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Mental illness in residency personal statement

Discussion in 'Psychiatry' started by lithiyum, Sep 1, 2009.

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  1. lithiyum

    lithiyum

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    Hey guys,

    Oldschoool member here in a new account to ask a silly question :oops:

    I'm wondering what some of you attendings and others would think about residency applicant focusing a personal statement on his or her own experience with mental illness.

    While I'm sure I would find psychiatry interesting regardless, the truth is my decision to pursue psychiatry is probably 90% based on suffering from bipolar disorder myself. I come from a family where literally every blood relative of mine either 1) committed suicide 2) is a drug addict or 3) suffers from a frank mental illness or 4) a combination of these.

    I am acutely aware of the stigma that mental illness carries in the professional world, even in the field of medicine. However, I have worked with many psychiatrists who were very open about their mental illness, and this has led me to wonder if perhaps the stigma is lessened in the field of psychiatry.

    I only ask because really the most compelling reasons for me to enter psychiatry revolve around my life experience prior to my becoming interested in medicine. In fact, I only decided to pursue medicine in order to enter psychiatry.

    I worry that a personal statement and/or interview that left these experiences out would not only be less interesting and compelling, but would actually be disingenuous.

    OK, I feel some babbling coming on, so I'll leave it here.

    Thanks.
  2. Doc Samson

    Doc Samson gamma irradiated

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    Do you want to be honest or do you want to match? No PD is going to be all that gung-ho about taking a resident that is more likely than their nearest competitor to miss work for whatever reason. Write a nice bland personal statement, match, THEN be completely honest and forthright with your PD.
  3. IAmAUser

    IAmAUser Member

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  4. psychotrope

    psychotrope

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    I wouldnt mention it.
  5. VMSmith

    VMSmith

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    I agree with the other posters. PDs are looking for residents who are bright, capable, and unlikely to run into problems during training. Unfortunately, disclosing that you have bipolar disorder will raise questions in PDs' minds regarding the latter, no matter how compelling your story is.
  6. masterofmonkeys

    masterofmonkeys Should Have Been A Cowboy

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    this is what I did regarding my physical ailment.
  7. nancysinatra

    nancysinatra

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    The PS is actually not a place to be totally honest or interesting or compelling. It's meant to sum up your accomplishments and qualifications, in a rather bland and reassuring way. This is a professional statement, not a memoir. I would avoid anything too personal, no matter what the topic.
  8. Abacab

    Abacab

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    In my opinion, a personal statement can help you more than it can hurt you. As a resident, I have been involved in the residency admissions process at my program. The attendings seem to give nothing more than a cursory once-over to the personal statement. Those with any grammatical mistakes, typos, misspelling stood out and showed a lack of attention to detail or poor english skills...this worked against the candidate. Other than that, the content of the personal statements did little to sway anybody one way or another.

    As a profession, we constantly strive to eliminate the stigma of mental illness. However, you will find that psychiatrists and other mental health professionals tend to raise an eyebrow when they discover that a colleague has a mental illness.

    Residency is challenging enough for those in good health mentally and physically. Programs want to be confident that you'll be able to brush off all the different emotional and physical stressors that come your way.

    Don't rock the boat right now. You've worked too hard thus far to compromise you ability to rank in your preferred programs.
  9. psychotrope

    psychotrope

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    agree on the not too personal part, but I've been told by attendings at multiple institutions that they do want some personal information that focuses on why the candidate is wowed by psychiatry and stuff like that.....


    After all, "summing up your accomplishments" is what your cv, usmle scores, and transcript are for.....and all that gets sent to the program immediately as well.

    Of course, the best way to do it is to tie accomplishments and experiences in with this.
  10. nancysinatra

    nancysinatra

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    Oh yeah, but it should be in an impersonal kind of way--ie don't air any personal drama in the PS, is all I'm saying. Those who can avoid being boring in the process and show a bit of humility--more power to you! However the genre leaves exceedingly little room for prose that would inspire a person to do anything other than fall asleep.
  11. billypilgrim37

    billypilgrim37 Unstuck in Time

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    You shouldn't put anything in your PS you shouldn't say on a first date (expecting to have a second).
  12. jettavr6

    jettavr6

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    If you want to match, don't even think about mentioning it... Psychiatry has in the past been accused of being the field for people with mental illness to go into... PD's have been fighting this off and are starting to get a handle on it... Psychiatry is getting competitive now; don't screw yourself...
  13. chameleonknight

    chameleonknight Friggin go away, freaks.

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  14. whopper

    whopper Former jolly good fellow

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    I agree with the above. IMHO several programs would hold it against you that you have a mental illness, even if you have a history of having it under good control.

    While I personally do not like that this happens, and even find it a form of unfair discrimination and hypocritical, its out there.

    The bottom line is a program will have several applicants for one spot. They start throwing people out of consideration for reasons that are unfair. One guy has bipolar? Maybe that guy will go manic, don't consider him as a candidate when you have 20 other people applying for one spot.

    I took a year off. Several programs asked me if I had a mental illness (which I do not). That seemed to be a red flag to them that someone may be mentally ill. One guy during an interview demanded I admit I had a mental illness in a fit of anger, and said some unflattering things about the mentally ill...which if anything just made me erase that program from my MATCH list. The guy's in a field to heal the mentally ill, but has an apparent disdain for them. Geez, how sad.
  15. loveoforganic

    loveoforganic -Account Deactivated-

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    Is it even remotely legal to ask that?
  16. 277768

    277768 Lifetime Donor

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    What an interesting thread!

    I think I have issues with social anxiety, alienation, etc. and am interested in going into psychiatry.

    I guess it would be bad to mention that my chief motivation to go into the field is to try to heal my own psycho-social-sexual-somatic-familial issues.
  17. IAmAUser

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  18. whopper

    whopper Former jolly good fellow

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    I haven't asked a lawyer if the asking about a mental illness is legal. I was told by laymen that it is not. However I do believe (at least when I applied) that there was a section in the applications that asked if the applicant had any medical disorders that may affect their job performance.

    Like I said, hypocritical. Any program that holds mental illness against a candidate that has it under control is akin to them telling their own patients "your employer had every right to fire/demote/not consider you for promotion because of your mental illness" or "of course its alright for you to be discriminated against when applying for a job because of your history of depression."

    Its a double standard. Most psychiatrists if they found out their patient was having unfair discrimination against them due to their illness if they were worth their title would help to advocate for their patient. Psychiatrists in general want the general public to understand mental illness, and not judge based on stereotypes. Yet this type of discrimination happens.

    I do understand if a medical illness (psychiatric or not) was held against a candidate if there is a highly likelihood it would affect job performance that was within the realm of the person's control. E.g. a histrionic woman making sexual advances on her patients--that of course cannot be excused. In fact in most legal interpretations the person cannot be excused if they have the mental ability to know doing such an action was wrong--which it would be in a histrionic PD person (with that diagnosis alone).
  19. notdeadyet

    notdeadyet Still in California Moderator

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    Probably cheaper to go into anesthesia and just hire a team of really good therapists.

    I had figured this would be one of the "two camps" threads... Interesting that everyone seems to be of the same mind...

    And I agree. Never reveal anything in any job application or interview that has a very large chance of hurting you and very little chance of helping you.
  20. jettavr6

    jettavr6

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    Interestingly, I think the same would hold true if one were dealing with some sort of chronic medical illness -- Lupus, MS -- If a program director has multiple qualified people for a job, they will pick the person who is least likely to take time off. At one psychiatry program, the PD asked one female candidate if she was planning on having any more children. I don't agree with any type of discrimination, but it does exist in every medical specialty.
  21. peppy

    peppy Senior Member

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    I do think this is a big factor. Another issue to consider is that they only have a very limited amount of time to get to know who you are. If you did an away at the program and showed them that you have good judgement and are reliable, then the story of your mental illness might be seen in a sympathetic light, but otherwise they have no real way to know how well controlled your illness really is. Every day, they see patients who don't have much insight into their illness and don't recognize that they have some major problems functioning because of it, so who could blame them for not wanting to take your word for it that your illness is stable and controlled?
  22. whopper

    whopper Former jolly good fellow

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    Which is fine so long as your interest is also in treating people.

    And this is true as well...however for a program to jump the gun and immediately not even consider someone with an illness at all is over the line.

    You figure the person's performance as written on their evaluations and LORs would reflect if the person had their specific disorder under control. Even in cases where the person's performance was rated as excellent, several programs still would hold a psychiatric disorder against that candidate.

    My own program did accept someone with a psychiatric disorder (who did not tell the program about it, and took several steps to hide it). My then PD's attitude was that was fine so long as the disorder didn't cause a problem. Ouch, it did--to the extreme. It was a horror story.

    It turned out her records had several red flags. Why the program took her when there were hundreds of other candidates who wanted her spot--I may never know.
    Last edited: Sep 6, 2009
  23. asdfff

    asdfff

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    What was the disorder, and what were the red flags?
  24. whopper

    whopper Former jolly good fellow

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    Her medical school wrote things in her records stating she had some "red flag" behaviors. What they were I don't know because I was never told. I do know the medical mentioned them because I was told that by several attendings.

    However I did hear that after she left our program, she went to another, and resumed the same problems she had at our program, so I do believe her medical school red flags were the same as the problems we saw her do.

    What was her diagnosis? She had histrionic PD, however I'm not sure if she had other comorbid issues. She had enough signs and sx to meet that diagnosis including the characteristic voice (which she could not quiet down, I had difficulty talking to her about patients because she'd talk back about them in a high pitched, loud voice) came into work wearing a see through shirt that exposed her breasts, sexual advances on patients, flirting with patients in a sexual manner, among several other things.
  25. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    Was she hot? If she toned it down a little for her residency interview, I can see how she might have (inappropriately) been selected for the program by the male members of the residency selection committee.
  26. whopper

    whopper Former jolly good fellow

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    I didn't think she was hot, though any woman that's not overweight that's in her 20s will definitely have sex appeal to older men. Hey, as you get older, younger women just start looking more attractive.

    That same thought crossed my mind. There was another resident in my program who was rather histrionic, though didn't have enough signs and sx for a histrionic PD diagnosis (and not enough for borderline, though altogether she had several of both to the point where it met Personality DO NOS). This other resident, though also bad wasn't bad enough to be kicked out. She readily turned the gossip wheels, was bothersome, and made several enemies, but didn't cross the -activity to get you kicked out of the program- lines such as giving pregnant patients depakote without okaying with the attending or make sexual advances on patients.

    Both of those individuals IMHO probably actually did very well during their interviews. Being histrionic on a short term observation could IMHO actually be to that person's advantage. A young woman being flirty, even a bit scandalous and fun during an interview would certainly appeal to people, even other females.

    That's a strong reason why I didn't really care for very good conversationalists during interviews. If you start making that an important factor in taking a person, you're going to get people higher on the social spectrum which would include more histrionic people. I felt people at my program were putting too much emphasis on that. Of course I wanted the person to be able to communicate well, but that's different from someone who's appearing very very enthusiastic and trying to talk to you as if you're their newest best friend.

    IMHO the 2 best residents I saw while I was in residency were actually somewhat schizoid. They were quiet, reliable, not very social (which was a blessing considering there were people in residency who were on the order of high school students with establishing cliques) did their work well, and their quietness didn't affect their ability to relate to patients.
  27. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor

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    Just an aside--we've noticed before when members start posting their Myers-Briggs profiles that there's actually quite a preponderance of introversion among us. There may be something about the ability to be reflective that makes this a useful trait. I've also found that most introverts I know, myself included, do better interpersonally when the "rules" are defined well--like in the structure of a physician-patient interview, as opposed to the free for all of a singles bar.
  28. whopper

    whopper Former jolly good fellow

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    I think some of the attendings were not caring so much about the LORs, evaluations and such because they figured if the person made it to the point of the interview, it must be good. OK--yes the filters did get rid of several people, but then to disregard the above, and be so very impressed with an interview, which is only a facade of a person IMHO is putting too much faith on the interview.

    I have seen people during interviews that very much impressed me, but it was because they demonstrated knowledge far beyond the standard. E.g. this wasn't an interview, but I got a resident now who's shadowing me in fellowship, and she's actively reading the landmark cases, and wants to do some HCR-20's with me which no one I knew in residency was actively doing.

    If a young attractive woman came into an interview, was tickling my ego, flirtatious (though within a culturally appropriate level), and appeared very bubbly that certainly is not IMHO a criteria to bring someone in. Though I guess we doctors are all too human to not notice if we're p-whipped. I also believe age is a factor. When one is a doctor well in an age bracket of 40 to above, and a young attractive person comes in and makes you feel alive, you might correlate that with appealing traits for residency (good communication skills). Yeah, well the person may have good communication skills (which were not tested under work conditions), but they could also be a histrionic and narcissistic. I don't know if those 2 people I mentioned fit the theory I mention (that their cluster B traits may have been what brought them in), though I suspect in several applicants, those traits could help in an interview, but when the program finds out the mess they're in, its too late. Person's already in, and kicking residents out is a very big deal.

    I was in a fraternity in college. The interviews I later came to learn were a load of bull. I interviewed about 20-30pledges a year for 3 years, and since I was on the executive board, I had a vested interest in seeing that the people who got in were good. There was little substance between a good interviewer and what eventually became a good fraternity brother--which IMHO was someone who would've helped you in a jam, and fulfilled their responsibilities--all of them, even the ones people didn't want to do such as community service. The 2 criteria I noticed that were the ones of real predictive value were--1) did the person do their community service without causing a fuss, and 2) did the person accept their pledging duties (E.g. having to clean up the fraternity house after a party). The interviews however did serve to act as a good ice breaker, and stepping stone to getting to know a person, but IMHO that was it.

    Which is another factor I that crossed my mind. All attendings should take a vested interest in making sure they only accept good applicants for residency, but they may not be taking it upon themselves to take the process as seriously as the chief resident, program director and program coordinator. Several of them may only be doing the interview because they have to do so as part of their job requirements, and thus be more susceptible to the "feel good" candidates.
    Last edited: Sep 7, 2009
  29. notdeadyet

    notdeadyet Still in California Moderator

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    Are you in the 40+ bracket? Curious. I don't know any friends in their 40's or 50's who "feel alive" when a pretty young thing comes in and bats her eyelashes. If anything, a guy in his 50's is more likely to know he's being played than a guy in his 20's or 30's. It's an experience thing.

    No doubt you get a lot of horndogs in their 40's with a soft spot for young hotties. But in my experience, most of them were horndogs with a soft spot for young hotties when they were in their 30's... and 20's... The handful of folks I've met with trophywives were players from day one. It wasn't a big character change that age thrust upon them.

    I agree with you that sex appeal can play a role in these things. But I think both genders and all age brackets are susceptible.
  30. whopper

    whopper Former jolly good fellow

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    Nope. I'm 36.

    You're correct. It depends on the person. With more experience, yes will come more wisdom. However I've seen my fair share (especially in forensic psychiatry) of narcissistic psychiatrists, even ones 40+ who will allow the "feel good" candidates to get the better of them. E.g. I've seen some programs where the majority of residents were attractive women. The program even developed a rumor where the PD was specifically out to get hotties. Now was that really the case or was it just a coincidence that it was full of hotties, and then the rumor developed from that? I don't know, but I have seen enough 40+ doctors deliberately show favoritism to the point where it was beyond rumor, and was to the point where it was clear.

    I've also seen a specific rotation where the psychiatrist worked one on one with a resident. The residents the doctor worked with were often times about 20-30 years younger than him, and he took those ladies out to lunch paid for it, and didn't do so for everybody. Let's just say he very much enjoyed the young attractive women more so than having a male or unattractive female with him. He was not judging them based on clinical ability.

    I know of a medical school where a professor in the admissions board actually scanned the pics of all the female candidates, and if it came down to candidates that were about the same in quality, to start putting the better looking females ahead of the other females. Now did he admit this to me? No, but 5 professors who were his colleagues told me this was going on.

    Someone older can also be argued to be more vulnerable. Older men are more susceptible to the old Heinz Kohut narcissist injury and rage. Is it a stereotype to think all men 40+ will be more vulnerable?--yes. Is it a stereotype to think all men 40+ because of their more experience will not be as vulnerable?--yes.

    Psychiatrists are people, and subject to human failings just like everyone else. While our mental health background you would think would give us added insight, it also in some creates added denial, and rationalization that since "I am a psychiatrist, of course I wouldn't be susceptible to making these types of mistakes."

    I agree. In general, I figure someone who's bigger head is in control in their 20s is going to keep that control.
    Last edited: Sep 7, 2009
  31. notdeadyet

    notdeadyet Still in California Moderator

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    I believe it. I have no doubt there is no shortage of 40yo+ narcissistic psychiatrists who go after the pretty young things. I just question how many of them did the same thing when they were in their 20's or 30's.

    The difference between a 20something horndog and a 40something horndog, in my experience, is that the 40something horndog is more likely to be in a position of power.
  32. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus

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    This thread is officially depressing me because I'm neither histrionic, narcissistic, nor a total hottie. I'm wondering if I'll have a harder time on the interview trail than I'd like. :eek:
  33. harmnot

    harmnot

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    Would admitting that you have ADHD be a trigger for a red flag?
  34. BobA

    BobA Member

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    The only purpose of the personal statement is to give your interviewer something to talk to you about.

    Why focus on your weaknesses? Is that what you want to talk about in your 30min to impress your future employer?

    I didn't talk about any personal issues in my personal statement, but my ps was a little racey and I came to regret it. I had to explain it to all my interviewers - sometimes this went well, sometimes it didn't. That's what you get with controversial material. Better to stick to the middle of the road because you never know who your audience will be.

    At the time, I was worried that I wouldn't get interviews and so I tried to write a memorable personal statement to get me in the door. But what gets you in the door is your board scores, your grades, medical school and maybe a good letter of rec.
  35. whopper

    whopper Former jolly good fellow

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    I wouldn't worry about it. Hey, I'm not histrionic, narcissistic nor a hottie either. You're going to get just as many perks and knocks as you probably have been the way you are. Its not like being histrionic is going to get you into a place (ok, it might in some of the examples I mentioned above), but if you are histrionic, its certainly going to cause many more problems than benefits, unless you're in a profession where its specifically beneficial to be like that (e.g. a pop star).

    The biggest obstacle is getting to the interviews. Once you're there, and you have a good number (a number over 7) just be yourself.

    The last few posts I wrote were not really for the applicants but for the residents and up. We see it through a different set of eyes because we want the best applicants, while the applicants are seeing it from the perspective of wanting to get into the best program. My intention in the last few posts was to knock those attendings that allow their "countertransference" (which I put in quotes because the applicant is not a patient) get the better of them when judging an applicant.

    I can think of situations where other personalities were better for other residents. E.g. those 2 residents I mentioned that were quiet were well respected because they got the job done, got it well and only complained when the situation was worthy of a complaint. That IMHO is pretty much what you want the most in a resident. Most of the yappers if anything just added to the gossip mill, but what bugged me was I felt in the interview process the yappers were looked upon more favorably.
  36. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor

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    ...yet your avatar wears a Speedo. :laugh:
  37. whopper

    whopper Former jolly good fellow

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    I think I'm more a weak spectrum voyeur, and hey, don't mess with David Hasslehoff. (The guy in the avatar in case you didn't know).
    http://cache.gizmodo.com/archives/images/hasselhoff_2003-07-27.jpg

    I'm a shorts and t shirt guy. Only reason why I dress up for work in something better is because I want to look like I fit the role. Right when I come home, I wear my dorky Star Trek t-shirt and shorts.

    Hypothetically I wouldn't care so long as I saw no reason to believe you didn't have it under control. If you had it under control, your LORs, scores, clinical evaluations were all good, I wouldn't see any reason to even factor it in. If I were a PD and you mentioned you had ADHD before you got in, and then you did get into the program, early on I would ask you to talk to me (in private and in confidence), about making sure the program did what it could within a reasonable amount to help you make sure you got the ADHD under control, and also establish with you that if you needed psychiatric help, it should be outside the program to avoid any possible conflict of interest problems.

    I would though also state that I would have to expect just as much out of you, vs any other resident. Like I said above, so long as the person had it under control, no problem. If it wasn't under control, and to the point where it could adversely affect performance, then that'd be a problem because doctors have a responsibility to give quality care to our patients.

    However like its been said above, IMHO several programs will hold a mental illness against a candidate. They will just not admit so out in the open. I'm not sure if applications still ask the applicant to name any medical disorders. I can't advocate someone lie on an application if that question is asked on an application.
    Last edited: Sep 9, 2009
  38. Kauka

    Kauka

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    Post Doc
    I'm starting the residency application process really late...

    How much if any of the following should I include in a personal statement for a child psychiatry residency application?

    I experienced the destructive impact on my family of the misdiagnosis of adult and childhood mental illness.

    I was married to a high functioning woman who was eventually diagnosed with borderline PD, narcissistic PD and bipolar disorder. She meets the criteria for antisocial PD, though was never diagnosed. We have a son together who is now 4 years old; she and her mother kidnapped my son twice, once at the age of 6 months, and once at 21 months of age.

    Her mother has similar traits. Her 6-year-old daughter was diagnosed with early onset bipolar disorder and had five inpatient psych hospitalizations within a 7 month period. Prior to that, her daughter collected a number of different diagnoses from different clinicians, and had been in filial play therapy since the age of three.

    We divorced after a very long and expensive court battle that featured heinous false allegations on her part. The court awarded me sole legal and physical custody of our son, and cleared me of all her false allegations. Part of the divorce process included a custody evaluation by a psychologist, who did an extensive psych eval and MMPI on both of us.

    My son and I have been clear of that family for a 1-1/2 years, and our life is back to normal.

    Thanks
  39. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor

    Joined:
    Dec 2, 2004
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    Attending Physician
    Physician SDN 7+ Year Member
    Short, easy answer: NONE of it.
  40. VMSmith

    VMSmith

    Joined:
    Aug 21, 2007
    Messages:
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    Fellow [Any Field]
    SDN 5+ Year Member
    Do not include any of that. Waaaay too personal.

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