Would an AvPD diagnosis be useful?

October 13, 2009 9:42 AM

I read the wikipedia page for avoidant personality disorder a few days ago and I was shocked how perfectly it described how I've felt since my mid-teens. I brought it up with my therapist (who I've just started seeing for depression) and he said he didn't think that kind of label was useful. I can see his point but I fit the diagnostic criteria so perfectly that not labeling myself with it seems like denial. Should I seek out a diagnosis or should I work on my problems without putting them in a box?
posted by Andy Harwood to health & fitness (21 comments total)

Andy, depression is a multi-layered beast. For many of us who have depression, one of those layers could be best described as "avoidant personality disorder". After reading that wiki page, I could apply those same descriptions to some of my depression symptoms. But I wouldn't go so far as to apply the "Avoidant personality disorder" on my psyche: the characteristics described on that page are a part of my depression, not a separate beast all on their own. To call those symptoms out as a whole other beast beyond depression calls into play two things you have to manage: your depression and your "avoidant personality disorder". Don't give the symptoms that power.

Perhaps this is why your therapist resists the idea of applying that kind of label.

Of course, YMMV.
posted by LOLAttorney2009 at 9:54 AM on October 13

Obviously, it's up to you, but I vote for the latter; work on your own issues that are specific to you because although you may be an exact description, you're still limiting yourself if you try to start seeing yourself through the filter of a specific disorder.

This can be dangerous because you can start to not identify your own problems as clearly because, very subconciously, you start to see all your problems though that lens and might miss other issues.

Likewise if you start limiting your treatment to this particular diagnosis, and it doesn't work for you, you could very easily feel worse for you aren't able to "cure" this problem you thought you'd do clearly identified.

Again, your situation is your own; I am basing this on experiences others have had, not with this particular diagnosis but with the whole concept/process of trying to label their own issues as a disorder. Thinking inside the box has a bad rep for a reason.

Good luck, and take care of yourself.
posted by MCMikeNamara at 9:56 AM on October 13

You can't resolve a problem until you've identified it. Labels like that can be helpful in clarifying what your issues are and the best way to go about working on them. It's not so that you can wear all your labels on a bracelet, it's just a way to articulate what you're dealing with. It may be helpful to say to your therapist that these are the issues you would like to work on, regardless of whether or not this group of symptoms has a name.
posted by amethysts at 10:00 AM on October 13

Nthing the above. Avoid the labels, by definition, they are limiting.

Another thing about the DSM definition, it uses the terms "pervasive pattern". IANAT, but that suggests to me a disorder that is wholly and utterly overpowering an individual. Like schizophrenia. Just having symptoms of the disorder, even if you have all of them, doesn't mean you really fall into that category.

Therapists get into barfights over these kinds of things at their annual conferences, and they are the ones who write the definitions. Sounds to me like your therapist has a good handle on it. Keep plugging away, and let things develop. If you have not had an "aha" moment yet, you will eventually. Those "aha" moments keep coming for me, just when I think I won't have any more.
posted by Xoebe at 10:06 AM on October 13

It seems to me that the Forer effect applies to both negative and positive assessments. There's a lot of rampant self-diagnosis around, and while labels can be helpful, they're also a danger because of it--which is why third parties, such as, oh, therapists, can be so helpful in assessing whatever's going on.
posted by Drastic at 10:09 AM on October 13

I realized halfway through a multi-year course of therapy that what I was being treated for was Borderline Personality Disorder. When I asked my therapist about this, she said that yes, this was the diagnosis she had given my insurance company, but she hadn't shared it with me for two reasons.

First, she knew I would look it up online and encounter the huge body of work that describes BPD as incurable, and second, that she didn't want me to identify with the disorder. However subconsciously, when you say "I have ______", you are incorporating that into your self-image, and that can make getting rid of it even harder.

I'd recommend recognizing that many of your issues fall into the cloud that is commonly recognized as Avoidant Personality Disorder, and keep an eye on the common treatment path for APD so you can be warned of what to expect, but try to stay away from identifying yourself with the disorder.
posted by KathrynT at 10:11 AM on October 13 [1 favorite]

I'm of the opinion that when you are this close to something, using a pre-defined label is not helping you identify anything, although it does help you feel less anxious about the ambiguity. I would guess that your therapist is interested in keeping you more off balance and exploring outside your comfort level than in making you feel secure that you have control of at least something in your life.

You can too easily use a diagnosis as a crutch and let it keep you from objective self-exploration. I would offer you the advice that you let it go and focus on your actual feelings and experiences against nothing other than yourself for now. Trust your therapist and see where you arrive under that trust.
posted by qwip at 10:16 AM on October 13

The advantage of having a therapist is so you don't have to figure it out yourself. You've just started seeing him so maybe you don't trust him yet and need to second-guess him. Or maybe you're dissatisfied in some way that transcends your personal issues.

With the limited information I have to go on, I would stick it out doing it his way. If you need further justification, DSM labels are notorious for being unhelpful by providing no clue to the underlying dynamics.
posted by Obscure Reference at 10:19 AM on October 13 [1 favorite]

Back when I was taking abnormal psychology, the prof reminded us that reading about a condition almost invariably makes people certain that they themselves or a close friend/relative fits the description. If your therapist doesn't think you have this condition, I'd tend to believe him/her, as he/she is generally trained to be objective about such things. Try not to self-diagnose.

HOWEVER, it doesn't hurt to get a second opinion, if you can afford it, with the caveat that a therapist you have been seeing for a while will know you much better than one you just met.
posted by caution live frogs at 10:22 AM on October 13

What do you want to get out of being diagnosed by this therapist? Do you want acknowledgment from him that you have had severe problems that have lasted for a long time and had an impact on every area of your life? Could you get that in another way?
posted by kathrineg at 10:27 AM on October 13

Diagnostics take a long time to do well, in that a lot is "deferred" (wait and see). Your therapist might think that doesn't fit you at all or is kind of watching and waiting. Doing a diagnostic cautiously is thought to be best for the client because it avoids immediate labels.
posted by ShadePlant at 10:28 AM on October 13 [1 favorite]

To go off of what ShadePlant is saying, my experience is that labels tend to follow you around the mental health care system, and if you have issues that are a bit ambiguous or you get misdiagnosed, you can still end up dragging old, possibly inaccurate, diagnoses around with you.
posted by kathrineg at 10:34 AM on October 13

He's right; the label per se isn't helpful. A lot of personality disorder diagnostic criteria are as vague and catch-all as horoscopes. The symptoms, however, are the reason you're there. If he's dismissing the symptoms off-hand just because they're covered by a tidy label, well, that seems slightly irresponsible.

Try describing the actual symptoms you're experiencing, without using that dreaded label. If he's still dismissive, it might be time to DTMFA and find a more receptive doctor. (It's been my experience that many Psych----ists tend to be a bit stubborn with their diagnoses, clinging to the first one that pops into their heads no matter how obviously off the mark it turns out to be.)
posted by Sys Rq at 10:40 AM on October 13

Thanks guys. I guess getting diagnosed with a specific disorder appeals to me because I'm a terrible communicator and I find it very hard to get across how I'm feeling and what my problems are. Having a wikipedia page that does that for me would make things a lot easier I think. I can see how that could cause its own problems though.
posted by Andy Harwood at 10:45 AM on October 13

Andy Harwood: I'm a terrible communicator and I find it very hard to get across how I'm feeling and what my problems are.

This is, for many people, a large part of the work of therapy. Struggling and learning to do just that is something you want to embrace, not something you want to shortcut with a wiki entry.
posted by DarlingBri at 10:58 AM on October 13

It seems like you feel like he does not understand you or is not really hearing what you have to say. It must be frustrating. You did well and took an active role in your own treatment when you asked him about it.
posted by kathrineg at 10:59 AM on October 13

I agree with many of the comments above--diagnoses, especially if they are used within the context of insurance companies, are really serious business. They will be on your permanent health record, which is just one of the reasons I consider diagnoses extensively before giving them. Another major concern is that a label is not necessarily always helpful to someone, especially concerning personality disorders (which tend to connote to people that there is something wrong with the entirety of themselves). We don't have a lot of hopeful research about the treatability of most personality disorders, and diagnosing any axis II traits is, as I said, considered to be very serious business.

Something else, though: mental health professionals are also highly trained in differential diagnosis--which means that they have the whole DSM catalogued into their brains, and are looking for certain things to rule out one diagnosis or to fit another, all the time. While this one may seem on the button to you right now, you may also not be thinking of/aware of of some other things that are going on, or aren't going on, that might better describe another diagnosis or might rule this one out.
posted by so_gracefully at 12:29 PM on October 13

It's totally acceptable for you to tell your therapist, "I don't think you're hearing me" or "I am wondering about X because we didn't get to talk about it." If communication is difficult for you you really can say "This is not clear." Therapists don't take (or shouldn't) take that personally, unlike friends. If you're still not feeling heard, look around for a supervisor or another psych. Good luck!
posted by ShadePlant at 12:56 PM on October 13

I'm very impressed with the answers given. I agree with your therapist and most of the posters here..that a "label" is problematic. I know a young man whose Mother was intent on getting a diagnosis for him. Eventually a doctor confirmed that the boy was "ADD." After that the young man tended to use the diagnosis for an excuse for behaviors. If he didn't get his homework done or didn't follow the plot of a movie he would say "well, what do you expect? I am ADD!"
There is such a big danger in identifying oneself with a word that an authority has assigned. You are fortunate to have the therapist that you do...and I am heartened that many people here realize the danger of diagnostic labels.
posted by naplesyellow at 3:30 PM on October 13

KathrynT: "I realized halfway through a multi-year course of therapy that what I was being treated for was Borderline Personality Disorder. When I asked my therapist about this, she said that yes, this was the diagnosis she had given my insurance company, but she hadn't shared it with me for two reasons.

First, she knew I would look it up online and encounter the huge body of work that describes BPD as incurable, and second, that she didn't want me to identify with the disorder. However subconsciously, when you say "I have ______", you are incorporating that into your self-image, and that can make getting rid of it even harder."

Just to offer some contrast, I too diagnosed myself with BPD and asked my therapist and psychiatrist who confirmed. I read everything I could get my hands on, and while I may never be "cured," I no longer meet at least 5 diagnostic criteria, and of the symptoms I have left, they have lessened in severity.

On the one hand, having a "label" gave me comfort in knowing I'm not alone and not a freak of nature, and motivated me to get better. When I start to have trouble I still seek out help from my mental health clinic. I am much more able to recognize when I'm having symptoms and reach out to ask for help.

On the other, I wouldn't go around sharing that label with others. I've already been treated like crap by people who knew I had a "mental illness" (really a personality disorder, it's different) and thought that I would "go crazy" on them, even though I'd always acted normal around them.
posted by IndigoRain at 1:10 AM on October 14

Most mental health diagnoses, especially personality disorders, are just descriptions of symptoms. That's literally all they are. They're useful as means of categorisation, but they aren't informative in the same way that, say, diagnoses of infections or genetic disorders are.

A diagnosis of E.Coli, for example, is useful. It tells you the precise cause of your illness (you got infected by a known bacterium, probably from eating unsafe food), the likely course your illness will take (you'll suffer pain and diarrhoea, you're at risk of dehydration), and the recommended treatment (a particular antibiotic, in a particular dose). A doctor can use a diagnosis of E.Coli, in combination with her knowledge of the medical literature, to help you get better.

A diagnosis of avoidant personality disorder isn't very useful because it tells you none of this information. It doesn't tell you why you feel the way you do. It can only give you the vaguest of predictions about how your life might pan out with, or without, treatment. And it doesn't tell your therapist anything about how to treat you that she doesn't already know. All it tells you is that you have the symptoms on the list, and that your particular cluster of symptoms is commonplace enough that the psychologists who wrote the DSM-IV thought it would be useful to give it a name.

Of course there is an overlap between physical and mental illness, and some scientists believe conditions like schizophrenia may one day turn out to have a discrete biological cause. But there's no evidence that that's the case for personality disorders - there are as many causes as there are people with symptoms. So by telling your therapist that you fit the AvPD diagnosis perfectly, all you have told her is that you have the symptoms on the list. She's telling you, quite sensibly, that the label itself isn't going to contribute anything useful to your treatment. If you begin identifying with the label, it might actually harm your treatment. So you may as well disregard the label, and just focus on treating the symptoms on the list. Which, presumably, is what your therapist was doing in the first place.

One last suggestion: stop googling your symptoms. Seriously. If you're dealing with any mental or physical health problem more serious than say, a stubbed toe, and you're fortunate enough to have access to actual face-to-face health care, nothing good can come from googling your condition. What you will get is: a) worsening anxiety from reading other people's worst-case-scenarios b) an unfounded belief that you know more about your condition than the person treating you, and c) a growing sense of identification with an illness, and a label, that may or may not have any relevance to you as an individual.

If you trust your therapist, then trust her when she says the label isn't hepful. If not, find a therapist you feel you can trust. Good luck.
posted by embrangled at 2:17 AM on October 14 [1 favorite]