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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Anna Laura on February 18, 2002, at 2:18:06
Hi all,
Is there any evidence that Axis II personality Disorders such as Borderline and Narcisistic could play a role in maintaining depressive symptoms within the sub-group of treatment resistant patients?
I've recently bumped in to The College Board's policy of British Psychopharmacologists stating that if the patient is not responding after two drug trials he should be reffered to a psychiatrist.
I've been to a psychiatrist who told me that i could be uncounsciously resisting the treatment, and when i said it wasn't so he added i could be suffering form a personality disorder that could prevent me form healing.
I've looked in to personality disorders and they don't seem to fit me that much.
I've done psychoterapy and a lot of self-interrogation with no significant results.
Do these theories have any scientific evidence/back up or is it just another subtle way of blaming the patient for not responding?
Posted by Dinah on February 18, 2002, at 9:47:13
In reply to Treatment resistant depression/Axis II disorders?, posted by Anna Laura on February 18, 2002, at 2:18:06
How about a little of both.
Certainly too many psychiatrists assign a personality disorder diagnosis out of frustration towards a patient who isn't responding to meds as expected or out of anger towards a patient they just don't like.
I've seen a lot of quite convincing literature (don't ask me where - I couldn't possibly remember) that sees personality disorders as a manifestation of another disorder. In other words, borderline personality disorder is a manifestation of an underlying mood disorder. Obsessive compulsive personality disorder and avoidant personality disorder are manifestations of underlying anxiety disorders. Schizoid and schizotypal personality disorders are manifestations of mild Asperger's (or schizophrenia, depending on the researcher). This group of theorists believe that if the underlying disorder is treated, the personality disorder will diminish or disappear. I would guess, however, that since personality disorders represent pervasive and habitual ways of perceiving and relating to the world that therapy to address distorted ways of thinking and unproductive ways of acting would be as important as medication under this theory.
Have you asked what personality disorder he thinks you might have? Have him pull out his diagnostic books and go over the criteria with you, telling you how they fit you. And if he thinks you don't really want to get better (I HATE that one) have him tell you in what ways he thinks you might be getting benefits from remaining ill. If he brings up these ideas it's up to him to explain them fully. You shouldn't have to guess what he means. Don't let him use these things as an excuse for not exploring better medication options.
Posted by jay on February 18, 2002, at 11:56:51
In reply to Re: Treatment resistant depression/Axis II disorders? » Anna Laura, posted by Dinah on February 18, 2002, at 9:47:13
Posted by Anna Laura on February 19, 2002, at 1:55:35
In reply to Re: Treatment resistant depression/Axis II disorders? » Anna Laura, posted by Dinah on February 18, 2002, at 9:47:13
> Have you asked what personality disorder he thinks you might have? Have him pull out his diagnostic books and go over the criteria with you, telling you how they fit you. And if he thinks you don't really want to get better (I HATE that one) have him tell you in what ways he thinks you might be getting benefits from remaining ill. If he brings up these ideas it's up to him to explain them fully. You shouldn't have to guess what he means. Don't let him use these things as an excuse for not exploring better medication options.
Dinah,
Thank you so much for your support.
If there were more persons like you the world would be a better place.
Well, the pdoc i was talking about didn't mention any personality disorder as he wrote that down on a piece paper which he put inside an envelope i was supposed to hand to a psychopharmacologist who's a friend of his. I know i shouldn't have but i opened that envelope (it was about me anyway). The letter stated i was suffering from the Weitbrecht type of endoreactive depression. I searched the net for that diagnosis since i didn't have a clue about it.
I finally found one of his on -line publications stating endoreactive depression wasn't a form of pure dhysthymia being linked to personality disorders such Borderline and Narcisistic.
I looked in to the criteria which don't seem to fit my case that much, borderlines having chaotic relationships and anger outbursts whereas i don't, narcisistics thinking to be special, lacking of empathy and being often envious of others whereas i don't.
I guess he labelled me such out of frustration.
Anyway, he should have told me instead of witholding informations and treating me like a jerk.
Well, that said , we could discuss the above issue on psycho-social board if you want.Thanks again
Blessings
Anna Laura
Posted by Denise528 on February 19, 2002, at 8:03:51
In reply to Treatment resistant depression/Axis II disorders?, posted by Anna Laura on February 18, 2002, at 2:18:06
Hi Anna Laura,
Just wanted to say I find it so annoying when people try to tell you that the tablets aren't working because you either don't want them to work (one I've been accused of), don't think they will work or because you are subconsciously resisting them from working. The tablets either work or they don't, full stop. Paxil used to work for me and now it doesn't and that is not because I am willing them not to work. If somebody took an aspirin for a headache and the headache didn't go away you wouldn't tell them that they were subconsciously resisting the asprin from working would you? Antidepressants are no different.
Just wanted to get that off my chest. Hope you find something that does work and which doestn't need will power for it to work :-)
Denise
Posted by Dinah on February 19, 2002, at 8:30:10
In reply to Re: Treatment resistant depression/Axis II disorde, posted by Anna Laura on February 19, 2002, at 1:55:35
I'd be happy to discuss it further on Social, but let me just say you were absolutely entitled to open that letter. Don't feel a bit guilty about it. I'm glad we have patient disclosure laws here that make that sort of thing hard for a doctor to do in this state.
Also, it really seems like you need to look for another doctor. (Although I suppose you could try confronting him for clarification first.)
Dinah
Posted by OldSchool on February 20, 2002, at 18:48:47
In reply to Treatment resistant depression/Axis II disorders?, posted by Anna Laura on February 18, 2002, at 2:18:06
>
> Hi all,
>
>
> Is there any evidence that Axis II personality Disorders such as Borderline and Narcisistic could play a role in maintaining depressive symptoms within the sub-group of treatment resistant patients?
> I've recently bumped in to The College Board's policy of British Psychopharmacologists stating that if the patient is not responding after two drug trials he should be reffered to a psychiatrist.
> I've been to a psychiatrist who told me that i could be uncounsciously resisting the treatment, and when i said it wasn't so he added i could be suffering form a personality disorder that could prevent me form healing.
> I've looked in to personality disorders and they don't seem to fit me that much.
> I've done psychoterapy and a lot of self-interrogation with no significant results.
> Do these theories have any scientific evidence/back up or is it just another subtle way of blaming the patient for not responding?LOL hehehe Youve found out the hard way about psychiatry. Its not very scientific or reliable. As for not responding to antidepressants and then the psychiatrist assigning you a "personality disorder" thats rather typical of mainstream psychiatry. For your knowledge, there is no such thing as a "personality disorder." Its a made up label the psychology people came up with. A personality disorder is a subjective, psychology based classification, not a brain based medical disorder like major depression, manic depression, schizophrenia or anxiety disorders.
Psychiatrists tend to assign personality disorder labels to patients that are hard to treat or whom the psychiatrist doesnt like. I wouldnt pay much attention to this personality disorder stuff...its BS.
However, if you dont respond to antidepressants there might be a problem with your diagnosis. You could be bipolar when they think you are unipolar depressed. You could have a thyroid problem thats not been diagnosed. There are lots of reasons why people dont respond good to antidepressants and Id be more inclined to search for a medical cause rather than one of these hokey pokey psychology labels like a "personality disorder."
Old School
Posted by noa on February 24, 2002, at 15:09:41
In reply to Re: Treatment resistant depression/Axis II disorders? » Anna Laura, posted by Dinah on February 18, 2002, at 9:47:13
I also think (based on what I've read from other Brittish posters here on Babble) that the Brittish psychiatric system is far behind in this regard--ie, bifurcating patients into treatable with medication and untreatable with medication due to personality disorder. Very rigid way of looking at it, still influenced by the Freudian psychoanalytic approach, not recognizing how experience and physiology have such intricately mutual patterns of influence--ie, it isn't nature vs. nurture--it's nature and nurture constantly feeding back to each other in a complicated way. (By the way, the 4th episode of that PBS special did a good job of illustrating how this works).
Here in the US, that used to be the norm, but now there seem to be increasing numbers of pdocs who see axis II disorders, like borderline personality disorder for example, as treatable with medication along with therapy, and possibly in the extended family of bipolar disorders, and/or having a hormonal basis (or as a contributing factor).
Remember, what is considered "typical" in the taxonomy of depression is based on years of research using male subjects. It is only recently that the way depression and anxiety and panic and cycling, etc. etc. has been seen as having many more variations that was earlier thought. Too bad the Brittish medicos haven't caught up---I hate to say it (because I have leanings toward universal welfare programs like universal health care coverage) but I think this delay in knowledge and practice could be due to the bureaucracy of the national health system.
This is the end of the thread.
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