Diagnosis Quotes

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.

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.

THE MAXIMS OF MEDICINE Before you examine the body of a patient,Be patient to learn his story.For once you learn his story,You will also come to knowHis body.Before you diagnose any sickness,Make sure there is no sickness in the mind or heart.For the emotions in a man’s moon or sun,Can point to the sickness inAny one of his other parts.Before you treat a man with a condition,Know that not all cures can heal all people.For the chemistry that works on one patient,May not work for the next,Because even medicine has its ownConditions.Before asserting a prognosis on any patient,Always be objective and never subjective.For telling a man that he will win the treasure of life,But then later discovering that he will lose,Will harm him more than by telling himThat he may lose,But then he wins.THE MAXIMS OF MEDICINE by Suzy Kassem

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.

One who doesn't recognise an opportunity is bigger loser than one who tries his hand at an opportunity.

The categories used in psychiatric diagnosis are based on observation of signs and symptoms, rather than on pathological processes. One can make use of a few signs, such as facial expressions associated with depression or the flight of ideas associated with mania. But what clinicians mainly use for diagnosis are symptoms, the subject experiences reported by patients. Psychiatrists have little knowledge of the processes that lie behind these phenomena. Thus psychiatric diagnoses, with very few exceptions, are syndromes, not diseases.

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.

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.

Rarely do I truly understand the disease which ails me. Therefore, rarely do I truly understand the fix that would cure me. And so maybe I should truly contemplate how rarely I recognize that God understands both.

Label-locked thinking can affect treatment. For instance, I heard a doctor say about a kid with gastrointestinal issues, “Oh, he has autism. That’s the problem”—and then he didn’t treat the GI problem.

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.

In the spring of 2009, I was the 217th person ever to be diagnosed with anti-NMDA-receptor autoimmune encephalitis. Just a year later, that figure had doubled. Now the number is in the thousands. Yet Dr. Bailey, considered one of the best neurologists in the country, had never heard of it. When we live in a time when the rate of misdiagnoses has shown no improvement since the 1930s, the lesson here is that it’s important to always get a second opinion.While he may be an excellent doctor in many respects, Dr. Bailey is also, in some ways, a perfect example of what is wrong with medicine. I was just a number to him (and if he saw thirty-five patients a day, as he told me, that means I was one of a very large number). He is a by-product of a defective system that forces neurologists to spend five minutes with X number of patients a day to maintain their bottom line. It’s a bad system. Dr. Bailey is not the exception to the rule. He is the rule.

What is actually observed in so-called 'biplar children'? If you read the research reports carefully, they describe broad and persistent emotional dysregulation. Although these children have mood swings, they do not develop manic or hypomanic episodes. They are moody, irritable, oppositional and likely to misbehave—like all children with disruptive behavior disorders. Their grandiose thinking usually consists of little beyond boastfulness. No evidence from genetics, neurobiology, follow-up studies or treatment response shows that this syndrome has anything in common with classical bipolarity.

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

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.

Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.

It has many forms, not all of which look like what you see in movies.

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.

These times are unfriendly toward Worlds alternative to this one

Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously.

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.

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

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.

God will bring you a gift. However, it is up to you to stop shaking the same box and expecting something wonderful will fall out of it again. After a while, you are going to break that box and it won't remind you of that moment when it meant everything to you.

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.

And what physicians say about consumptive illnesses is applicable here: that at the beginning, such an illness is easy to cure but difficult to diagnose; but as time passes, not having been recognized or treated at the outset, it becomes easy to diagnose but difficult to cure.

I told Augustus the broad outline of my miracle: diagnosed with Stage IV thyroid cancer when I was thirteen. (I didn’t tell him that the diagnosis came three months after I got my first period. Like: Congratulations! You’re a woman. Now die.)

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.

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.

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

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.

In this chapter I restrict myself to exploring the nature of the amnesia which is reported between personality states in most people who are diagnosed with DID. Note that this is not an explicit diagnostic criterion, although such amnesia features strongly in the public view of DID, particularly in the form of the fugue-like conditions depicted in films of the condition, such as The Three Faces of Eve (1957). Typically, when one personality state, or ‘alter’, takes over from another, they have no idea what happened just before. They report having lost time, and often will have no idea where they are or how they got there. However, this is not a universal feature of DID. It happens that with certain individuals with DID, one personality state can retrieve what happened when another was in control. In other cases we have what is described as ‘co-consciousness’ where one personality state can apparently monitor what is happening when another personality state is in control and, in certain circumstances, can take over the conversation.

I put the word "diagnosis" in quotes because I have not yet seen that case in which a "diagnosis" led to a "cure," or in fact to any outcome other than a confirmed, and therefore an enforced, debility.

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

If two people with no symptoms in common can both receive the same diagnosis of schizophrenia, then what is the value of that label in describing their symptoms, deciding their treatment, or predicting their outcome, and would it not be more useful simply to describe their problems as they actually are? And if schizophrenia does not exist in nature, then how can researchers possibly find its cause or correlates? If psychiatric research has made so little progress in recent decades, it is in large part because everyone has been barking up the wrong tree. It is not a question of getting a bigger and better scanner, but of going right back to the drawing board.What’s more, medical-type labels can be as harmful as they are hollow. By reducing rich, varied, and complex human experiences to nothing more than a mental disorder, they not only sideline and trivialize those experiences but also imply an underlying defect that then serves as a pseudo-explanation for the person’s disturbed behaviour. This demeans and disempowers the person, who is deterred from identifying and addressing the important life problems that underlie his distress.

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.

If someone loves sweet things and constantly eats angel´s hair tartlets should this be diagnosed as having some sort of heavenly trichotillomania?

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

The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders.The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).

...American psychology effectively guaranteed its place as a cultural icon by helping to create the pathologies it simultaneously promised to treat. (p. 37)

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.

I know, Little Man, you are quick with the diagnosis of craziness when you meet a truth you don’t like. And you feel yourself as the ‘homo normalis’. You have locked up crazy people, and the normal people manage this world. Who then is to blame for all the misery? Not you, of course, you only do your duty, and who are you to have an opinion of your own? I know, you don’t have to repeat it. It isn’t you that matters, Little Man. But when I think of your newborn children, of how you torture them in order to make them into ‘normal’ human beings after your image.

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.

In this world where value is unknown, but the price of anything is marked, where the creation of self has been abandoned for the search for self, the behavior diagnosed as antisocial is often too quickly ascribed to intelligence when thrust into contact with widespread conformity, and refuses.

The shrinks call it Posttraumatic Stress Disorder. I call it hell. The demons are waiting in each corner, ready to drag me back to the battlefield.- Puncture Wounds (2014)

Before you diagnose any sickness, make sure there is no sickness in the mind or heart. For the emotions in a man's moon or sun, can point to the sickness in any one of his other parts.

Some people have the experience of being accused of lying when they do not think that they have lied. Circle a number to show what percentage of the time this happens to you.[question from the Dissociative Experiences Scale]