Question regarding personality disorder of "undetermined type"

[IAmStillHere]

Hi, I have an important question.

A year ago I was given a "diagnostic impression" after taking some tests (personality questionnaires) of borderline traits ("mild to moderate" according to the specialist) with sensitivity to rejection and abandonment, unstable relationships, identity disturbance,... I spent an hour speaking with her.

Last week, I met with a specialist in BPD and Bipolar disorder, he said I don't have BPD because I don't have risky/impulsive behaviors, I don't cut, I've never tried to kill myself,... I spent 30 minutes speaking with him and he took no tests, said you diagnose by history-taking. He said his team would see me again to further evaluate me and that they could help me with therapy.

HE SAID I HAVE A PERSONALITY DISORDER OF UNDETERMINED TYPE, as half the people with personality disorders do. He said it's a problem with emotion regulation, with relationships, etc. He said it comes from the hard life I've had (severe emotional abuse from father). I have a HUGE problem with fear of rejection and feeling worthless. He asked me "have you been rejected a lot in your life?"......

Both these specialists are psychiatrists, the first one in a personality disorder and in an anxiety disorder clinic, the second one is a specialist of BPD and Bipolar disorder, both in hospitals.

What do you know about personality disorders of "undetermined type" and how come I cannot find any info about it online? How can I find peace when I feel so flawed in my personality? I mean, WHO wants to have a flawed personality?????

 

[Jazzey]

I think that I've learned to hate labels IASH...We all have different issues to contend with. I've learned that I don't need that 'specific label' - I just need my psychologist to recognize my issues and help me to cope with them.

I know it's easier said than done in some circumstances - it would be so reassuring to know exactly what we're contending with and how to 'fix it'. But we're all individuals, with different life experiences. And those life experiences sometime dictate how we deal with life itself.

There's nothing wrong with that. Can I just recommend to you tonight that you be a little more open minded about your issues? That you recognize that a circle can't always fit neatly into a square?

I have very specific issues to my life circumstances (I think) - so right now, I just want to learn how to deal with my specific issues. I think that I'm dealing with rejection issues, and others. And, I'm trying to be ok with no particular 'formal' diagnosis - mostly because I think some of us are dealing with really complex life situations that a solid diagnosis is not feasible. It doesn't lessen those issues. It just means that we have to be broader minded. We have to seek out professionals who can help us deal with our issues irrespective of giving us the 'perfect diagnosis that fits into the perfect mold' (if you know what I mean?)

Still listening to you -right here.

 

[IAmStillHere]

I hear you and I agree!

Only I have spent most of my life seeking help and being open to my experience and issues, going to support groups in women's centers and reading self-help books and journaling, allowing myself to contemplate and trying to deal with abandonment issues, etc.

only I have never really gotten better... I still suffer immensely and my life hasn't really turned out so well (one of my problems is cyclical depression and I did tell the last psychiatrist this... i asked might I have Bipolar II but he said no, he said my personal story didn't reflect that, in 30 minutes!!!... this is a guy who teaches at a prestigious university and has written several books etc.).... and in the support groups, group therapies and individual therapies I did, it never really helped much.... (and that's why a diagnosis is important, to receive proper help, which I am sure you know!).

I just want to be helped! I feel like such a failure to not have been able, all along, to grow more and to learn to cope better and to find more inner peace and to not have been able to STOP falling back into episodes of major depression (and increasingly bad PMS depression) and worsening anxiety.. I told the psychiatrist that too. It doesn't feel like it's just a matter of developing coping skills, I feel like I have something biochemically wrong with me.

 

[Jazzey]

I just want to be helped! I feel like such a failure to not have been able, all along, to grow more and to learn to cope better and to find more inner peace and to not have been aboe to STOP falling back into episodes of major depression (and increasingly bad PMS depression) and worsening anxiety.. I told the psychiatrist that too. It doesn't feel like it's just a matter of developping coping skills, I feel like I have something biochemically wrong with me.

You're not a failure IASH...but you may not have yet found the right mental health professional - it took me a few tries before I found someone that I could trust.
I also suffer with major depression. And, to be very honest, it took me almost 10 years before I accepted it.

You could, very well, have something biochemically wrong with you - maybe you just haven't found the right health professional yet. I really don't mean to dismiss what you're going through -It took me a long time to find a mental health professional that I could genuinely trust.

We're all here to support you. And I hope that you'll believe that. This is a great forum for support. I don't mean to dominate your thread tonight -I just want you to know that: 1) you're being heard; 2) we're here for you.

Instinctively -I just want to tell you that you haven't yet found the right mental health support. But I also recognize that I don't have a sufficient background on you to be making that kind of statement.

Just keep your eyes and your ears pealed - I really believe that we instinctively know when we find that support network - and, you haven't found it yet. But it's out there for you...

 

[David Baxter PhD]

The second psychiatrist was right when he said there are no tests which are are definitive when it comes to differential diagnosis. And the reasons cited for indicating that you do not meet the criteria for either Borderline Personality Disorder or Bipolar Disorder appear to be sound. Note that even the first psychiatrist said only that you showed some "mild to moderate" borderline traits, which would suggest to me that even on the test you didn't meet the full criteria.

Diagnosis is really best done as an interactive process, looking at history, family history, and current symptoms along with how the patient responds to certain questions or elements of the diagnostic interview. In the case of diagnosis of a mental disorder, the process is in some ways more an art than a science and often the diagnosis will shift over time as the professional receives more information about the patient.

Being diagnosed with a personality disorder doesn't mean that you are "flawed" necessarily but rather that certain aspects of your personality have not developed normally, and certainly a history of neglect, rejection, abandonment, or abuse in early childhood is one significant cause of this (another is genetic predisposition).

The diagnosis of Personality Disorder NOS (where NOS means Not Otherwise Specified) is usually given when you partially meet the criteria for two or more different personality disorders but do not fully meet the criteria for any. This may be because the degree of disruption in personality is not severe enough to meet the criteria, or because you exhibit a mixed combination of symptoms which don't fit well into any existing diagnosis.

A personality disorder of any kind (known as an Axis II diagnosis) doesn't mean that your symptoms are necessarily less severe than a diagnosis of Major Depression or Bipolar Disorder or one of the anxiety disorders (these are called Axis I disorders). Also, one can be diagnosed with both an Axis I disorder and an Axis II disorder, so you may have episodes of major depression along with a personality disorder, where perhaps it is the personality disorder which is the primary problem and the depression develops secondary to the difficulties you encounter in life and relationships as a result of that personality disorder.

But ultimately it may be more important for you to seek psychotherapy (i.e., not just support groups) for your specific issues and symptoms rather than worrying so much about a diagnosis. You have ruled out two things, Bipolar Disorder and Borderline Personality Disorder, which would have required specialized treatment (e.g., medications) and I'm guessing that at present you don't show evidence of another Axis I disorder (e.g., major depression) or that would have shown up in one or both of your evaluations.

Are you seeing a therapist regularly at this time?

 

[IAmStillHere]

Thanks for your support jazzey and I am ready to ask for help. The past psychiatrist said they could help me with group and individual therapies at the hospital on a weekly basis and they are supposed to call me soon.

Dr Baxter thanks for the precious info, it's exactly the answers to my questions. I actually was diagnosed with major depression (with anxiety) along with the borderline traits. I have had many bouts of depression in my life, the last one lasted about 3 weeks and started with my period (bad PMS depression, another issue). I cried for days and days, suicidal thoughts, a lot of pain with no specific trigger.

I was also given a diagnosis of GAD 10 years ago when I attended day hospital (group therapy on a daily basis). It didn't help much at all. the group was a mixture of a schizophrenic, a girl who cut herself (BPD maybe), a woman in a deep depression who had just come out of a psychotic episode, a guy with a lot of anger who threatened me with his fist one day, ... etc... just a weird mix and it didn't help me at all.

 

[David Baxter PhD]

I suspect that individual therapy will be of more help to you. What about medications?

 

[IAmStillHere]

why do you think individual therapy would be more suited for me ?

they offered me both group and indivisual, should I accept? I am just scared I will end up in a scary group like last time.

I am not on meds right now and he didn't prescribe any, he said he wanted to wait. that was a first in all my history of consulting doctors and psychiatrists.

I would consider taking them if they might help. in the past I have taken Paxil and Effexor none of which really helped, Paxil made me really hyper and Effexor didn't help much at 75mg but when they upped my dosage to 112,5mg, I had major anxiety and restlessness, tossing and turning violently in bed at night and couldn't stop kicking my feet (scary), all within a couple of days of the increase, so I decreased back to 75mg.

later on I stopped the hormonal birth control I was on and felt better within 10 days so I weaned myself off the Effexor. I think I noticed that I was fine until I weaned off the last 37,5mg, then I became more anxious, irritable and aggressive-feeling, and starting ruminating negative thoughts more...

 

[David Baxter PhD]

why do you think individual therapy would be more suited for me ?

they offered me both group and indivisual, should I accept? I am just scared I will end up in a scary group like last time.

I'm not suggesting group therapy will harm you or that it won't be helfpul. I'm just suggesting that, hearing you're issues, you may benefit more from individual therapy, at least in the beginning.

I am not on meds right now and he didn't prescribe any, he said he wanted to wait. that was a first in all my history of consulting doctors and psychiatrists.

Wait for what? Do you have a followup appointment? Has he ordered blood tests or other medical tests?

I would consider taking them if they might help. in the past I have taken Paxil and Effexor none of which really helped, Paxil made me really hyper and Effexor didn't help much at 75mg but when they upped my dosage to 112,5mg, I had major anxiety and restlessness, tossing and turning violently in bed at night and couldn't stop kicking my feet (scary), all within a couple of days of the increase, so I decreased back to 75mg.

I have a bias against Paxil based on expoeriences of my clients over the years, although it seems to work well for some people. For many of my clients, it doesn't seem to have a loing enough half-life to provide stability so their moods even on Paxil are up and down, and the discontinuation effects for those who have them are probably the worst of all drugs in this family.

And Effexor is a dual action serotonin and norepinephrine booster, which may simply have been too much for you. The jitteriness and agitation in your muscles may well have been the norepinephrine boost.

But there are pkenty of other medications to treat depression and anxiety that would very likely be better for you...

later on I stopped the hormonal birth control I was on and felt better within 10 days so I weaned myself off the Effexor. I think I noticed that I was fine until I weaned off the last 37,5mg, then I became more anxious, irritable and aggressive-feeling, and starting ruminating negative thoughts more...

That tells me two things: One, that attention needs to be paid to your hormone levels and general endocrine functioning. The endocrine system (hormones) is tightly interwoven with the neurotransmitters (brain chemistry) so when one is out of whack it affects the other. Ask your doctors about thgis. Two, the Effexor quite likely was providing some benefit, even at that low dose, since your symptoms got worse when it was discontinued (unless that was just in the short term in which case it may have been a discontinuation effect). That would suggest that medication could very well be helpful again.

 

[IAmStillHere]

thanks for the info. I'm not gonna try Paxil again. for some reason it,s always the 1st one they prescribe (last time I asked to be on Effexor, they prescribed Paxil. I had heard it was better than othe rantidepressants at curing depression (avoiding a relapse))....


regarding the endocrinian system I had my hormones checked 8 years ago via blood tests and an appointment with an endocrinologist. he said the results were normal (though high testosterone but within a normal range) but did refer me to a psychiatrist as he acknowledged "severe cyclical depression" as apart of PMS. I never went to the psychiatrist though (fear and denial I think).

I'll ask for blood tests again.

thank you very much for your help