Disorder Diagnosis Quotes

Insanity is everyone expecting you not to fall apart when you find out everything you believed in was a lie.

Calling it lunacy makes it easier to explain away the things we don't understand.

Stigma against mental illness is a scourge with many faces, and the medical community wears a number of those faces.

People's behaviors are messages, not a diagnosis because I can no longer discern the world's version of insanity.

I couldn’t trust my own emotions. Which emotional reactions were justified, if any? And which ones were tainted by the mental illness of BPD? I found myself fiercely guarding and limiting my emotional reactions, chastising myself for possible distortions and motivations. People who had known me years ago would barely recognize me now. I had become quiet and withdrawn in social settings, no longer the life of the party. After all, how could I know if my boisterous humor were spontaneous or just a borderline desire to be the center of attention? I could no longer trust any of my heart felt beliefs and opinions on politics, religion, or life. The debate queen had withered. I found myself looking at every single side of an issue unable to come to any conclusions for fear they might be tainted. My lifelong ability to be assertive had turned into a constant state of passivity.

No one would ever say that someone with a broken arm or a broken leg is less than a whole person, but people say that or imply that all the time about people with mental illness.

Mental illness" is among the most stigmatized of categories.' People are ashamed of being mentally ill. They fear disclosing their condition to their friends and confidants-and certainly to their employers.

You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.

The biographies of the great men see their excesses as signs of their greatness. But Jean Rhys, in her biography, is read as borderline; Anaïs Nin is borderline; Djuna is borderline; etc. etc. Borderline personality disorder being an overwhelmingly gendered diagnosis. I write in Heroines: “The charges of borderline personality disorder are the same charges against girls writing literature, I realize—too emotional, too impulsive, no boundaries.

Accepting a psychiatric diagnosis is like a religious conversion. It's an adjustment in cosmology, with all its accompanying high priests, sacred texts, and stories of religion. And I am, for better or worse, an instant convert.

You can't compare men or women with mental disorders to the normal expectations of men and women in without mental orders. Your dealing with symptoms and until you understand that you will always try to find sane explanations among insane behaviors. You will always have unreachable standards and disappointments. If you want to survive in a marriage to someone that has a disorder you have to judge their actions from a place of realistic expectations in regards to that person's upbringing and diagnosis.

When he first said my diagnosis, I couldn't believe it. There must be another PTSD than post-traumatic stress disorder, I thought. I have only heard of war veterans who have served on the front lines and seen the horrors of battle being diagnosed with PTSD. I am a Beverly Hills housewife, not a soldier. I can't have PTSD. Well, I was wrong. Housewives can get PTSD, too, and yours, truly did.

And if we do speak out, we risk rejection and ridicule. I had a best friend once, the kind that you go shopping with and watch films with, the kind you go on holiday with and rescue when her car breaks down on the A1. Shortly after my diagnosis, I told her I had DID. I haven't seen her since. The stench and rankness of a socially unacceptable mental health disorder seems to have driven her away.

we estimate that more than 50 percent of all children with an ADHD diagnosis actually have a sleep disorder, yet a small fraction know of their sleep condition and its ramifications. A major public health awareness campaign by governments—perhaps without influence from pharmaceutical lobbying groups—is needed on this issue.

Complex PTSD consists of of six symptom clusters, which also have been described in terms of dissociation of personality. Of course, people who receive this diagnosis often also suffer from other problems as well, and as noted earlier, diagnostic categories may overlap significantly. The symptom clusters are as follows: Alterations in Regulation of Affect ( Emotion ) and Impulses Changes in Relationship with others Somatic Symptoms Changes in Meaning Changes in the perception of Self Changes in Attention and Consciousness

Denial and minimizing is often seen in genuine PTSD and, hence, should be a target of detection and measurement.

I had a character disorder. When I got my diagnosis it didn’t sound serious, but after a while it sounded more ominous than other people’s. I imagined my character as a plate or shirt that had been manufactured incorrectly and was therefore useless.

...some patients resist the diagnosis of a post-traumatic disorder. They may feel stigmatized by any psychiatric diagnosis or wish to deny their condition out of a sense of pride. Some people feel that acknowledging psychological harm grants a moral victory to the perpetrator, in a way that acknowledging physical harm does not.

One day I would like to make up my own DSM-111 with a list of “disorders” I have seen in my practice. For example, I would want to include the diagnosis “psychological modernism,” an uncritical acceptance of the values of the modern world. It includes blind faith in technology, inordinate attachment to material gadgets and conveniences, uncritical acceptance of the march of scientific progress, devotion to the electronic media, and a life-style dictated by advertising.

As it stands, the diagnostic criteria for depression are so loose that two people with absolutely no symptoms in common can both end up with the same unitary diagnosis of depression. For this reason especially, the concept of depression as a mental disorder has been charged with being little more than a socially constructed dustbin for all manner of human suffering.

While a psychiatric diagnosis can serve a purpose in treatment plans, it should not become a tool to discredit a person's disclosure of abuse.

I thought the doctor's diagnosis was the first step to mending her. I know now that a diagnosis is taken in like an orphaned dog. We brought it home, unsure how to care for it, to live with it. It raised its hackles, snarled, hid in the farthest corner of the room; but it was ours, her diagnosis. The diagnosis was timid and confused, and genetically wired to strike out.

There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life....We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

Bizarrely, my biggest fear was that the tests would prove I didn’t have Asperger’s or that the psychologist would think I wasn’t autistic enough to merit a diagnosis. Then I’d be back to having no explanation for all the atypical things about me.

I was told that the disorder was not really in my eyes, but in my central nervous system. I might or might not experience symptoms of neural damage all my life. These symptoms, which might or might not appear, might or might not involve my eyes. They might or might not involve my arms or legs, they might or might not be disabling. Their effects might be lessened by cortisone injections, or they might not. It could not be predicted. The condition had a name, the kind of name usually associated with telethons, but the name meant nothing and the neurologist did not like to use it. The name was multiple sclerosis, but the name had no meaning. This was, the neurologist said, an exclusionary diagnosis, and meant nothing. I had, at this time, a sharp apprehension not of what it was like to be old but of what it was like to open the door to the stranger and find that the stranger did indeed have the knife. In a few lines of dialogue in a neurologist’s office in Beverly Hills, the improbable had become the probable, the norm: things which happened only to other people could in fact happen to me. I could be struck by lightning, could dare to eat a peach and be poisoned by the cyanide in the stone. The startling fact was this: my body was offering a precise physiological equivalent to what had been going on in my mind.

I was, however, a handful. I was overly smart, easily bored, very curious and constantly in motion. Consequently, I got a lot of guidance from adults on how to behave properly. This reined in my more problematic behaviors, but it also made me feel like I was forever in danger of doing something “wrong,” especially when I “wasn’t trying hard enough.

Patients with complex trauma may at times develop extreme reactions to something the therapist has said or not said, done or not done. It is wise to anticipate this in advance, and perhaps to note this anticipation in initial communications with the patient. For example, one may say something like, "It is likely in our work together, there will be a time or times when you will feel angry with me, disappointed with me, or that I have failed you. We should except this and not be surprised if and when it happens, which it probably will." It is also vital to emphasize to the patient that despite the diagnosis and experience of dividedness, the whole person is responsible and will be held responsible for the acts of any part. p174

I am truly crazy, I told myself. It's over. I am not fixable. I cannot tell Tom. I cannot even tell Francisco. So I won't tell anyone. My brain seemed out of control. Tom does not deserve a crazy wife and my children do not deserve a crazy mother. I finally get it. This is not just repressed memory. This is dissociative identity disorder.

Speechlessness, however, affirmed in the diagnosis, is carefully based on the facts of the examination, as we see by rendering the statements concerned, just as they stand in examination and diagnosis: "If thou examinest a man having a wound in the temple, ...; if thou ask of him concerning his malady and he speak not to thee; ...; thou shouldst say concerning him, 'One having a wound in his temple, ... (and) he is speechless'.

Once the individual has learned to dissociate in the context of trauma, he or she may subsequently transfer this response to other situations and it may be repeated thereafter arbitrarily in a wide variety of circumstances. The dissociation therefore “destabilizes adaptation and becomes pathological.”[6] It is important for the psychiatrist to accurately diagnose DDs and also to place the symptoms in perspective with regard to trauma history.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.

narcissistic personality disorder—the characteristics of this diagnosis include a long-term pattern of exaggerated feelings of self-importance, cravings for admiration, and impaired empathy.

What daily life is like for “a multiple” Imagine that you have periods of “lost time.” You may find writings or drawings which you must have done, but do not remember producing. Perhaps you find child-sized clothing or toys in your home but have no children. You might also hear voices or babies crying in your head. Imagine that you can never predict when you will be able to have certain knowledge or social skills, and your emotions and your energy level seem to change at the drop of a hat, and for no apparent reason. You cannot understand why you feel what you feel, and, if you are in therapy, you cannot explore those feelings when asked. Your life feels disjointed and often confusing. It is a frightening experience. It feels out of control, and you probably think you are going crazy. That is what it is like to be multiple, and all of it is experienced by the ANPs. A multiple may also experience very concrete problems, even life-threatening ones.

I recently consulted to a therapist who felt he had accomplished something by getting his dissociative client to remain in her ANP throughout her sessions with him. His view reflects the fundamental mistake that untrained therapists tend to make with DID and DDNOS. Although his client was properly diagnosed, he assumed that the ANP should be encouraged to take charge of the other parts at all times. He also expected her to speak for them—in other words, to do their therapy. This denied the other parts the opportunity to reveal their secrets, heal their pain, or correct their childhood-based beliefs about the world. If you were doing family therapy, would it be a good idea to only meet with the father, especially if he had not talked with his children or his spouse in years? Would the other family members feel as if their experiences and feelings mattered? Would they be able to improve their relationships? You must work with the parts who are inside of the system. Directly.

Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.

Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with a psychiatric diagnosis or treat them with a pill.

Like so many other high school discipline cases, he'd probably been given some hybrid cockamamie ADHD- bipolar diagnosis at a very young age and been medicated into submission for the benefit of his homeroom teacher. We've all read about them in the paper, the problem kids who get slapped with five disorders by the time they're twelve, and horse-pilled by a culture that has pathologized everything from PMS to teen angst.

Janna knew - Rikki knew — and I knew, too — that becoming Dr Cameron West wouldn't make me feel a damn bit better about myself than I did about being Citizen West. Citizen West, Citizen Kane, Sugar Ray Robinson, Robinson Crusoe, Robinson miso, miso soup, black bean soup, black sticky soup, black sticky me. Yeah. Inside I was still a fetid and festering corpse covered in sticky blackness, still mired in putrid shame and scorching self-hatred. I could write an 86-page essay comparing the features of Borderline Personality Disorder with those of Dissociative Identity Disorder, but I barely knew what day it was, or even what month, never knew where the car was parked when Dusty would come out of the grocery store, couldn't look in the mirror for fear of what—or whom—I'd see. ~ Dr Cameron West describes living with DID whilst studying to be a psychologist.

Conviction rates in the military are pathetic, with most offenders going free AND THERE IS NO RECOURSE FOR APPEAL! The military believes the Emperor has his clothes on, even when they are down around his ankles and he is coming in the woman's window with a knife! Military juries give low sentences or clear offender's altogether. Women can be heard to say “it's not just me” over and over. Men may get an Article 15, which is just a slap on the wrist, and doesn't even follow them in their career. This is hardly a deterrent. The perpetrator frequently stays in place to continue to intimidate their female victims, who are then treated like mental cases, who need to be discharged. Women find the tables turned, letters in their files, trumped up Women find the tables turned, letters in their files, trumped up charges; isolation and transfer are common, as are court ordered psychiatric referrals that label the women as lying or incompatible with military service because they are “Borderline Personality Disorders” or mentally unbalanced. I attended many of these women, after they were discharged, or were wives of abusers, from xxx Air Force Base, when I was a psychotherapist working in the private sector. That was always their diagnosis, yet retesting tended to show something different after stabilization, like PTSD.

This child did not need to “change his behaviors.” We needed to understand his behaviors and what they suggested as the probable underlying reason for the behaviors. We needed to remember that behaviors are a message, a symptom—not a diagnosis.

Finally, those who do not meet the SCID-D-R standard for "distinct identities or personality states," but who do meet the SCID-D-R's other four standards (for DSM-IV's Criterion A and Criterion B) for DID, receive a SCID-D-R diagnosis of DDNOS-1a.

We must understand that those who experience abuse as children, and particularly those who experience incest, almost invariably suffer from a profound sense of guilt and shame that is not meliorated merely by unearthing memories or focusing on the content of traumatic material. It is not enough to just remember. Nor is achieving a sense of wholeness and peace necessarily accomplished by either placing blame on others or by forgiving those we perceive as having wronged us. It is achieved through understanding, acceptance, and reinvention of the self. At this point in time there are people who question the validity of the DID diagnosis. The fact is that DID has its own category in the Diagnostic and Statistical Manual of Mental Disorders because, as with all psychiatric conditions, a portion of society experiences a cluster of recognizable symptoms that are not better accounted for by any other diagnosis.

DID survivors are failed twice: once at the initial point of their abuse/trauma and again when the system fails to acknowledge their needs, even doubting their diagnosis if they have been fortunate enough to obtain one. This cannot be right in the twenty-first century.

President Barack Obama The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 November 29, 2016 Dear President Obama, We are writing to express our grave concern regarding the mental stability of our President-Elect. Professional standards do not permit us to venture a diagnosis for a public figure whom we have not evaluated personally. Nevertheless, his widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office. We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neuropsychiatric evaluation by an impartial team of investigators. Sincerely, Judith Herman, M.D. Professor of Psychiatry Harvard Medical School Nanette Gartrell, M.D. Dee Mosbacher, M.D.

felt like I was somehow mothering my younger self—revisiting each moment, looking at it in a new light and telling that younger version of me that it wasn’t my fault, that I’d done the best I could, that to expect more from me in the absence of support would have been unreasonable.

Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren't. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. Medication interferes with homeostasis for those who are suffering from the problems of everyday life.

The Dialectical Dilemma for the Patient The borderline individual is faced with an apparently irreconcilable dilemma. On the one hand, she has tremendous difficulties with self-regulation of affect and subsequent behavioral competence. She frequently but somewhat unpredictably needs a great deal of assistance, often feels helpless and hopeless, and is afraid of being left alone to fend for herself in a world where she has failed over and over again. Without the ability to predict and control her own well-being, she depends on her social environment to regulate her affect and behavior. On the other hand, she experiences intense shame at behaving dependently in a society that cannot tolerate dependency, and has learned to inhibit expressions of negative affect and helplessness whenever the affect is within controllable limits. Indeed, when in a positive mood, she may be exceptionally competent across a variety of situations. However, in the positive mood state she has difficulty predicting her own behavioral capabilities in a different mood, and thus communicates to others an ability to cope beyond her capabilities. Thus, the borderline individual, even though at times desperate for help, has great difficulty asking for help appropriately or communicating her needs. The inability to integrate or synthesize the notions of helplessness and competence, of noncontrol and control, and of needing and not needing help can lead to further emotional distress and dysfunctional behaviors. Believing that she is competent to “succeed,” the person may experience intense guilt about her presumed lack of motivation when she falls short of objectives. At other times, she experiences extreme anger at others for their lack of understanding and unrealistic expectations. Both the intense guilt and the intense anger can lead to dysfunctional behaviors, including suicide and parasuicide, aimed at reducing the painful emotional states. For the apparently competent person, suicidal behavior is sometimes the only means of communicating to others that she really can’t cope and needs help; that is, suicidal behavior is a cry for help. The behavior may also function as a means to get others to alter their unrealistic expectations—to “prove” to the world that she really cannot do what is expected.

Having DID is, for many people, a very lonely thing. If this book reaches some people whose experiences resonate with mine and gives them a sense that they aren't alone, that there is hope, then I will have achieved one of my goals. A sad fact is that people with DID spend an average of almost seven years in the mental health system before being properly diagnosed and receiving the specific help they need. During that repeatedly misdiagnosed and incorrectly treated, simply because clinicians fail to recognize the symptoms. If this book provides practicing and future clinicians certain insight into DID, then I will have accomplished another goal. Clinicians, and all others whose lives are touched by DID, need to grasp the fundamentally illusive nature of memory, because memory, or the lack of it, is an integral component of this condition. Our minds are stock pots which are continuously fed ingredients from many cooks: parents, siblings, relatives, neighbors, teachers, schoolmates, strangers, acquaintances, radio, television, movies, and books. These are the fixings of learning and memory, which are stirred with a spoon that changes form over time as it is shaped by our experiences. In this incredibly amorphous neurological stew, it is impossible for all memories to be exact. But even as we accept the complex of impressionistic nature of memory, it is equally essential to recognize that people who experience persistent and intrusive memories that disrupt their sense of well-being and ability to function, have some real basis distress, regardless of the degree of clarity or feasibility of their recollections. We must understand that those who experience abuse as children, and particularly those who experience incest, almost invariably suffer from a profound sense of guilt and shame that is not meliorated merely by unearthing memories or focusing on the content of traumatic material. It is not enough to just remember. Nor is achieving a sense of wholeness and peace necessarily accomplished by either placing blame on others or by forgiving those we perceive as having wronged us. It is achieved through understanding, acceptance, and reinvention of the self.

By far the most common comorbidities that co-exist with ADHD are anxiety and depression, which are probably caused by having the disorder. Given how the traits of restlessness, impulsivity, and distraction can impact on anyone’s life, it is understandable how these two disabilities will arise.

The label neurodiverse includes everyone from people with ADHD, to Down Syndrome, to Obsessive-Compulsive Disorder, to Borderline Personality Disorder. It also includes people with brain injuries or strokes, people who have been labeled “low intelligence,” and people who lack any formal diagnosis, but have been pathologized as “crazy” or “incompetent” throughout their lives. As Singer rightly observed, neurodiversity isn’t actually about having a specific, catalogued “defect” that the psychiatric establishment has an explanation for. It’s about being different in a way others struggle to understand or refuse to accept.

A mental illness diagnosis does not automatically sentence you to a bleak and painful life, devoid of pleasure or joy or accomplishment. I also wanted to dispel the myths held by many mental-health professionals themselves—that people with a significant thought disorder cannot live independently, cannot work at challenging jobs, cannot have true friendships, cannot be in meaningful, sexually satisfying love relationships, cannot lead lives of intellectual, spiritual, or emotional richness.

Now that she had the diagnosis to explain her sense of reality, she sorted some of the chaotic jumble of thoughts and memories. "I'd feel funny having 'daydreamed' my way through whole seasons," Jo said, "but then I'd hear someone say, 'Time flies,' or 'How did it get to be three o'clock already?' and I'd think that everyone was like me.

In less than a year, the magic of being diagnosed had begun to wear off, and my bipolar disorder no longer felt like a story hook. It felt like a part of me I wasn't sure I wanted to sit with anymore. So the further away I got from the diagnosis and all that had led up to it, the more I downplayed the extremes or made them punchlines I could use before anybody else could. I came to resent the head tilts and looks of surprise that go hand in hand with sharing what I'd come to see as a particularly unglamorous part of my life. If this was what interesting was, I didn't want it anymore. I hadn't counted on the most interesting people not being able to opt out. I didn't want to be the woman who does everything despite her bipolar disorder. I wanted to be the woman who has many complexities, her bipolar disorder being just one of them. (You know, a person).

Assessing dangerousness is different from making a diagnosis: it is dependent on the situation, not the person. Signs of likely dangerousness due to mental disorder can become apparent without a full diagnostic interview and can be detected from a distance, and one is expected to err, if at all, on the side of safety when the risk of inaction is too great.

the essential feature of the Dissociative Disorders is a disruption in the usually integrated functions of consciousness, memory, identity,or perception

I think the stigma attached to mental illness will disappear just like it did for cancer years ago.

You should consult your physician to find out which of these treatment methods is most suitable for your condition. You may also want to check if your insurance policy covers rehabilitation

Modern researchers have identified one or more major mood disorders in John Quincy Adams, Charles Darwin, Emily Dickinson, Benjamin Disraeli, William James, William Tecumseh Sherman, Robert Schumann, Leo Tolstoy, Queen Victoria, and many others. We may accurately call these luminaries “mentally ill,” a label that has some use—as did our early diagnosis of Lincoln—insofar as it indicates the depth, severity, and quality of their trouble. However, if we get stuck on the label, we may miss the core fascination, which is how illness can coexist with marvelous well-being. In

Interestingly, the patients who presented to me self-diagnosed [with Dissociative Identity Disorder] had tried to tell previous therapists of their plight, but had been disbelieved. These therapists had used fallacious "capricious criteria" (KIuft, 1988) to discredit the diagnosis; e.g., that the patient could not possibly have MPD because she was aware of the other alters [sic!].

It is not unusual for subjects diagnosed with a Dissociative Disorder on the SCID-D to be surprised at having their symptoms validated by a clinician who understands the nature of their disorder.

Within the mental-health system in North America, the borderline victim of severe childhood trauma is usually blamed for her behaviour, which is regarded as having no legitimate basis and being self-indulgent; her trauma history is ignored and not talked about; and she is given as little treatment and follow-up as possible. At St Boniface Hospital in Winnipeg, many staff members expressed the opinion, in my presence, that borderlines and multiple personality disorder patients did not have a legitimate right to in-patient treatment, and the out-patient department would not accept patients with either diagnosis. (1995)

In 2010, the psychiatrist Thomas Insel, then director of NIMH, called for the research community to redefine schizophrenia as “a collection of neurodevelopmental disorders,” not one single disease. The end of schizophrenia as a monolithic diagnosis could mean the beginning of the end of the stigma surrounding the condition. What if schizophrenia wasn’t a disease at all, but a symptom? “The metaphor I use is that years ago, clinicians used to look at ‘fever’ as one disease,” said John McGrath, an epidemiologist with Australia’s Queensland Centre for Mental Health Research and one of the world’s authorities on quantifying populations of mentally ill people. “Then they split it into different types of fevers. And then they realized it’s just a nonspecific reaction to various illnesses. Psychosis is just what the brain does when it’s not working very well.

Ritual abuse diagnosis research – excerpt from a chapter in: Lacter, E. & Lehman, K. (2008).Guidelines to Differential Diagnosis between Schizophrenia and Ritual Abuse/Mind Control Traumatic Stress. In J.R. Noblitt & P. Perskin(Eds.), Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, pp. 85-154. Bandon, Oregon: Robert D. Reed Publishers. quotes: A second study revealed that these results were unrelated to patients’ degree of media and hospital milieu exposure to the subject of Satanic ritual abuse. “In fact, less media exposure was associated with production of more Satanic content in patients reporting ritual abuse, evidence that reports of ritual abuse are not primarily the product of exposure contagion.” Responses are consistent with the devastating and pervasive abuse these victims have experienced, so often including immediate family members.

It is safe to assume that, no matter how it appears, the attempt probably did not come out of the blue. Look for clues. Some possibilities include a family history of mental illness, a history of abuse, unusual or stressful family dynamics, prior diagnosis or evidence of a psychiatric disorder and/or bizarre behavior long before or in the days or weeks immediately preceding the crisis. Part of your job is to be a detective, assembling the pieces in the puzzle that is depression.

My other client, whom I will call Teresa, thought Lorraine had MPD and hoped I could help her. Almost no one recognized this condition in those days. Lorraine was forty years old and had been in and out of psychiatric hospitals since she was thirteen. She had had various diagnoses, mainly severe depression, and she had made quite a few serious suicide attempts before I even met her. She had been given many courses of electric shock therapy, which would confuse her so much that she could not get together a coherent suicide plan for quite a while. Lorraine’s psychiatrist was initially opposed to my seeing her, as her friend Teresa had been stigmatized with the "borderline personality disorder" diagnosis when in hospital, so was seen as a bad influence on her. But after Lorraine spent a couple of months in hospital calling herself Susie and acting consistently like a child, he was humble enough to acknowledge that perhaps he could learn some new things, and someone else’s help might be a good idea.

Ardie wondered if something was wrong with her. Some actual diagnosis. A personality disorder. Something more concrete than just: natural introvert. But, well, to find out, she’d actually have to talk to someone she hardly knew for an extended time period, which was out of the question.

DSM-5 is not 'the bible of psychiatry' but a practical manual for everyday work. Psychiatric diagnosis is primarily a way of communicating. That function is essential but pragmatic—categories of illness can be useful without necessarily being 'true.' The DSM system is a rough-and-ready classification that brings some degree of order to chaos. It describes categories of disorder that are poorly understood and that will be replaced with time. Moreover, current diagnoses are syndromes that mask the presence of true diseases. They are symptomatic variants of broader processes or arbitrary cut-off points on a continuum.

attention deficit disorder in his own son. “I had worked in an ADHD clinic during my residency, and had strong feelings that this was overdiagnosed,” he said. “That it was a ‘savior’ diagnosis for too many kids whose parents wanted a medical reason to drug their children, or to explain their kids’ bad behavior.

DID may be underdiagnosed. The image derived from classic textbooks of a florid, dramatic disorder with overt switching characterizes about 5% of the DID clinical population. The more typical presentation is of a covert disorder with dissociative symptoms embedded among affective, anxiety, pseudo-psychotic, dyscontrol, and self-destructive symptoms, and others (Loewenstein, 1991). The typical DID patient averages 6 to 12 years in the mental health system, receiving an average of 3 to 4 prior diagnoses. DID is often found in cases that were labeled as "treatment failures" because the patient did not respond to typical treatments for mood, anxiety, psychotic, somatoform, substance abuse, and eating disorders, among others. Rapid mood shifts (within minutes or hours), impulsivity, self-destructiveness, and/or apparent hallucinations lead to misdiagnosis of cyclic mood disorders (e.g., bipolar disorder) or psychotic disorders (e.g., schizophrenia).

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

The closest term to sociopath is antisocial personality disorder. The criteria for diagnosis include impairments in self-esteem, self-direction, empathy, intimacy, plus the use of manipulation and deceit, and the presence of hostility, callousness, irresponsibility, impulsivity, and a lack of concern for one’s limitations: risk-taking.

In the first sixteen years of my life, my parents took me to at least a dozen so called professionals. Not one of them ever came close to figuring out wheat was wrong with me. In their defense, I will concede that Asperger's did not yet exist as a diagnosis, but autism did, and no one ever mentioned I might have any kind of autistic spectrum disorder. Autism was viewed by many as a much more extreme condition - one where kids never talked and could not take care of themselves. Rather than take a close sympathetic look at me, it proved easier and less controversial for the professionals to say I was just lazy, or angry, or defiant. But none of those words led to a solution to my problem.

...Why is it, that from the moment you enter medical school to the moment you retire, that the only disorder you will ever diagnosis with a physics book - is obesity? This is biology folks, it's endocrinology, it's physiology - physics has nothing to do with it. The law of thermodynamics is always true, [but] the energy balance equation is irrelevant...

Robert Hare has pointed out that sociologists are more likely to focus on the environmental or socially modifiable facets of the disorder, so prefer the term sociopathy, whereas psychologists and psychiatrists prefer to include the genetic, cognitive, and emotional factors as well as the social factors when making a diagnosis, and therefore would opt for psychopathy.

My own studies on the natural history of DID indicate only 20% of DID patients have an overt DID adaption on a chronic basis, and 14% of them deliberately disguise their manifestations of DID. Only 6% make their DID obvious on an ongoing basis. Eighty percent have windows of diagnosability when stressed or triggered by some significant event, interaction, situation or date. Therefore, 94% of DID patients show only mild or suggestive evidence of their conditions most of the time. Yet DID patients often will acknowledge that their personality systems are actively switching and/or far more active than it would appear on the surface (Loewenstein et al., 1987). R.P. Kluft (2009) A clinician's understanding of dissociation. pp 599-623.

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks. “Oooh, I like my pens in a line, I’m so OCD.” NO YOU’RE FUCKING NOT. “Oh my God, I was so nervous about that presentation, I literally had a panic attack.” NO YOU FUCKING DIDN’T. “I’m so hormonal today. I just feel totally bipolar.” SHUT UP, YOU IGNORANT BUMFACE. Told you I got angry. These words – words like OCD and bipolar – are not words to use lightly. And yet now they’re everywhere. There are TV programmes that actually pun on them. People smile and use them, proud of themselves for learning them, like they should get a sticker or something. Not realizing that if those words are said to you by a medical health professional, as a diagnosis of something you’ll probably have for ever, they’re words you don’t appreciate being misused every single day by someone who likes to keep their house quite clean. People actually die of bipolar, you know? They jump in front of trains and tip down bottles of paracetamol and leave letters behind to their devastated families because their bullying brains just won’t let them be for five minutes and they can’t bear to live with that any more. People also die of cancer. You don’t hear people going around saying: “Oh my God, my headache is so, like, tumoury today.” Yet it’s apparently okay to make light of the language of people’s internal hell

Motivators, if that’s the right word, interest Laney. What motivates someone to do whatever. Not in the psychopharmacology sense. Sure, in her case it’s partly chemical. Some combination of a mood disorder, impulse control, alcoholism. Still, whatever the diagnosis, whatever the fuck any of it means, there’s no discounting she’s a liar. A good liar at that. When she’s not being offended, not

A patient complains of feeling nervous or fearful. These feelings and behaviors suggest that the patient has an anxiety disorder, and the doctor prescribes whatever drug will most probably work for an anxiety disorder. However, there's no conclusive way to tell that this patient definitely has an anxiety disorder. Even if the doctor did get the diagnosis correct, there's a great deal of variation regarding which drug class (for example, anti-anxiety drugs versus antidepressants) a particular individual will respond to and which drug within a class (for example, Prozac versus Zoloft) will work best. If the drug doesn't work, the doctor will try the next one on the list and so on, thus delaying treatment success and complicating the process with the mix-and-match type of treatment.

shocking conclusion. It suggested that there appears to be one common pathway to all mental illnesses. Caspi and Moffitt called it the p-factor, in which the p stands for general psychopathology. They argued that this factor appears to predict a person’s liability to develop a mental disorder, to have more than one disorder, to have a chronic disorder, and it can even predict the severity of symptoms. This p-factor is common to hundreds of different psychiatric symptoms and every psychiatric diagnosis. Subsequent research using different sets of people and different methods confirmed the existence of this p-factor.25 However, this research was not designed to tell us what the p-factor is. It only suggests that it exists—that there is an unidentified variable that plays a role in all mental disorders.

000-x02 Dissociative reaction This reaction represents a type of gross personality disorganization, the basis of which is a neurotic disturbance, although the diffuse dissociation seen in some casts may occasionally appear psychotic. The personality disorganization may result in aimless running or "freezing." The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc. The diagnosis will specify symptomatic manifestations. These reactions must be differentiated from schizoid personality, from schizophrenic reaction, and from analogous symptoms in some other types of neurotic reactions. Formerly, this reaction has been classified as a type of "conversion hysteria.

The spurned diagnosis Shame "By shame, I have in mind the terrible, at times unfathomable, feeling of being outcast from human society, of being shunned and spurned, of being wanted by no one, and having no one who empathizes with you (Lynd 1958). Part of this experience of shame is the focus on the inadequacies of oneself in the eyes of others and oneself, and of feeling mortified, wanting to disappear, to hide inside a crack in the wall (Lewis 1971).

Although the terminology implies scientific endorsement, false memory syndrome is not currently an accepted diagnostic label by the APA and is not included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Seventeen researchers (Carstensen et al., 1993) noted that this syndrome is a "non-psychological term originated by a private foundation whose stated purpose is to support accused parents" (p.23). Those authors urged professionals to forgo use of this pseudoscientific terminology. Terminology implies acceptance of this pseudodiagnostic label may leave readers with the mistaken impression that false memory syndrome is a bona fide clinical disorder supported by concomitant empirical evidence.(85)... ... it may be easier to imagine women forming false memories given biases against women's mental and cognitive abilities (e.g., Coltrane & Adams, 1996). 86

There is clear evidence from internal investigations in the past that some raters actually see themselves as adversaries to veterans. If a claim can be minimized, then the government has saved money, regardless of the need of the veteran. Just recently, the press exposed an official e-mail from a high-level staff person who stated in essence that PTSD diagnosis was becoming too prevalent and offered ways to delay and deflect ratings in order to save the government money.

The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR. While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false. Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.

DSM-5 pathologized those who hold on to their stuff for too long, who clutter their homes too much, who do not clean that often, and who harbor too many things. The manual labeled these activities “hoarding disorder” (HD, as it is sometimes called) and gave them an International Classification of Diseases (ICD-9-CM, to be precise) code of 300.3. Legitimized as a psychiatric disease and categorized under Obsessive-Compulsive and Related Disorders, this diagnosis rendered unsound certain relations to certain personal property. Hoarding, it seems, had arrived.

For a while, every smart and shy eccentric from Bobby Fischer to Bill Gate was hastily fitted with this label, and many were more or less believably retrofitted, including Isaac Newton, Edgar Allen Pie, Michelangelo, and Virginia Woolf. Newton had great trouble forming friendships and probably remained celibate. In Poe's poem Alone, he wrote that "All I lov'd - I lov'd alone." Michelangelo is said to have written "I have no friends of any sort and I don't want any." Woolf killed herself. Asperger's disorder, once considered a sub-type of autism, was named after the Austrian pediatrician Hans Asperger, a pioneer, in the 1940s, in identifying and describing autism. Unlike other early researchers, according to the neurologist and author Oliver Sacks, Asperger felt that autistic people could have beneficial talents, especially what he called a "particular originality of thought" that was often beautiful and pure, unfiltered by culture of discretion, unafraid to grasp at extremely unconventional ideas. Nearly every autistic person that Sacks observed appeard happiest when alone. The word "autism" is derived from autos, the Greek word for "self." "The cure for Asperger's syndrome is very simple," wrote Tony Attwood, a psychologist and Asperger's expert who lives in Australia. The solution is to leave the person alone. "You cannot have a social deficit when you are alone. You cannot have a communication problem when you are alone. All the diagnostic criteria dissolve in solitude." Officially, Asperger's disorder no longer exists as a diagnostic category. The diagnosis, having been inconsistently applied, was replaced, with clarified criteria, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders; Asperger's is now grouped under the umbrella term Autism Spectrum Disorder, or ASD.

Simply put, within AS, there is a wide range of function. In truth, many AS people will never receive a diagnosis. They will continue to live with other labels or no label at all. At their best, they will be the eccentrics who wow us with their unusual habits and stream-of-consciousness creativity, the inventors who give us wonderfully unique gadgets that whiz and whirl and make our life surprisingly more manageable, the geniuses who discover new mathematical equations, the great musicians and writers and artists who enliven our lives. At their most neutral, they will be the loners who never now quite how to greet us, the aloof who aren't sure they want to greet us, the collectors who know everyone at the flea market by name and date of birth, the non-conformists who cover their cars in bumper stickers, a few of the professors everyone has in college. At their most noticeable, they will be the lost souls who invade our personal space, the regulars at every diner who carry on complete conversations with the group ten tables away, the people who sound suspiciously like robots, the characters who insist they wear the same socks and eat the same breakfast day in and day out, the people who never quite find their way but never quite lose it either.

Some parents resist the idea of ADD for fear of seeing their children labeled and categorized. They do not like the idea of pinning a medical diagnosis on a child who, except in certain areas of functioning, seems quite well. Such fears are not baseless. Too often ADD seems no more than a judgment that characterizes a child as a problem student, incapable of normal activity. How people use language is quite revealing. People commonly say that this adult or that child “is ADD.” That, indeed, is labeling, identifying the whole person with an area of weakness or impairment. No one is ADD, and no one should be defined or categorized in terms of it or any other particular problem. Recognizing a child’s ADD should be simply a way of understanding that helping him calls for some knowledgeable and creative approaches, not a judgment that there is anything fundamentally or irretrievably wrong with him. This recognition should enable us to support the child in fullfilling his potential, not to further limit him. That even open-minded people may have difficulty coming to terms with this diagnosis is only to be expected. Our usual mode of thinking about illness (or anything else, for that matter) is not comfortable with ambiguity. A patient either has pneumonia or does not; she either has some illness affecting the mind or does not. There is a popular discomfort with any condition of the mind perceived as “abnormal.” But what if illness is not a separate category, if there is no line of distinction between the “healthy” and the “nonheaithy,” if the “abnormality” is just a greater concentration in an individual of disturbed brain processes found in everyone? Then perhaps there are no fixed, immutable brain disorders, and we could all be vulnerable to mental breakdowns or malfunctions under the pressure of stressful circumstances. We could all go crazy. Maybe we already have.

I believe the perception of what people think about DID is I might be crazy, unstable, and low functioning. After my diagnosis, I took a risk by sharing my story with a few friends. It was quite upsetting to lose a long term relationship with a friend because she could not accept my diagnosis. But it spurred me to take action. I wanted people to be informed that anyone can have DID and achieve highly functioning lives. I was successful in a career, I was married with children, and very active in numerous activities. I was highly functioning because I could dissociate the trauma from my life through my alters. Essentially, I survived because of DID. That's not to say I didn't fall down along the way. There were long term therapy visits, and plenty of hospitalizations for depression, medication adjustments, and suicide attempts. After a year, it became evident I was truly a patient with the diagnosis of DID from my therapist and psychiatrist. I had two choices. First, I could accept it and make choices about how I was going to deal with it. My therapist told me when faced with DID, a patient can learn to live with the live with the alters and make them part of one's life. Or, perhaps, the patient would like to have the alters integrate into one person, the host, so there are no more alters. Everyone is different. The patient and the therapist need to decide which is best for the patient. Secondly, the other choice was to resist having alters all together and be miserable, stuck in an existence that would continue to be crippling. Most people with DID are cognizant something is not right with themselves even if they are not properly diagnosed. My therapist was trustworthy, honest, and compassionate. Never for a moment did I believe she would steer me in the wrong direction. With her help and guidance, I chose to learn and understand my disorder. It was a turning point.

... as Herman (1992b) cogently noted two decades ago, these personality disorders can be iatrogenic, causing harm to individuals as an inadvertent result of the social stigma they carry and the widespread (but not entirely accurate) belief among professionals and insurers that those with Cluster B personality disorders (especially borderline personality disorder[BPD]) cannot be treated successfully, cannot recover, and are a headache to practitioners. For example, the BPD diagnosis continues to be applied predominantly to women often, but not always, in a negative way, usually signifying that they are irrational and beyond help. Describing posttraumatic symptoms as a personality disorder not only can be demoralizing for the client due to its connotation that something is defective with his or her core self (i.e., personality) but also may misdirect the therapist by implying that the patient's core personality should be the focus of treatment rather than trauma-related adaptations that affect but are distinct from the core self. In this way, both therapists and their clients may overlook personality strengths and capacities that are healthy and sources of resilience that can be a basis for building on and enhancing (rather than "fixing" or remaking) the patient's core self and personality.

I do believe that we (autistic individuals such as myself) are very susceptible to suicidal thinking for multiple reasons that include: chronic high levels of anxiety, tendency to fixate on or get stuck on negative disturbing thoughts, low self-worth, inability to have significant or intimate relationships with others, replaying over and over again negative statements that others have said to us, feeling unable to be understood, lack [of] a solid self-identity, difficulty with expressing self to others, feelings of great isolation, feeling that you are or may be a burden to others, feeling unable to contribute to society or the greater good, etc […] I do believe that the most important thing that someone else can do for a struggling autistic individual is to affirm their self-worth, recognise and validate their struggles and affirm the things that they do that are greatly valued by others. The worst thing to do for an autistic individual, or any struggling individual for that matter, is to not believe them or to deny the validity of their struggles. My greatest and deepest hurt is that doctors, family members and important others did not believe me in my struggles, particularly when I was younger, before my diagnosis at the age of 35 years. This has been the strongest impetus for my feelings of unworthiness and suicidal thoughts. (Woman with autism)

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

Once I had found the courage to tell Rebecca about the children in my head, it wasn't so hard in the coming months to tell Roberta. On the train from Huddersfield one day in May I made a roll call of the usual suspects: Baby Alice; Alice 2, who was two years old and liked to suck sticky lollipops; Billy; Samuel; Shirley; Kato; and the enigmatic Eliza. There was boy I would grow particularly fond of named limbo, who was ten, but like Eliza he was still forming. There were others without names or specific behaviour traits. I didn't want to confuse the issue with this crowd of 'others' and just counted off the major players with their names, ages and personalities, which Roberta scribbled down on a pad. Then she looked slightly embarrassed. 'You know, I've met Billy on a few occasions, and Samuel once too,' she said. 'You're joking.' I felt betrayed. 'Why didn't you tell me?' 'I wanted it to come from you, Alice, when you were ready.' For some reason I pulled up my sleeves and showed he my arms. 'That's Kato,' I said, 'or Shirley.' She looked a bit pale as she studied the scars. I had feeling she didn't know what to say. The problem with counsellors is that they are trained to listen, not to give advice or diagnosis. We sat there with my arms extended over the void between us like evidence in court, then I pushed down my sleeves again. 'I'm so sorry, Alice,' she said finally and I shrugged. 'It's not your fault, is it?' Now she shrugged, and we were quiet once more.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Although there are no set methods to test for psychiatric disorders like psychopathy, we can determine some facets of a patient’s mental state by studying his brain with imaging techniques like PET (positron emission tomography) and fMRI (functional magnetic resonance imaging) scanning, as well as genetics, behavioral and psychometric testing, and other pieces of information gathered from a full medical and psychiatric workup. Taken together, these tests can reveal symptoms that might indicate a psychiatric disorder. Since psychiatric disorders are often characterized by more than one symptom, a patient will be diagnosed based on the number and severity of various symptoms. For most disorders, a diagnosis is also classified on a sliding scale—more often called a spectrum—that indicates whether the patient’s case is mild, moderate, or severe. The most common spectrum associated with such disorders is the autism spectrum. At the low end are delayed language learning and narrow interests, and at the high end are strongly repetitive behaviors and an inability to communicate.

In studies of first-episode bipolar patients, investigators at McLean Hospital, the University of Pittsburgh, and the University of Cincinnati Hospital found that at least one-third had used marijuana or some other illegal drug prior to their first manic or psychotic episode.10 This substance abuse, the University of Cincinnati investigators concluded, may “initiate progressively more severe affective responses, culminating in manic or depressive episodes, that then become self-perpetuating.”11 Even the one-third figure may be low; in 2008, researchers at Mt. Sinai Medical School reported that nearly two-thirds of the bipolar patients hospitalized at Silver Hill Hospital in Connecticut in 2005 and 2006 experienced their first bout of “mood instability” after they had abused illicit drugs.12 Stimulants, cocaine, marijuana, and hallucinogens were common culprits. In 2007, Dutch investigators reported that marijuana use “is associated with a fivefold increase in the risk of a first diagnosis of bipolar disorder” and that one-third of new bipolar cases in the Netherlands resulted from it.13

Prior to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of Dissociative Identity Disorder had been referred to as Multiple Personality Disorder. The renaming of this diagnosis has caused quite a bit of confusion among professionals and those who live with DID. Because dissociation describes the process by which DID begins to develop, rather than the actual outcome of this process (the formation of various personalities), this new term may be a bit unclear. We know that the diagnosis is DID and that DID is what people say we have. We’d just like to point out that words sometimes do not describe what we live with. For people like us, DID is just a step on the way to where we live—a place with many of us inside! We just want people who have little ones and bigger ones living inside to know that the title Dissociative Identity Disorder sounds like something other than how we see ourselves—we think it is about us having different personalities. Regardless of the term, it is clear that, in general, the different personalities develop as a reaction to severe trauma. When the person dissociates, they leave their body to get away from the pain or trauma. When this defense is not strong enough to protect the person, different personalities emerge to handle the experience. These personalities allow the child to survive: when the child is being harmed or experiencing traumatic episodes, the other personalities take the pain and/ or watch the bad things. This allows these children to return to their body after the bad things have happened without any awareness of what has occurred. They do this to create different ways to make sense of the harm inflicted upon them; it is their survival mechanism.