Concerned About Personality Disorder Diagnosis and Treatment: The Dangers of Doctor Shopping

Reader’s Question

I am a 20-year-old male and I believe I have Borderline Personality Disorder. My first doctor just prescribed me Prozac for four weeks. It didn’t help at all. Then Anafranil (because I also have OCD) was prescribed, along with some anxiolytics. Still, there were no good results. I thought the Anafranil might help me if I continued on it for more weeks, but unfortunately my doctor was abroad and I couldn’t get a new prescription. I didn’t like the doctor anyway because he didn’t give me a clear diagnosis. My second doctor thinks that I have Bipolar Disorder because of my severe mood swings (depression, anxiety, irritability), so he started with Convulex as a mood stabilizer. Although I don’t think I have Bipolar Disorder at all, I’m planning to ask in the next session whether a mood stabilizer, an SSRI and also Anafranil would be the right mix to help.

What do you think?

Psychologist’s Reply

Sometimes making an accurate diagnosis requires more than just an initial visit, testing, and thorough history taking. Even monitoring how an individual responds to various medical and other interventions can help clarify the diagnostic picture. Further, few diagnoses are mutually exclusive. Some secondary conditions can accompany and/or exacerbate other conditions. And, because of the nature of the diagnostic schemes used, if a person meets certain criteria, they qualify for a particular diagnosis. Diagnoses are not inextricably linked to underlying etiology.

If indeed you suffer from Borderline Personality Disorder, there are some additional caveats to observe. The disorder is characterized by a very unstable sense of self and deficient emotional self-regulation. In many cases, it’s linked to severe trauma in the formative years that makes it difficult to acquire self-regulatory skill and to develop a stable sense of self. Part of the disorder is not having a strong enough sense of trust and a tendency toward dialectical modes of thinking (especially initial over-valuing of others followed by disenchantment) and feelings that increase the likelihood of erratic, impulsive, and unpredictable behaviors and shifts of mood. And there are many medications which can help with various features of the disorder, but they are most often insufficient on their own to treat the condition.

So, it’s important to share your concerns and issues with your treating professional but also to be aware of a possible tendency to engage in self-destructive “doctor-shopping.” With time, sincerity, and a firm commitment to getting better, you and your doctor should be able to find the optimum treatment regimen.

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