Reader’s Question

The supervisor of a MHMR clinic said they couldn’t treat me because of my issues. They diagnosed me as having PTSD, depressive disorder, and Personality Disorder NOS. I don’t understand the latter one, NOS. How do I figure this one out since it’s mixed with different symptoms. What do I have?

JUST ME!

Our Clinical Psychologist’s Reply

I’ve recently posted an introduction to personality disorders on this website. Individuals with a Personality Disorder (PD) have many characteristics in common, most of which I’ve discussed in my article. There are about ten distinct Personality Disorders in mental health work — each having a totally different collection of symptoms and behaviors. In the diagnosis of “Personality Disorder, NOS” the “NOS” represents “Not Otherwise Specified”. This diagnosis is used when the clinician suspects a PD is present but doesn’t have enough information or clinical contact; or a lack of consistent history required for a specific diagnosis. The highest number of individuals with a Personality Disorder have Antisocial, Histrionic, Borderline, or Narcissistic Personality. My article briefly describes each of those diagnoses. You might review the criteria for each PD to see if one is a good fit for your symptoms and behaviors.

A refusal to provide services/treatment is rarely due to the presence of PTSD or depression. The “issues” mentioned are most likely related to the suspected Personality Disorder. These “issues” are usually things like inappropriate behavior, poor attitude toward treatment, manipulative behavior, hostility, hidden agendas (drug seeking for example), and inconsistent compliance with treatment. Failure to cooperate with treatment is one of the major reasons treatment is terminated from a clinical and administrative standpoint. Cancellations, no-shows, refusal to follow treatment plans, etc. can all bring an administrative end to your treatment.

Treatment professionals have a legal and ethical responsibility for the patients under their care. They are not obligated to continue this level of responsibility if the patient is uncooperative, noncompliant, resistive, or inconsistent with treatment.