder NOS" diagnosis, suggesting to other clinicians that something is happening in the personality disorders (Axis II) direction, but it isn’t yet possible to say its nature. Specifiers can be applied to the NOS diagnosis too, to indicate which personality disorders are partially present. So it is possible to be diagnosed with "Personality Disorder NOS with antisocial, paranoid, borderline, schizotypal, schizoid and narcissistic traits", although this would be silly to diagnosis in practice, because it is so very unspecified. Us clinicians don’t like to make such vague diagnoses unless we have to.
Here is another angle to consider. The personality disorders are grouped into three categories called clusters. Cluster A, containing Paranoid, Schizoid and Schizotypal diagnoses is thought of as the "odd and eccentric" cluster. Cluster B, containing Antisocial, Borderline, Histrionic and Narcissisticic diagnoses is thought of as the "dramatic and erratic" cluster. Finally, Cluster C, containing the Avoidant, Dependent and Obsessive-Compulsive diagnoses, is thought of as the anxious cluster. Looking at the personality disorders you describe as partially fitting you, I’m struck by the absence of Cluster C diagnoses, and the abundance of Cluster A and B diagnoses. If we take a broad view of this, you are suggesting that your behavior is moody and emotional, eccentric and odd, and intense/dramatic in nature, but not particularly hesitant. It is likely that you are more impulsive than not in your approach to life.
Diagnoses are important in so much as they help people understand what is happening to them and get access to an appropriate treatment that will best help them to recover themselves. There is a heirarchy of what is important to address at any given moment. If you are suicidal, all other diagnostic concerns sort of fall away until you are recovered from that suicidality which has to be the primary treatment concern. In that light, my advice to you is to not worry so much about what labels are the right ones to put on yourself or confuse with your identity, and worry more about doing what you can do to help insure that your life will be less painful. This means being treatment compliant (when treatment makes sense to you and when other people you trust say that it is helping you), and working on yourself and your lifestyle so as to keep yourself as healthy and stress-free as practical.
Hope this helps you.