Define Crazy. Psych Disorders and Treatment

[nm2310]

I'm really interested in psychological disorders and treatment. Any elaboration or thoughts on the following is totally welcome.

Personality, somatoform, anxiety, mood, schizophrenic. Does our environment cause them or are people genetically just more likely to have them, with or without a healthy environment. Diathesis stress model?

Dissociative Identity Disorder: Can people truly have multiple personalities, or is it something else? (Wanting attention, an excuse, etc.)

Are people being diagnosed with mental disorders too much? Drugs overprescribed?

Why are personality disorders in Axis 2.....not exactly thought provoking lol but I just don't get why theyre placed here

Being guilty of a crime (i.e. murder) means it was done with intent. If a bipolar individual kills another in a manic phase, are they sane or insane?


A bunch of topics....What's your view. Throw around some intelligent thought.

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[ILGirl]

IBeing guilty of a crime (i.e. murder) means it was done with intent. If a bipolar individual kills another in a manic phase, are they sane or insane?

One can be mentally insane without being found legally insane. The criteria for each is different.

 

[nm2310]

Oo and my thoughts on everything:

I think the diathesis stress model is most logical. However, what makes me rethink this and say it's all biological and "triggers" don't cause full blown psychological disorders, is because of psychopharmacology. If someone takes prozac, and it works like it usually does, then the individual will not become depressed, even in an environment that is unhealthy. With the right combo of drugs, a person can be happy and energetic, depressed and anxious, or calm and careless, regardless of the situation they're in. Does this not disprove environment being considered a factor?

Regarding DID, I don't think people have multiple personalities in the sense that one of their "identities" is a middle aged man and the other is a teenage boy. I think that people use this "disorder" as an excuse. For example, they can say "oo one of my personalities is Bob, he's a mean and aggressive person who loses her temper easily." By doing this whenever they get in a fight with someone or react in a way that embarrasses them, they can free themselves of blame and say it was out of their control because they have this disorder. A defense mechanism because they don't have to blame themselves anymore. Also maybe a way for them to get attention...

I don't think people are being diagnosed with mental disorders too much. Critics say that the estimates of people with depression and GAD and personality disorders are too high and that they may even trivialize psychiatric diagnoses. They say that characterizing someone as mentally ill doesn't mean much if the label is applicable to half of the population. Well I say why not? No one in this world is completely healthy. A cold here, an ear infection there, people could always be healthier physiologically. I compare a cold physiologically, to mild anxiety psychologically. With a cold you rest and drink lots of fluids, but you're not on any drugs usually. With mild anxiety, maybe youre in group therapy and learning relaxation techniques. However, many people have cancer and diabetes and high blood pressure. Many people also are unhealthy mentally. No one says cancer is over diagnosed. Why should bipolar disorder or depression be?

Determining sane or insane. A bipolar person is not delusional. They understand reality, they just can't control their emotions. Even if they were incredibly angry and sad, they knew they were killing a person, so they should be punished.

 

[cheer12345]

.....

 

[nm2310]

One can be mentally insane without being found legally insane. The criteria for each is different.

I know it's a legal concept ultiamtley saying that an individual couldn't be held responsible for his or her actions because of mental illness. I just recently read an article, maybe you've heard of it, about a bipolar Rene Pavon. She was bipolar and killed a nurse. After reading the article, I personally think she must have been schizoaffective because she seemed extremely delusional, but if she was only bipolar, then she should be punished for what she did. She's pleading not guilty on reasons of insanity. Going back to the mnaghten rule, Pavon knew right from wrong (assuming she was correctly diagnosed as bipolar), she just couldn't control her emotions.

 

[cara susanna]

A good portion of the changes anti-depressants have can be accounted for by the placebo effect.

 

[loveoforganic]

Oo and my thoughts on everything:

I think the diathesis stress model is most logical. However, what makes me rethink this and say it's all biological and "triggers" don't cause full blown psychological disorders, is because of psychopharmacology. If someone takes prozac, and it works like it usually does, then the individual will not become depressed, even in an environment that is unhealthy. With the right combo of drugs, a person can be happy and energetic, depressed and anxious, or calm and careless, regardless of the situation they're in. Does this not disprove environment being considered a factor?

I disagree. Diathesis-stress model says you need both biological predisposition and environmental factors for a disorder to occur. Take away the biological "predisposition," and the disorder should disappear. At any rate, I think one of the better disorders to look at environmental effect would be borderline.

Regarding DID, I don't think people have multiple personalities in the sense that one of their "identities" is a middle aged man and the other is a teenage boy. I think that people use this "disorder" as an excuse. For example, they can say "oo one of my personalities is Bob, he's a mean and aggressive person who loses her temper easily." By doing this whenever they get in a fight with someone or react in a way that embarrasses them, they can free themselves of blame and say it was out of their control because they have this disorder. A defense mechanism because they don't have to blame themselves anymore. Also maybe a way for them to get attention...

Being a defense mechanism doesn't mean it couldn't be unconscious and uncontrolled. E.g. dissociative amnesia.

I don't think people are being diagnosed with mental disorders too much. Critics say that the estimates of people with depression and GAD and personality disorders are too high and that they may even trivialize psychiatric diagnoses. They say that characterizing someone as mentally ill doesn't mean much if the label is applicable to half of the population. Well I say why not? No one in this world is completely healthy. A cold here, an ear infection there, people could always be healthier physiologically. I compare a cold physiologically, to mild anxiety psychologically. With a cold you rest and drink lots of fluids, but you're not on any drugs usually. With mild anxiety, maybe youre in group therapy and learning relaxation techniques. However, many people have cancer and diabetes and high blood pressure. Many people also are unhealthy mentally. No one says cancer is over diagnosed. Why should bipolar disorder or depression be?

The DSM outlines guidelines for diagnosing disorders. I don't think it's particularly useful to redefine what a disorder is for this question. In the context of DSM guidelines, my answer would be "some are overdiagnosed, some are underdiagnosed" with more emphasis on the underdiagnosed.

Determining sane or insane. A bipolar person is not delusional. They understand reality, they just can't control their emotions. Even if they were incredibly angry and sad, they knew they were killing a person, so they should be punished.

This article outlines some interesting stuff. The laws vary from state to state, but this outlines Maryland. I'm curious what constitutes volition impairment, as it seems substantially more subjective than cognitive impairment. At any rate, they seem to sometimes include manic episodes under VI.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710106/

And please don't feel like I'm arguing with you. Your reply just gave me a nice context to put mine into!

 

[sunlioness]

Regarding DID, I don't think people have multiple personalities in the sense that one of their "identities" is a middle aged man and the other is a teenage boy. I think that people use this "disorder" as an excuse. For example, they can say "oo one of my personalities is Bob, he's a mean and aggressive person who loses her temper easily." By doing this whenever they get in a fight with someone or react in a way that embarrasses them, they can free themselves of blame and say it was out of their control because they have this disorder. A defense mechanism because they don't have to blame themselves anymore. Also maybe a way for them to get attention...

People might try this, but if you know anything about DID you know that doing so doesn't fly. Part of the therapy for DID focuses on responsibility. The person is responsible for all of their behaviors whether they remember them or not and should be held accountable. Therefore it actually behooves them to develop co-consciousness sooner rather than later rather than do and be held accountable for something illegal/immoral/embarrassing for which they are amnestic. DID is real, but not everyone who says they have DID actually has it. There are some people who seize on DID and intentionally malinger in order to evade responsibility as you described (and this shouldn't be allowed to "work" because as I said even legitimate DID isn't a free pass), but that doesn't invalidate the genuine disorder for those who do actually have it.

 

[PsyDGrrrl]

One can be mentally insane without being found legally insane. The criteria for each is different.

Insanity is a legal term, not a clinical one. There is no such thing as "mentally insane."

 

[Therapist4Chnge]

Insanity is a legal term, not a clinical one. There is no such thing as "mentally insane."

Beat me to it. A small pet peeve of mine...same with multi-personality disorder, though recently on one of the crime shows they used the correct term.

 

[loveoforganic]

Yes, and it was a poor choice of words, but I think the point was mental illness does not necessarily mean criminal insanity.

 

[PsyDGrrrl]

I know it's a legal concept ultiamtley saying that an individual couldn't be held responsible for his or her actions because of mental illness...She's pleading not guilty on reasons of insanity. Going back to the mnaghten rule, Pavon knew right from wrong (assuming she was correctly diagnosed as bipolar), she just couldn't control her emotions.

Different states have different insanity tests. Here in California (where Pavon is) the test is the M'Naughten rule which is that the person does not know the nature and quality of the act, OR, if they knew it, they did not know it was wrong. An individual could, theoretically, know an act was legally wrong but if they believed they had to do it (e.g., kill someone they delusionally believed was going to kill them) and be found NGI. I don't know the details of Pavon's case or plea, but the truth is, people who are found NGI usually end up spending way more time confined than people who go to prison. Even for murder.

 

[Therapist4Chnge]

To actually achieve NGI status is very very rare, so it definitely would not be a good defense to try and fake, though many still try.

 

[nononora]

She was bipolar and killed a nurse. After reading the article, I personally think she must have been schizoaffective because she seemed extremely delusional, but if she was only bipolar, then she should be punished for what she did. She's pleading not guilty on reasons of insanity.

It's quite a popular, but misguided, belief that pleading not guilty by reason of insanity is somehow escaping punishment. Quite the contrary. If the plea is upheld, she will be in an inpatient state psychiatric facility until she is deemed safe to be released, which will probably be when she stops being mobile.

There are many CPL cases at where I extern who've been in the system for 30+ years for offenses much less severe than murder.

 

[lexicon]

People might try this, but if you know anything about DID you know that doing so doesn't fly. Part of the therapy for DID focuses on responsibility. The person is responsible for all of their behaviors whether they remember them or not and should be held accountable. Therefore it actually behooves them to develop co-consciousness sooner rather than later rather than do and be held accountable for something illegal/immoral/embarrassing for which they are amnestic. DID is real, but not everyone who says they have DID actually has it. There are some people who seize on DID and intentionally malinger in order to evade responsibility as you described (and this shouldn't be allowed to "work" because as I said even legitimate DID isn't a free pass), but that doesn't invalidate the genuine disorder for those who do actually have it.

+1 to this! Couldn't have said it better myself.

 

[PrisonPsych]

this smells like a homework assignment...

 

[loveoforganic]

Maybe. Poster did put his opinions forward before others did though, so even if it is, we're at least not just handing answers away.

 

[nm2310]

Prison Psych-

I'm in an AP psych class so there's no homework. But read the rest of the posts because I was the first one to state my views on each of the thoughts.

I'm really interested in psychology in general, specifically mental disorders and why people do what they do and how to change maladaptive thinking and behavior so one can be successful.

I started this thread to see some other views from real people on controversial topics that could challenge my own and make me think more critically about the conclusions I had already come to.

What's your view on those topics? Do you think people can really have multiple "identities?" What do you think is the best therapy for treating mental disorders? drug, insight, behavioral....eclectic?

Enlighten me

p.s. For the record, I can see how asking about why personality disorders are on axis 2 v. axis 1 could come across as me fishing for a HW answer. I really am curious though! Anyone know why?

 

[lexicon]

nm2310, have you read any R.D. Laing?

 

[robinsena]

I'm really interested in psychological disorders and treatment. Any elaboration or thoughts on the following is totally welcome.

Why are personality disorders in Axis 2.....not exactly thought provoking lol but I just don't get why theyre placed here

A bunch of topics....What's your view. Throw around some intelligent thought.

My understanding is that Axis 2 disorders are those that have believed to have developmental underpinnings. Personality disorders fit into this category because they are hypothesized to occur through a person's lifelong development which is why there are some discussions now about moving some of the Axis 2 to Axis 1 because of new genetic and brain research. Like Borderline Personality Disorder and OCPD, for example. Someone can correct me if I'm wrong on this.

 

[KillerDiller]

Oo and my thoughts on everything:

I think the diathesis stress model is most logical. However, what makes me rethink this and say it's all biological and "triggers" don't cause full blown psychological disorders, is because of psychopharmacology. If someone takes prozac, and it works like it usually does, then the individual will not become depressed, even in an environment that is unhealthy. With the right combo of drugs, a person can be happy and energetic, depressed and anxious, or calm and careless, regardless of the situation they're in. Does this not disprove environment being considered a factor?

I think the environmental/biological distinction has lost a lot of its relevance in recent years. It is impossible to disentangle environment from biology because everything we experience has a biological underpinning.The environment exerts an impact on individuals via chemical and structural changes in the brain. Some of these changes mirror those of pharmacological agents (therapy changes the brain in many of the same ways as antidepressants and both of these things work by changing gene transcription patterns).

Also, considering that those with one episode of major depression are then very vulnerable to repeated episodes, I would say prozac is definitely not something that guards against environmental stressors,

 

[AcronymAllergy]

Prison Psych-

I'm in an AP psych class so there's no homework. But read the rest of the posts because I was the first one to state my views on each of the thoughts.

I'm really interested in psychology in general, specifically mental disorders and why people do what they do and how to change maladaptive thinking and behavior so one can be successful.

I started this thread to see some other views from real people on controversial topics that could challenge my own and make me think more critically about the conclusions I had already come to.

What's your view on those topics? Do you think people can really have multiple "identities?" What do you think is the best therapy for treating mental disorders? drug, insight, behavioral....eclectic?

Enlighten me

p.s. For the record, I can see how asking about why personality disorders are on axis 2 v. axis 1 could come across as me fishing for a HW answer. I really am curious though! Anyone know why?

It's been a little while since my advanced psychopathology course, but from memory, I believe the axis 1 vs. axis 2 distinction is partly based on the premise that axis 2 conditions were supposed to be those that are long-standing and far-reaching, and is partly just an artifact of the DSM's progression through the years. Some axis 1 conditions (e.g., dysthymia, cyclothymia) could likely fit right in over on axis 2, while the current axis 2 disorders themselves have fairly atrocious numbers regarding inter-clinician diagnostic agreement (i.e., we're generally pretty good at getting the cluster right, but aren't nearly as great at agreeing on whether it's borderline vs. histrionic vs. narcissistic vs. antisocial vs. a combination of the four, for example).

As for DID, the answers are going to vary widely based on who you ask, and what their theoretical orientation is. Personally, I don't know that I've seen much research supporting the actual existence of separate and distinct personalities. Rather, from what I've been able to tell in my limited experience with the condition, it seems like a mix of depersonalization, avoidance/distraction, and severely maladaptive cognitive coping strategies and processes.

 

[AcronymAllergy]

Oo and my thoughts on everything:

Determining sane or insane. A bipolar person is not delusional. They understand reality, they just can't control their emotions. Even if they were incredibly angry and sad, they knew they were killing a person, so they should be punished.

An individual with bipolar disorder who is going on two+ weeks of heightened activity and sleep deprivation can become quite delusional (and in actuality, delusions of grandeur are one of the diagnostic symptoms) and/or hallucinatory. Whether or not they would qualify as not guilty be reason of insanity would vary from case to case, but there's a reason that many inpatient units have quite a few individuals with bipolar. If nothing else, it's definitely a condition which can lead to someone being PEC'd, which is a process that's generally never taken lightly.

 

[cara susanna]

In order to understand DID, you need to understand dissociation. Everyone dissociates, but it's when it becomes extreme and pathological that it becomes a problem (a dissociative disorder).

 

[PsyDGrrrl]

Personality disorders are coded on Axis II, separately from Axis I, so that when a clinician is making a diagnosis they do not overlook the possibility of a personality disorder in addition to Axis I conditions.

 

[AcronymAllergy]

In order to understand DID, you need to understand dissociation. Everyone dissociates, but it's when it becomes extreme and pathological that it becomes a problem (a dissociative disorder).

Dissociation is indeed an interesting phenomenon, and goes to show just how good our brains can become at "tuning out" various internal and external events and conditions.

 

[erg923]

Oo and my thoughts on everything:

Regarding DID, I don't think people have multiple personalities in the sense that one of their "identities" is a middle aged man and the other is a teenage boy. I think that people use this "disorder" as an excuse. For example, they can say "oo one of my personalities is Bob, he's a mean and aggressive person who loses her temper easily." By doing this whenever they get in a fight with someone or react in a way that embarrasses them, they can free themselves of blame and say it was out of their control because they have this disorder. A defense mechanism because they don't have to blame themselves anymore. Also maybe a way for them to get attention....

I dont understand this. Because some people attempt to feign this illness= illness is not real? I dont understand that logic.....

Oo and my thoughts on everything:
However, many people have cancer and diabetes and high blood pressure. Many people also are unhealthy mentally. No one says cancer is over diagnosed. Why should bipolar disorder or depression be?.

I dont know what your training is but I would suggest 1.) you start critically thinking about the nature of diagnosis in psychiatry and how this process is different, both in term of senstivity and specificity, from physical medicine. 2.) the nature and risks of treatments that follow from these diagnosis 3.) the stigma that can result from these diagnostic labels. I think the answer to your question will be readilty apparent.

Determining sane or insane. A bipolar person is not delusional. They understand reality, they just can't control their emotions. Even if they were incredibly angry and sad, they knew they were killing a person, so they should be punished.

Delusions and ideas of reference are relatively common in severe mania. Whether that would qualify legally for "Diminshed Capicity" in a forensic context is a totally seperate matter.

 

[erg923]

By the way, everyone is making the Axis 2 thing into way more than it really is. It was developed simply so personality disorders and compromised intellectual fucntioning were not overlooked in the evaluation process because, usually, more pronouced disorders (ie., depression, schizophrenia, etc) are the cause for chief complaint and much of the presenting distress. It was a just a way to make sure clincians never overlooked evaluating/considering how these diagnosis play into the complete diagnostic picture.

EDIT: Whoops, it was already said and i missed it, my bad...

 

[erg923]

If someone takes prozac, and it works like it usually does, then the individual will not become depressed, even in an environment that is unhealthy.

Where on earth did you here this?

Yea, give me some prozac and lock me up in Gitmo and I'll be just fine.....

 

[Therapist4Chnge]

Some axis 1 conditions (e.g., dysthymia, cyclothymia) could likely fit right in over on axis 2, while the current axis 2 disorders themselves have fairly atrocious numbers regarding inter-clinician diagnostic agreement (i.e., we're generally pretty good at getting the cluster right, but aren't nearly as great at agreeing on whether it's borderline vs. histrionic vs. narcissistic vs. antisocial vs. a combination of the four, for example).

It frustrates me to no end the "loose" Dx's that I see scattered across medical records. A personal pet peeve is Borderline PD v. Bipolar. I also get frsturated when I consistantly see clinicans use MDD (unspecified) and Adjustment Disorder (unspecified and often violating duration specs), but rarely using Dysthymia, Double Depression, etc. I think it is mostly laziness and/or a lack of firm differential skills.

I wish more clinicians did thorough and proper intake interviews, as I often have to re-do most of the interview to get enough information about differential considerations, both rule-in and rule-out. I have been pretty lucky with my current location (even getting solid intakes from psychiatry!), though my experience seems to be in the minority. I'm also an assessment and report person, so I'm probably more particular with these things, but there is definitely a difference between a "good" report....and everything else out there.

Great...now I want to go teach report writing and interview classes.

ea, give me a some prozac and lock me up in Gitmo and I'll be just fine.....

A mix of some benzos could be interesting, but not an SSRI like prozac.

 

[phillydave]

It frustrates me to no end the "loose" Dx's that I see scattered across medical records. A personal pet peeve is Borderline PD v. Bipolar. I also get frsturated when I consistantly see clinicans use MDD (unspecified) and Adjustment Disorder (unspecified and often violating duration specs), but rarely using Dysthymia, Double Depression, etc. I think it is mostly laziness and/or a lack of firm differential skills.

I wish more clinicians did thorough and proper intake interviews, as I often have to re-do most of the interview to get enough information about differential considerations, both rule-in and rule-out. I have been pretty lucky with my current location (even getting solid intakes from psychiatry!), though my experience seems to be in the minority. I'm also an assessment and report person, so I'm probably more particular with these things, but there is definitely a difference between a "good" report....and everything else out there.

Great...now I want to go teach report writing and interview classes.

I totally agree. It's so frustrating when you feel like most of your clients are misdiagnosed. It happens so frequently, for all of the reasons you cite. Are our colleagues just lazy? Or did they sleep through psychopathology and assessment?!

 

[Therapist4Chnge]

I totally agree. It's so frustrating when you feel like most of your clients are misdiagnosed. It happens so frequently, for all of the reasons you cite. Are our colleagues just lazy? Or did they sleep through psychopathology and assessment?!

1. Axis-II Dx's most likely won't be re-imbursed by insurance, so an Axis-I Dx's is given as the primary issue.

2. Time/Money. Many times doing a thorough intake assessment isn't feasible in the setting. In private practice you won't get paid for all of your time from an insurance company, and it is a much harder sell if the person is cash pay because they don't "see" the benefit. While they pay for your expertise, they want it face to face.

3. Poor training. Not all clinicians are created equal. It could be a Ph.D. / Psy.D. / M.D. / D.O / SW, etc....making the Dx, and many do not have enough training to do it well. Honestly I think Dx'ing should be left up to a Psy.D. / Ph.D., but that is rarely the case at most facilities. Many times the elimination of symptom presentation is the primary motivating factor, not getting the Dx. right. It can also be quite hard to accurately Dx. someone when you have 5 minutes with them, which often happens in an ER....not because the physician/social worker/psychologiet/etc wants it that way, but they have to work within the system.

etc.

 

[AcronymAllergy]

1. Axis-II Dx's most likely won't be re-imbursed by insurance, so an Axis-I Dx's is given as the primary issue.

2. Time/Money. Many times doing a thorough intake assessment isn't feasible in the setting. In private practice you won't get paid for all of your time from an insurance company, and it is a much harder sell if the person is cash pay because they don't "see" the benefit. While they pay for your expertise, they want it face to face.

3. Poor training. Not all clinicians are created equal. It could be a Ph.D. / Psy.D. / M.D. / D.O / SW, etc....making the Dx, and many do not have enough training to do it well. Honestly I think Dx'ing should be left up to a Psy.D. / Ph.D., but that is rarely the case at most facilities. Many times the elimination of symptom presentation is the primary motivating factor, not getting the Dx. right. It can also be quite hard to accurately Dx. someone when you have 5 minutes with them, which often happens in an ER....not because the physician/social worker/psychologiet/etc wants it that way, but they have to work within the system.

etc.

I particularly enjoy reading about personality disorder diagnoses being tossed around after a ten-minute "clinical interview" with the patient. True, if a client frequently frustrates you then he/she MAY be borderline, but that's not something I'd be comfortable suggesting with any degree of certainty after a single evaluation.

And yes, I've seen quite a few wonderfully "creative" uses of diagnoses myself. In all honesty, I'd much rather come across "Psychotic Disorder NOS" or "Anxiety Disorder NOS" than someone with Bipolar + GAD + Borderline.

Oh, and I completely agree with respect to Borderline vs. Bipolar, especially in male clients. That's a tough differentiation to make.

 

[phillydave]

1. Axis-II Dx's most likely won't be re-imbursed by insurance, so an Axis-I Dx's is given as the primary issue.

2. Time/Money. Many times doing a thorough intake assessment isn't feasible in the setting. In private practice you won't get paid for all of your time from an insurance company, and it is a much harder sell if the person is cash pay because they don't "see" the benefit. While they pay for your expertise, they want it face to face.

3. Poor training. Not all clinicians are created equal. It could be a Ph.D. / Psy.D. / M.D. / D.O / SW, etc....making the Dx, and many do not have enough training to do it well. Honestly I think Dx'ing should be left up to a Psy.D. / Ph.D., but that is rarely the case at most facilities. Many times the elimination of symptom presentation is the primary motivating factor, not getting the Dx. right. It can also be quite hard to accurately Dx. someone when you have 5 minutes with them, which often happens in an ER....not because the physician/social worker/psychologiet/etc wants it that way, but they have to work within the system.

etc.

Totally, and in my personal experience, #1 has been the most common probable reason. Unfortunately poor training seems to be prevalent too, which, from what I've seen, is often from lack of or improper supervision during training.

 

[Therapist4Chnge]

I particularly enjoy reading about personality disorder diagnoses being tossed around after a ten-minute "clinical interview" with the patient. True, if a client frequently frustrates you then he/she MAY be borderline, but that's not something I'd be comfortable suggesting with any degree of certainty after a single evaluation.

Oh, and I completely agree with respect to Borderline vs. Bipolar, especially in male clients. That's a tough differentiation to make.

My personal feeling about Axis-II Dx'ing is that I want multiple interactions with the patient before giving a definitive dx, and honestly I'd probably want some psych testing just to confirm. I am definitely more conservative with my dx'ing, though I think prudence is the proper course with these things.

As for BPD v. Bipolar....it is quite difficult to accurately dx. without a good clinical interview AND some behavioral observation. Many times these dx's are thrown around and the patient is intoxicated, self-harming, or otherwise quite unstable. The self-harm piece can be quite a red herring because often times it happens under the influence, though many people want to slap on a BPD just because of some emotional lability and SH. Many times an "agitated" presentation is withdrawl related and not "a manic episode", and just because someone describes "mania-like" experiences does not mean it was a manic episode. People often confuse symptoms of anxiety as symptoms of mania. The pervasiveness of a PD is also often overlooked. Someone may have traits, though they could be learned behaviors/coping styles, and not so much actual pathology.

 

[cara susanna]

I think BPD's interpersonal component also differentiates it from bipolar.

 

[Therapist4Chnge]

I think BPD's interpersonal component also differentiates it from bipolar.

Agreed, though that usually isn't part of the initial Dx. if it happens in an acute setting.

I don't do much therapy now, but when I do, I prefer to do a relatively "blind" introduction interview*. I like to form my first impression of someone by meeting them, and not by reading their chart. Obviously this doesn't work for every setting and case, but I think it provides me with a more pure basis with which to build my clinical impressions.

*not a full session, but enough to get a feel. The follow-up appointment would be a more traditional intake.

 

[nm2310]

nm2310, have you read any R.D. Laing?

I have not. Just googled him though and I'm interested. Recommendations for any other books/movies... people.. I should google?

I'm just taking a class in high school right now so I'm not a grad student or psychologist or anything (hopefully one day ), I'm just really fascinated by the subject in general. It's cool that I can get some input and challenging ideas from people that have a lot more experience and knowledge than me.

In my class we just speed through bullet point powerpoint slides because the end goal isn't to become a psychologist. It's to ace the AP psych exam. That's why I posted on here!

Hope the convo keeps flowing.

 

[PsychStudent82]

I think the environmental/biological distinction has lost a lot of its relevance in recent years. It is impossible to disentangle environment from biology because everything we experience has a biological underpinning.

I agree with what you said. It is impossible to disentangle them because environment can never be taken away and the environment affects us in the way we perceive it. Perhaps our perception has a biological component to it or perhaps we have learned to perceive things a certain way (either through experience or observing the way others react in the same situation).

We could try to (unethically) raise a kid in a box but that box wouldn't be lack of environment it would be the environment that would be affecting that said individual. So since there is no such thing as lack of environment or lack of genetics it's impossible to say. It would have to judged on a case by case basis. Some people may be affected more by genetics than experience in their pathologies and others vice versa. It doesn't mean that it has to be 50/50 nature vs. nurture.

Also - you can say that genetics gives us a predisposition to certain pathologies however environment can cause that "gene" to become "activated".

Comments? Opinions?

I like this thread thanks for starting it

 

[PsychStudent82]

I would agree with what was said before some disorders are overdiagnosed and some are underdiagonsed.

Also - about your question on if medications are over prescribed..I would say it depends to who you talk to. A primary physician (if anyone is over prescribing medications it's them!)? Psychiatrist? Psychologist?

I personally was appalled when my aunt was prescribed anti-depressants a few weeks after her father passed away. Her primary care physician was sooo quick to diagnose her with depression and put her on medication. How about letting her go through the natural process of grieving or give her a proper referral to a mental health professional that may be better qualified to deal with grief counseling before getting pad happy? (Sorry it's a sore subject)

 

[robinsena]

I personally was appalled when my aunt was prescribed anti-depressants a few weeks after her father passed away. Her primary care physician was sooo quick to diagnose her with depression and put her on medication. How about letting her go through the natural process of grieving or give her a proper referral to a mental health professional that may be better qualified to deal with grief counseling before getting pad happy? (Sorry it's a sore subject)

Yeah, sadly that's too common a story nowadays. Don't even get me started on kids being overprescribed meds. The topic of 'pediatric bipolar disorder' come up once during a case conference I was presenting, and whether it is a 'real' disorder and if we should be treating it with lithium. If you really want to see child mental health professionals go at it, just bring that topic up.

 

[nm2310]

Prozac was a bad example. But nevertheless, even if an individual was in gitmo (Lol can't get more hopeless than that) if they were on an ssri or mao inhibitor then wouldn't they still not become depressed? Or to a lesser extent than if they weren't?

Environmental influence is inevitable. Like psych student said even unethically raising a kid in a box is still an environment. I just think biological factors are more influential, and not even limited to the development of psych disorders but personality among other things too. Take a really hyper kid and give him some add meds and they're quiet... Unnaturally zombielike even if the dose is wrong. Or a timid self conscious worry wart can become outgoing and even careless on benzos.

I might be way off base here. Let me know.

 

[nm2310]

Also, regarding phobias, could antianxiety med like lexapro or even Valium be used to help the person desensitize themselves from the anxiety arousing stimulus. Because with a phobia the individual knows their fear is irrational the problem is the physiological symtoms that keep them confronting it, right? So if they were on a benzo and their inhibitions low , wouldn't their fear be gone....phobias are anxiety related disorders.

Heads up major topic change: Aversion therapy. I say for extreme things like alcoholism and heavy smokers, "Heck yes!" Whenever your sick and you eat something that makes you hurl it usually doesn't stay a fav food choice. I really see this working. Flooding too. Unethical mAybe but if the individual truly wants to change their malaptive habits and talk therapy and pure moivation doesn't work than this seems key.

Hmmm I wonder if this works for chocolate chip cookies... : b

 

[PsychStudent82]

Heads up major topic change: Aversion therapy. I say for extreme things like alcoholism and heavy smokers, "Heck yes!" Whenever your sick and you eat something that makes you hurl it usually doesn't stay a fav food choice. I really see this working. Flooding too. Unethical mAybe but if the individual truly wants to change their malaptive habits and talk therapy and pure moivation doesn't work than this seems key.

Hmmm I wonder if this works for chocolate chip cookies... : b

In theory it should seem to work but what also comes into play is compliance. Lets say an alcoholic knows that by taking his meds and drinking alcohol he WILL get sick he may just opt to NOT take the meds. I think with addictions its better to think of a pincushion that has pins in it. Inside the cushion is pain and life and all that good ol stuff and the pins are what the person uses to cope with pain. It keeps the bad inside of the cushion. If you take the pin out they are left with a hole. An empty part of themselves. Often times substance abuse is a symptom of a problem and not the problem itself. The substance abuser needs to find another object/thing/activity to replace that pin in his/her cushion. Something else to turn to automatically when life gets hard or they get bored or want to celebrate something good. Think of it this way are there things in your life that are bad for you that you still do anyway? We all do things that hurt us but also feel so good that we keep repeating it. To a lesser extent perhaps than using drugs and alcohol but in a way it's all a spectrum of severity of the addictive behavior.
Change is hard even if you are making yourself ill physically or mentally.

 

[PsychStudent82]

I just think biological factors are more influential, and not even limited to the development of psych disorders but personality among other things too. Take a really hyper kid and give him some add meds and they're quiet... Unnaturally zombielike even if the dose is wrong. Or a timid self conscious worry wart can become outgoing and even careless on benzos.
I might be way off base here. Let me know.

I like to think of meds as a bandage. When you cover a wound with a bandage does that mean the wound is not there anymore? No we all know that the wound is there and needs to be treated to go away. I believe that medication should be used in conjunction with psychotherapy.

My professor told us that anti-depressants only work on those that are severely depressed w/ chemical imbalance. Those that are depressed due to situational/environmental stuff won't benefit from anti-depressants as much as those that have a more genetic biological source for their depression. Has anyone else heard this? If this is true, it would make sense that my aunt has not benefited from the anti-depressants she continues to take because she is still depressed!

 

[PsychStudent82]

Yeah, sadly that's too common a story nowadays. Don't even get me started on kids being overprescribed meds. The topic of 'pediatric bipolar disorder' come up once during a case conference I was presenting, and whether it is a 'real' disorder and if we should be treating it with lithium. If you really want to see child mental health professionals go at it, just bring that topic up.

I read a study that said that they are starting to realize that the long term effects of all these ADHD medications on the brain are similar to that of long term cocaine users. How scary is that!

I guess it's no surprise that the drug of choice of addicts that have ADHD is usually cocaine.

 

[robinsena]

Change is hard even if you are making yourself ill physically or mentally.

My friends who specialize in substance abuse work often tell me that aversion therapy sounds more intriguing on paper than in practice. If you have a client who is THAT motivated to get better to the point where he/she would consent to making oneself sick to do it, there are a ton of evidence-based techniques you can practice with him/her that do not require the use of aversion. One rarely (if ever) has a client that is motivated enough to consent to aversion therapy, but is not successful or committed to learning every other technique under the sun to address their problems.

Maybe those who can really benefit from this type of therapy are unfortunately those who are not so motivated for any therapy at all... who knows?

 

[AbbyNormal]

 

[PsychStudent82]

Maybe those who can really benefit from this type of therapy are unfortunately those who are not so motivated for any therapy at all... who knows?

Perhaps they see it as an easier route than the other routes? Or they have tried every other route with no prevail. You are right though who knows. Its hard to say who will benefit from what. Some people can change naturally on their own, others needs 12-step programs, or TC's or religion or a hobby or private therapy (the list could be endless really).

I agree though that aversion therapy sounds better on paper than in practice. They also use aversion therapy with pedophiles but if it worked all the time then they could just use it on all those incarcerated for sexual crimes and those said people would be "cured" but we all know that is not the case.

Sure sometimes bad experiences with something is enough to keep you away from it forever however how many of us used to drink to the point of getting sick when we were younger and swore that the next time you went out with your college buddies you wouldn't drink as much and then you did? You have to ask "what is this person getting out of this behavior even though it is hurting them" (Yes, very MI of me I know haha). As I said before it's at a different level of behavior and consequence as an addict but I find it easier to understand the difficulty in certain things by making examples that I could relate to. I don't know maybe I am wrong..Input please?

 

[AcronymAllergy]

My friends who specialize in substance abuse work often tell me that aversion therapy sounds more intriguing on paper than in practice. If you have a client who is THAT motivated to get better to the point where he/she would consent to making oneself sick to do it, there are a ton of evidence-based techniques you can practice with him/her that do not require the use of aversion. One rarely (if ever) has a client that is motivated enough to consent to aversion therapy, but is not successful or committed to learning every other technique under the sun to address their problems.

Maybe those who can really benefit from this type of therapy are unfortunately those who are not so motivated for any therapy at all... who knows?

Very true--sustained motivation is a particularly problematic issue in substance abusing populations. Which is why many professionals go with an MI + relapse prevention-based approach for treatment.