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Diagnose Me!
Thursday, November 6, 2003 | 12:00 a.m. CST; updated 10:02 a.m. CDT, Thursday, July 24, 2008

 

Playing amateur psychologist can make for hours of Freudian fun, but be careful before you slap someone with a personality disorder diagnosis — this game isn’t as easy as it looks. There is a common phenomenon in medical school called second-year syndrome. As students read about the symptoms of different illnesses in their second year of study, some begin to imagine that they have rare diseases. A sinus headache is interpreted as a brain tumor. A skin rash from cosmetics is the first manifestation of the Ebola virus.

 

John Kerns, an MU clinical psychology assistant professor, says this also happens as students go through professional training in his field. He warns his abnormal psych students on the first day of class to avoid internalizing the personality disorder descriptions as they study.

 

But sometimes they just can’t help it.

 

“It’s easy to look at the criteria for a personality disorder and think, ‘Ooh, that’s me,’” says Christine Durrett, a third-year MU psychology grad student.

 

She says diagnosing yourself is ill-advised for the same reason medical doctors should not treat themselves: lack of perspective.

 

Diagnosing friends and family can be even worse. For the amateur psychologist, this is an attractive yet ethically perilous option. According to the ethical code published by the American Psychological Association, students aren’t allowed to diagnose anyone without supervision. Yet the temptation, psychology students say, is difficult to resist — at least in an informal way.

 

When Rachel Swain was taking abnormal psychology at Westminster College, she decided both her roommates had personality disorders. One roommate couldn’t study unless the apartment was spotless. Swain once left a plate in the living room, and the roommate left a note on the refrigerator chiding Swain for her slovenly ways.

 

The other roommate was fixated on her appearance. “I look good today,” Swain remembers her saying on more than one occasion.

 

She pegged them as Obsessive-Compulsive and Narcissistic, respectively.

 

As Swain learned more about personality disorders, she learned the key to avoiding a misdiagnosis is to be on the lookout for traits that result in substantial impairment of function.

 

When Scott Albright was an undergraduate — he’s now a psychiatric resident at MU — he offered an amateur diagnosis but chose an ethically safer subject: Martin Janionas, a great-grandfather he’d never met. From family anecdotes, he theorized that Janionas, a Lithuanian immigrant who never adjusted to his new country, had Delusional Disorder, a common ailment in elderly people who have difficulty communicating.

 

Aside from the dead, Albright says even licensed psychologists should avoid diagnosing family. Treating them is even worse. “It’s bad medicine to prescribe medications to your family,” he says. “It’s like selling a car to your neighbors.”

 

The Diagnostic and Statistical Manual of Mental Disorders defines a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible and leads to distress or impairment.” Only about one in 50 adults in the general public has a clinically definable personality disorder. Most who suffer are harmless, and most cases are not severe.

 

The typical Obsessive-Compulsive, Histrionic or Dependent person, for example, poses little danger to himself or herself or to society. Other disorders are more serious. Borderline Personality Disorder types might engage in self-mutilation or attempt suicide. An Antisocial person could engage in criminal activity. A Paranoid might find interacting with society almost impossible.

 

Diagnosing a disorder, according to most psychologists and counselors, is best left to professionals. Accurate self-diagnosis, they say, is almost impossible anyway because of a brain-scratching paradox: If you think you might have a personality disorder, you almost certainly don’t. If you don’t think you have a personality disorder — well, you still probably don’t — but you might.

 

For example, if you think of yourself as a well-adjusted Missourian, but the above statement is triggering feelings of general distrust (including, perhaps, very specific malevolent thoughts about this publication) — you might suffer from Paranoid Personality Disorder. But if you are experiencing these feelings, and you are starting to wonder if you might be paranoid, then you can relax because you’re fine.

 

Probably.

 

Lloyd Whyte, a licensed clinical social worker, says people who suffer from a personality disorder are unlikely to seek treatment on their own. “Most people with personality disorders don’t see anything wrong with themselves,” he says. He also says most personality disorder sufferers don’t seek treatment until forced, usually by a spouse or parent. People with extreme disorders, he says, are usually in prison. (According to a New York Times article, roughly 16 percent of American inmates have serious psychiatric illnesses.)

 

Further complicating diagnosis of any kind is the reality that few individuals exhibit all the symptoms for a disorder. They are more likely to exhibit isolated symptoms or exhibit symptoms of several different disorders because traits overlap. Kerns says a better understanding of the blurred lines between disorders is causing researchers to reevaluate how they diagnose patients. He says the DSM itself, long the bible of the American Psychiatric Association, is due for a revision. It was last updated in 2000.

 

Tim Trull, also an MU clinical psychology professor, has developed a method for classifying personality pathology different from the one suggested by the DSM. His method is considered a dimensional approach. In contrast to the categorical approach, which assumes you either have a disorder or you don’t, Trull’s method presumes that everyone at one time or another exhibits traits of a personality disorder, but most individuals find themselves somewhere in the middle (open to trying a new brand of beer, closed to trying bungee jumping, for example). Individuals at either extreme are generally those most likely to develop a personality disorder.

 

For the casual eccentric — the

 

person who washes his or her hands

 

20 times a day or thinks the mail carrier is a CIA spy but is otherwise happy and well-adjusted — the dimensional way of thinking should come as some relief. We’re all a little crazy from time to time, but that doesn’t mean we need to be branded with a textbook disease.

 

And even if we do, we’d rather not have our friends tell us about it.

 

If a friend is behaving erratically, consult a counselor or psychologist. In many cases, confronting the person and telling him or her why the behavior is unacceptable is the best solution. There is a common phenomenon in

 

medical school called second-year syndrome. As students read about the symptoms of different illnesses in their second year of study, some begin to imagine that they have rare diseases. A sinus headache is interpreted as a brain tumor. A skin rash from cosmetics is the first manifestation of the Ebola virus.

 

John Kerns, an MU clinical psychology assistant professor, says this also happens as students go through professional training in his field. He warns his abnormal psych students on the first day of class to avoid internalizing the personality disorder descriptions as they study.

 

But sometimes they just can’t help it.

 

“It’s easy to look at the criteria for a personality disorder and think, ‘Ooh, that’s me,’” says Christine Durrett, a third-year MU psychology grad student.

 

She says diagnosing yourself is ill-advised for the same reason medical doctors should not treat themselves: lack of perspective.

 

Diagnosing friends and family can be even worse. For the amateur psychologist, this is an attractive yet ethically perilous option. According to the ethical code published by the American Psychological Association, students aren’t allowed to diagnose anyone without supervision. Yet the temptation, psychology students say, is difficult to resist — at least in an informal way.

 

When Rachel Swain was taking abnormal psychology at Westminster College, she decided both her roommates had personality disorders. One roommate couldn’t study unless the apartment was spotless. Swain once left a plate in the living room, and the roommate left a note on the refrigerator chiding Swain for her slovenly ways.

 

The other roommate was fixated on her appearance. “I look good today,” Swain remembers her saying on more than one occasion.

 

She pegged them as Obsessive-Compulsive and Narcissistic, respectively.

 

As Swain learned more about personality disorders, she learned the key to avoiding a misdiagnosis is to be on the lookout for traits that result in substantial impairment of function.

 

When Scott Albright was an undergraduate — he’s now a psychiatric resident at MU — he offered an amateur diagnosis but chose an ethically safer subject: Martin Janionas, a great-grandfather he’d never met. From family anecdotes, he theorized that Janionas, a Lithuanian immigrant who never adjusted to his new country, had Delusional Disorder, a common ailment in elderly people who have difficulty communicating.

 

Aside from the dead, Albright says even licensed psychologists should avoid diagnosing family. Treating them is even worse. “It’s bad medicine to prescribe medications to your family,” he says. “It’s like selling a car to your neighbors.”

 

The Diagnostic and Statistical Manual of Mental Disorders defines a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible and leads to distress or impairment.” Only about one in 50 adults in the general public has a clinically definable personality disorder. Most who suffer are harmless, and most cases are not severe.

 

The typical Obsessive-Compulsive, Histrionic or Dependent person, for example, poses little danger to himself or herself or to society. Other disorders are more serious. Borderline Personality Disorder types might engage in self-mutilation or attempt suicide. An Antisocial person could engage in criminal activity. A Paranoid might find interacting with society almost impossible.

 

Diagnosing a disorder, according to most psychologists and counselors, is best left to professionals. Accurate self-diagnosis, they say, is almost impossible anyway because of a brain-scratching paradox: If you think you might have a personality disorder, you almost certainly don’t. If you don’t think you have a personality disorder — well, you still probably don’t — but you might.

 

For example, if you think of yourself as a well-adjusted Missourian, but the above statement is triggering feelings of general distrust (including, perhaps, very specific malevolent thoughts about this publication) — you might suffer from Paranoid Personality Disorder. But if you are experiencing these feelings, and you are starting to wonder if you might be paranoid, then you can relax because you’re fine.

 

Probably.

 

Lloyd Whyte, a licensed clinical social worker, says people who suffer from a personality disorder are unlikely to seek treatment on their own. “Most people with personality disorders don’t see anything wrong with themselves,” he says. He also says most personality disorder sufferers don’t seek treatment until forced, usually by a spouse or parent. People with extreme disorders, he says, are usually in prison. (According to a New York Times article, roughly 16 percent of American inmates have serious psychiatric illnesses.)

 

Further complicating diagnosis of any kind is the reality that few individuals exhibit all the symptoms for a disorder. They are more likely to exhibit isolated symptoms or exhibit symptoms of several different disorders because traits overlap. Kerns says a better understanding of the blurred lines between disorders is causing researchers to reevaluate how they diagnose patients. He says the DSM itself, long the bible of the American Psychiatric Association, is due for a revision. It was last updated in 2000.

 

Tim Trull, also an MU clinical psychology professor, has developed a method for classifying personality pathology different from the one suggested by the DSM. His method is considered a dimensional approach. In contrast to the categorical approach, which assumes you either have a disorder or you don’t, Trull’s method presumes that everyone at one time or another exhibits traits of a personality disorder, but most individuals find themselves somewhere in the middle (open to trying a new brand of beer, closed to trying bungee jumping, for example). Individuals at either extreme are generally those most likely to develop a personality disorder.

 

For the casual eccentric — the

 

person who washes his or her hands

 

20 times a day or thinks the mail carrier is a CIA spy but is otherwise happy and well-adjusted — the dimensional way of thinking should come as some relief. We’re all a little crazy from time to time, but that doesn’t mean we need to be branded with a textbook disease.

 

And even if we do, we’d rather not have our friends tell us about it.

 

If a friend is behaving erratically, consult a counselor or psychologist. In many cases, confronting the person and telling him or her why the behavior is unacceptable is the best solution. There is a common phenomenon in

 

medical school called second-year syndrome. As students read about the symptoms of different illnesses in their second year of study, some begin to imagine that they have rare diseases. A sinus headache is interpreted as a brain tumor. A skin rash from cosmetics is the first manifestation of the Ebola virus.

 

John Kerns, an MU clinical psychology assistant professor, says this also happens as students go through professional training in his field. He warns his abnormal psych students on the first day of class to avoid internalizing the personality disorder descriptions as they study.

 

But sometimes they just can’t help it.

 

“It’s easy to look at the criteria for a personality disorder and think, ‘Ooh, that’s me,’” says Christine Durrett, a third-year MU psychology grad student.

 

She says diagnosing yourself is ill-advised for the same reason medical doctors should not treat themselves: lack of perspective.

 

Diagnosing friends and family can be even worse. For the amateur psychologist, this is an attractive yet ethically perilous option. According to the ethical code published by the American Psychological Association, students aren’t allowed to diagnose anyone without supervision. Yet the temptation, psychology students say, is difficult to resist — at least in an informal way.

 

When Rachel Swain was taking abnormal psychology at Westminster College, she decided both her roommates had personality disorders. One roommate couldn’t study unless the apartment was spotless. Swain once left a plate in the living room, and the roommate left a note on the refrigerator chiding Swain for her slovenly ways.

 

The other roommate was fixated on her appearance. “I look good today,” Swain remembers her saying on more than one occasion.

 

She pegged them as Obsessive-Compulsive and Narcissistic, respectively.

 

As Swain learned more about personality disorders, she learned the key to avoiding a misdiagnosis is to be on the lookout for traits that result in substantial impairment of function.

 

When Scott Albright was an undergraduate — he’s now a psychiatric resident at MU — he offered an amateur diagnosis but chose an ethically safer subject: Martin Janionas, a great-grandfather he’d never met. From family anecdotes, he theorized that Janionas, a Lithuanian immigrant who never adjusted to his new country, had Delusional Disorder, a common ailment in elderly people who have difficulty communicating.

 

Aside from the dead, Albright says even licensed psychologists should avoid diagnosing family. Treating them is even worse. “It’s bad medicine to prescribe medications to your family,” he says. “It’s like selling a car to your neighbors.”

 

The Diagnostic and Statistical Manual of Mental Disorders defines a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible and leads to distress or impairment.” Only about one in 50 adults in the general public has a clinically definable personality disorder. Most who suffer are harmless, and most cases are not severe.

 

The typical Obsessive-Compulsive, Histrionic or Dependent person, for example, poses little danger to himself or herself or to society. Other disorders are more serious. Borderline Personality Disorder types might engage in self-mutilation or attempt suicide. An Antisocial person could engage in criminal activity. A Paranoid might find interacting with society almost impossible.

 

Diagnosing a disorder, according to most psychologists and counselors, is best left to professionals. Accurate self-diagnosis, they say, is almost impossible anyway because of a brain-scratching paradox: If you think you might have a personality disorder, you almost certainly don’t. If you don’t think you have a personality disorder — well, you still probably don’t — but you might.

 

For example, if you think of yourself as a well-adjusted Missourian, but the above statement is triggering feelings of general distrust (including, perhaps, very specific malevolent thoughts about this publication) — you might suffer from Paranoid Personality Disorder. But if you are experiencing these feelings, and you are starting to wonder if you might be paranoid, then you can relax because you’re fine.

 

Probably.

 

Lloyd Whyte, a licensed clinical social worker, says people who suffer from a personality disorder are unlikely to seek treatment on their own. “Most people with personality disorders don’t see anything wrong with themselves,” he says. He also says most personality disorder sufferers don’t seek treatment until forced, usually by a spouse or parent. People with extreme disorders, he says, are usually in prison. (According to a New York Times article, roughly 16 percent of American inmates have serious psychiatric illnesses.)

 

Further complicating diagnosis of any kind is the reality that few individuals exhibit all the symptoms for a disorder. They are more likely to exhibit isolated symptoms or exhibit symptoms of several different disorders because traits overlap. Kerns says a better understanding of the blurred lines between disorders is causing researchers to reevaluate how they diagnose patients. He says the DSM itself, long the bible of the American Psychiatric Association, is due for a revision. It was last updated in 2000.

 

Tim Trull, also an MU clinical psychology professor, has developed a method for classifying personality pathology different from the one suggested by the DSM. His method is considered a dimensional approach. In contrast to the categorical approach, which assumes you either have a disorder or you don’t, Trull’s method presumes that everyone at one time or another exhibits traits of a personality disorder, but most individuals find themselves somewhere in the middle (open to trying a new brand of beer, closed to trying bungee jumping, for example). Individuals at either extreme are generally those most likely to develop a personality disorder.

 

For the casual eccentric — the

 

person who washes his or her hands

 

20 times a day or thinks the mail carrier is a CIA spy but is otherwise happy and well-adjusted — the dimensional way of thinking should come as some relief. We’re all a little crazy from time to time, but that doesn’t mean we need to be branded with a textbook disease.

 

And even if we do, we’d rather not have our friends tell us about it.

 

If a friend is behaving erratically, consult a counselor or psychologist. In many cases, confronting the person and telling him or her why the behavior is unacceptable is the best solution.

 

By Ben Hallman


additional reporting by Ingrid Ahlgren


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