The Complexity of Psychiatric Diagnoses

[@DrSyl]

The comments section has been so interesting to read and reflect on guys, thank you so much for your openness and your stories. Just a clarifying point to say that I don't think neglect 'causes' autism. The cause of ASD is not fully understood and there are likely biological, psychosocial contributing factors. But emotional neglect is an important consideration in ALL psychiatric diagnoses and can definitely influence one's social skills (which can contribute to ASD diagnosis). Anyway, it's ALWAYS more complicated than it seems.

[@shapeofsoup]

You may need to let go of the idea that autism is a psychiatric condition in the first place. It’s not. It’s fundamentally neurological. There are psychiatric aspects of autistic presentation, but those observable symptoms and traits have nothing to do with the actual cause, only its perceived existence. Current standardized diagnostic criteria for autism are a fundamental mischaracterization of what autism actually *is* (a distinctive divergence in neurological sensory processing from what is broadly understood as neurotypical-and even that lacks specificity, but it’s the best we’ve got until we can identify it neurologically or biologically). There’s a reason the DSM-5 can’t even define autism; it can only describe what autism looks like. Such is the limitation of a deficit-based diagnostic standard. The diagnostic criteria for ASD are all externally observed behaviors. But here’s the thing: autism isn’t a behavioral condition. Behavior is a secondary symptom of autism at best, tertiary or less if trauma-induced. Frankly, the fact that diagnosis of neurological conditions is still just lumped in with general psychiatry is a huge problem, and it’s downright depressing for the likely millions of undiagnosed ND adults out there just trying to survive in a world that wasn’t built for them.

[@aspidoscelis]

"can definitely influence one's social skills (which can contribute to ASD diagnosis)" - I think you're pointing to a flaw in the diagnostic process. If someone's mind works differently than mine, I'll probably find it awkward or difficult to socialize with them. If I further consider my own way of socializing to be correct, I might say that person has social skill deficits. Either of us could probably be trained to socialize more like the other. Convergence in social interaction would conceal rather than reduce the difference between us. If we rely on social interactions to recognize that difference, we'll have a harder time of it. This is becoming understood in the academic literature, generally findable under the terms "double empathy problem" and "social camouflaging".

[@sherrijennings9309]

Hey Syl, my niece is clearly autistic, but her parents didn't want her to have a "label" until I explained that from the perspective of a teacher, and the school, it gives us tools to catre to your child's needs better. Everyone's experience of autism/ADHD/dyslexia etc. is different, but when i see a diagnosis on the student's file, i know that I will need to pay extra attention to how that child learns best and what accommodations they need. A diagnosis also means funding for the school to put supports in place for the child. I realise this isn't everyone's experience, and that makes me sad, but I like to think that society is slowly becoming more informed on these things

[@kiarranarisse]

I'm glad that you would see it that way, and you're right for the most part. The biggest issue is that ppl still aren't nearly as accepting as they often say they are of autistics. I've known many autistics who've had issues with teachers infantilizing them after knowing their diagnosis, or treating them as a burden bc of their accommodations. It's hard to trust that all of the child's teachers will be like you. I didn't grow up with the label, but I've had multiple friends who "accepted" my autism, but dropped me after an undesirable one showed. I had a partner that "accepted" it, but then treated me like a child and got mad when I didn't seem to react enough to things. Very few ppl are willing to say they don't like autistics, and even fewer are willing to learn about it. As long as your niece's parents keep an eye out for any teacher in the wrong, it should be okay tho👍

[@NeonCicada]

@@kiarranarisse I have to agree with you both. Simply tolerating a person's existence isn't the same as actually accepting them. Personally speaking, my autism is so enmeshed with *WHO I AM* -- that I don't even think of "it" as an "it" at all 😄 So, when people don't _(or can't)_ accept my autism It's like they don't _(or can't)_ accept ME ... and I think that's why it hurts me the way it does.

[@ktreid112]

My diagnosis (CPTSD) was critical for me because it changed the way I looked for an appropriate therapist (one that is trauma trained, has EMDR or CPT training/certification). I was previously going to a therapist who did not have trauma training and I felt worse after each therapy session. From a medication perspective it’s been extremely helpful too.

[@Amanda-il8ks]

My 1st encounter with psychiatrists was as an inpatient, suffering with depression & post concussion syndrome following a TBI sustained at work (first responder) & I was diagnosed with BP & BPD (dx that made absolutely no sense & the psychiatrists wouldn’t explain which criteria I met)… this is after they completely disregarded the opinion of my sister, a PhD clinical psychologist who has observed me her whole life! .. turns out you can’t just overturn an incorrect dx … it stays with you & follows you for years! I’ve had a GP tell me he hates patients like me (BPD) & psychs not give me the treatment I need for the actual condition I have because of misdiagnosis & blind stubbornness not to change someone else’s diagnosis. Turns out the correct dx is MDD & PTSD & it’s taken 6 years to finally get the correct treatment. Research how the DSM was “created” ….the diagnostic criteria are hardly based on empirical evidence

[@FusRoTEAPot]

I'm a 3rd year MH nurse and my biggest issue with diagnoses is the stigma, especially surrounding the personality disorders. It seems like some (not all) professionals hear PD and just switch off, not wanting to make the effort to understand someone better or even thinking it's pointless. Also the lack of services that will work with people once they know they have this diagnosis. Hopefully one day we can change this

[@bzzwiebel963]

I was once diagnosed as a borderline just because I cut myself but all the other symptoms and behaviours were not present. After getting antidepressants my mood symptoms became worse instead of better. I had this DX for more than 5years. I had no abandonment issues, no emptiness, no lack of identity and definitely had my feelings under control. The argument that borderline is under diagnosed I.e as bipolar 2 is ridiculous. My moods lasted longer than a few hours and were much deeper than the superficial borderline outbursts. I did DBT and use this kind of therapy to get through my mania and depression. I also did not end up in the ER often. I have now the DX of bipolar 1 because I was psychotic several times and a lot of hypomanic states despite antipsychotic drugs and mood stabilizers. I am somebody who hates psych wards hence endure mood swings at home. A borderline would not have the rational to deal with the tough mood swings I am dealing with. Self harm-I was new to this mental health matter and a borderline suggested cutting to deal with emotions. Therefore I tried it. It was horrible completely stupid hence some psychiatrists still believe that I have borderline traits. I have not shown any borderline behaviour whatsoever for more than 20 years. The DX was wrong. None of the shrinks came to the conclusion that I have never been a borderline.

[@stevejabroney159]

Hey Bzzwiebel963. This is so interesting. I’d be curious to know how old you are, as I encountered a lot of teens with very visible self harm scars around a decade ago, in a workplace. It was very frightening and confronting and yet they didn’t outwardly appear to experience suicidal ideation, major depression, they fit in per se. Was there a moment in time a while back where self harm was a signifier of belonging, perhaps to a subculture? Like tattoos or piercings?

[@stevejabroney159]

Ritual scarification as a rite of passage? People seeking a meaningful place in society and culture and not an act of self annihilation

[@diamondskies55]

As someone with complex mental health issues, getting my diagnosis of Bipolar Disorder made me feel like I wasn't just lazy, or that I wasn't trying hard enough. It was proof there was a true medical condition that I had, that others had too. I was able to find a support group for people with bipolar disorder, and it was really affirming to meet with people who had stories similar to mine, and hearing what worked for others and what didn't. My problem is that I do not fit neatly into the Bipolar Disorder box. I have other diagnoses too, and it gets really difficult to understand what symptoms come from where and how I should approach treatment. Some of my diagnoses have multiple overlapping symptoms, but the traditional treatments for each are completely different. I pray that before I die the science will progress to the point where there will be some sort of genetic test, or imaging or something objective that could help better understand mental illness.

[@deborahbasel184]

My diagnosis has allowed me to research my condition and find the best, up to date treatment options.

[@allisonkeevers6076]

I was diagnosed BP2 at age 40. I was so relieved. I finally had a reason, a path to follow, and something I could investigate to study and learn about and help myself to be my best me. It hasn't all been smooth sailing for the past 14yrs but at least now I know what's going on. Some people call it a label, I call it my salvation.

[@jemimalamb78]

I'd love to hear more about ADHD & Trauma and it's correlation.

[@bl3524]

For me it was incredibly helpful and validating to get diagnosis after suffering for longer than 10 years. I know how to manage my health and struggles now because of the diagnosis. However at some points I was pretty scared that it would become a self fulfilling profecy and that I would get stuck in the symptoms.

[@suddenlyautistic]

I think I understand your perspective and feel I'm being triggered because I'm late diagnosed and spent the best part of 46 years having my narrative twisted by others. Now, with my diagnosis, I can correct or inform the narrative while taking responsibility for myself (thoughts and feelings). And when I say 'correct the narrative' that's mostly my internalising of how others respond and relate to me. I accept that while I can now offer more accurate explanations of why I have the habits and routines I do, I can't control how other people recieve them or my explanations (as information, never excuses). I feel it's super important for mental health professionals to sit on their hands a bit and do a little gentle guidance with what may be perceived my them as over-identifying rather than respond with a quick correction. Have you read Camus 'The stranger'? It's a lesson in how human relationships work. Perception is reality. We're neurologically wired that way. One can identify, explain and seek to continue growing. Dialectics in action.

[@Liv_Says]

I am beyond glad personally I have my diagnosis, my most helpful one being bpd. As much as it sucks to not be able to get proper treatment for bpd here, I can learn to manage it with the research I do online and standard counselling

[@annagalabova1289]

Another con - if doctors/therapists see the person they’re dealing with as a diagnosis, they risk missing the opportunity to connect with them and help. I have seen this in coaching and therapy and it is very sad, because the client/patient learns that they are incorrigible.

[@aspidoscelis]

I've had the opposite experience. Therapists who can't connect with me, misunderstand me, and invalidate my experience because they're trying to interpret me as "neurotypical person who is broken" rather than as "autistic person". It becomes a relentless cycle of feeling misunderstood, trying to explain, and the therapist moving on to a different misunderstanding-because the idea that they might be wrong in their basic assumptions isn't even on their radar. When a particular diagnosis implies a different theory of mind, therapists need to understand that and figure out how to change their own interpretations and behavior accordingly-or at least realize that they are out of their depth and don't understand what's going on!

[@aspidoscelis]

"I've got [x] so I can't do that." - To me, that is unquestionably a healthy, positive response *when* it's true that you can't do that. And sometimes it is true. In those cases, the alternative is trying and failing repeatedly without a realistic chance of success. It sucks. I think that's a big part of why autism, especially, is associated with anxiety disorders and depression. It's easy to end up going through life pushing yourself harder and harder, and still always failing.

[@aspidoscelis]

And if you're "pushing yourself harder and harder, and still always failing", the last thing you need is someone on the sidelines telling you to redouble your efforts, it's your responsibility, you're broken but you can fix it. But that's more or less what you get if you reach out for help-someone who's going to tighten the downward spiral if you let them.

[@SomeoneBeginingWithI]

When working with autistic people it's really important to be aware of autistic burnout as a risk. Some autistic people could theoretically become very proficient in masking, but masking intensely on a regular basis can lead to burnout which harms the autistic person's health, sometimes their physical health as well as their mental health. Stimming /more/ and learning how not to mask, trying to create a good sensory environment in your home, seeking out communities and environments where they are understood, can be very beneficial. Putting a lot of effort into seeming neurotypical might be helpful in some situations but it's not a good long-term solution. Trying to just "not be autistic" will indead lead to depression, anxiety and social isolation. Self acceptance and realistic expectations are really important for mental health.

[@benjamintausheck6368]

It's really cool to see a psych provider getting real with the limitations of our current system. I find practicing psychiatry so cool but so frustrating as sometimes we are put in situations where we have to decide to use meds to try to treat "insert DSM V Dx" that is actually really a broken life syndrome. Its hard work to get those pieces back together and in a working order for a lot of folks and I thank all the therapists, supportive care, social workers, teachers, and everyone else involved in the care of these folks. I wish meds could fix everything but it's so much more complicated. I hope research gets more specific on etiologies of mental illnesses and biomarkers to help us make better recommendations.for when to use meds. I love the videos. The world is lucky to have you as a junior doctor and a wonderful psychiatrist to be. Thanks for taking the extra time to give even more here on KZbin. You rock and happy holidays to you and your loved ones.

[@alphadog3384]

Good analogy: Identical twins have difference (learning to Spot the difference is the key). Can't assume everything and everyone is the same in a given diagnosis or traits.

[@fionascheibel977]

Oh. So many people who have had misdiognosis in the comments. I feel seen. I have a long list of diognosis stuck on me by psychiatrists. I often felt like i was getting the diognosis that was being given away as a bonus that week.

[@patroy2691]

I’ve been in and out of treatment since I was 14. I was in my 60’s before I was diagnosed with a dissociative disorder (finally). And FINALLY I’m getting treatment that can get to the heart of things and I’m changing and healing by leaps and bounds. I’ve had good treatment before for depression, ptsd, and depression and relationship issues but until I got this diagnosis it just treated symptoms, not the underlying issue. So YES diagnosis is so helpful, even if I’m speaking as one who has a stigmatized but somehow coveted (?!!!) diagnosis.

[@victorialondon769]

Autism can be caused by childhood neglect ? Isn’t that exactly what we have been trying to teach people is not true ????

[@thebeatles9]

this is a topic so few are talking about, and and the issue with wearing a dx as an identity is problematic.

[@xo3737]

just about a registered psychologist. thank you for your content, you've been very helpful.

[@shawnaford5540]

Autism is not from neglect - the refrigerator mother reason for autism is as relevant as vaccines caused autism. These have long been disproven and went out of ‘style’ years ago. The autistic brain is different. If you can only read two books “Neuro Tribes” and “Unmasking Autism” to understand the harm certain methods such as ABA which is similar to conversion therapy to alter gender identity.

[@tcort]

What do you think about providers with various levels of expertise making diagnoses? Should it just be psychiatrists making the diagnosis? What about GPs? In Canada, a psychologist can make a diagnosis (psychologist = PhD in psychology + appropriate training). In the USA, a psychotherapist can make a diagnosis (psychotherapist = Masters in psychology + appropriate training). On one hand, I feel like it needs to be someone with a high level of education and training. On the other hand, access to providers with that high level of education and training is difficult and/or expensive to obtain.

[@zoeyelh]

medical diagnosis is a medicalisation of the mind. so it's really just medical professionals to term with medicine. other professions have their own terminology and theories.

[@thebeatles9]

This is a good point, as most therapists are educated / licenses at the master's level, and psychometry/research is generally what distinguishes doctoral level clinicians. This goes back into the fluid nature of dx, where it can vary from clinician to clinician. The important thing to focus on is the treatment plan, rather than the etiology. Restoration of function is the only goal, the label as mentioned is not important outside of possible tips for treatment plans.

[@Jo411yo]

Third year nursing student from NZ. Love your vids. Makes me super excited for MH placement next year!

[@JHabc]

One major problem with diagnosis is when providers see a label and change how they treat you based on that label. Borderline Personality Disorder is often weaponized against patients by providers. I saw it working with teenage girls in residential treatment when I started my career, and it was wrong. My boss assumed all the girls were borderline, even though they had very different symptoms and unique presentations. I have experienced it myself as well. I have a long history of c-ptsd and severe depression. And I’m having new symptoms that are more consistent with mania, but having trouble getting an appointment with a psychiatrist. I was slapped with a borderline diagnosis at one point when I was suicidal and not improving with treatment. I was assigned a psychiatrist who was very dismissive, and was completely blown off when I asked to see someone else. Borderline tendencies and then borderline personality disorder were put in my chart without a word to me. I asked for an explanation of the diagnosis and the psychiatrist claimed he already told me. All my medical providers started treating me very dismissively. My mental health symptoms and physical health got worse and worse, and I struggled to get treatment. I finally went to a different hospital ER for admission after sitting at home with a suicide plan for far too long. The doctors acknowledged that the only borderline symptoms I seemed to have were chronic suicidality and a childhood history of self harm. The treatment I received targeted the depression, and I improved. But the borderline diagnosis stayed. I had a lot of physical health problems in the years following, and with doctors dismissing symptoms, one issue cascaded into another. It took a very long time and a lot of effort on my part, challenging doctors and switching providers, and I had to address the trauma that was being triggered in therapy. I had to be trained to advocate for myself with doctors and to find doctors who listened. It took several years for everything to get treated, for my physical symptoms to improve to a tolerable level. But my grad school education was interrupted, and I was never able to return. I lost my career and had to give up my life goal of being a therapist. I still have to work through the fear and the trauma every time I see a new doctor, and they don’t understand my struggles, which makes everything extremely challenging.

[@bzzwiebel963]

Some psychiatrists patronized me because of my borderline DX. It was very difficult to show respect for this shrink because I knew that rebelling and showing "bad behavior" would get me into deep shit trouble. Therapy is important because one learns how to deal with one's illness. I never minded CBT nor other approaches to my insanity. One gets to know oneself from a completely different angle than the feedback one gets from one's friends and family.

[@jaskiratsingh7750]

Just love the way you present everything so well and in an easy way.... ❤❤

[@BrokePencil]

luckily, most of us reality adjacent patients spend years suffering before seeking out help (usually due to a friend, family, or call to a talk-line). So most of us go in with some idea of what symptoms are important, and a vague concept of what is wrong. With years of self-reflection, I was obviously aware of the MDD. The doctor caught onto the GAD, which I was only vaguely aware of. I'd felt it so long, I just thought it was normal (and it never got better unlike depression which was cyclical). It was actually treatment of the GAD that revolutionized my life. I never knew the knot in my stomach wasn't supposed to be there. My first day on the medicine, I was riding down the road, and realized I was switching lanes, driving faster, and the knot was gone (something I'd never known). I spent my whole life with that nagging feeling that someone was just about to punch me, hyper aware of my environment, not speeding, not switching lanes, not socializing outside of work. Now, I still don't speed, but much of the other negative effects of anxiety/anger (basically the whole cortisol river) are controlled. Still have panic attacks, still have bad days, but it's better, much better.

[@toscaschutjes3335]

hello dr. Syl, I discovered your videos a few months ago and feel they are great. one thing you said in this one however touched me and I feel the need to comment on it. You said that people with autism, it could be something that developed in the childhood years. As a mother of three children, two of whom have the diagnosis of autism and ADHD, and the third not diagnosed but visibly having similarities, i disagree. My eldest was 10 days old when I noticed she was behaving in a way that most babies don't do. Back in the day it was said that autism could only be diagnosed at the age of 7, so it was hard to get it recognised. My second child, when I was 7 or 8 months pregnant, I went somewhere really busy. They started kicking when we arrived, and didn't stop until two hours after we left, which was in total 8 hours later. I have always taught all my children the basic social skills, by telling them and by showing them. They still have issues looking people in the eye or shaking a hand. To me, these and far more things I can't all mention because it would be too much for a small comment, show me that with my children the ADHD and the autism are part of genetics (it does run in the family on both sides.) So as a mother of these three amazing, beautiful, special children who 'can' accomplish what they wish it hurt to hear you say that.

[@CD-qr7ec]

I agree with the problem not being diagnosis but whether they are used well. They should explain but not 'excuse' and certainly don't excuse abusive behaviour. In children perhaps, but then they still need supported to learn healthier ways to manage and to gradually learn accountability for that. I would add that time of diagnosis can be a very vulnerable time. The language used in them seem to be mostly deficit based and that can be a punch gut in itself, having all used deficits laid out in black and white. I was late diagnosed at 40 with asd level 1, adhd and dyspraxia. Initial relief at understanding what and why soon gave way to feeling depressed and suicidal because I had to accept that I wasn't going to 'grow out' of anything and the struggles were going to be lifelong. I thought it was always going to be so hard. Fast forward, and yes, in a way it's true that it will always be this hard. But, it's also not quite so hard in the fact that now I have the proper diagnosis and understanding for why the struggles are there, I not only give myself more grace, but Im now learning accommodations. They may seem small things but they all add up so overall they do bring more ease.. Perhaps support is they better word. They accommodate and support and make things bit more doable. Eg foam free toothpaste, coverless duvets, ear defenders, step by step guides, visual aids, etc I have questions though.... What is your evidence base for adhd being trauma induced and autism being neglect? I thought current research was saying these are not caused by environmental factors? And that there are overlapping symptoms which make it extra challenging to discern what is trauma and what is something else. Esp if both coexist. But that they are distinct from each other and so treatment/management is very different (unless both present) Interested to know what studies you use to base this on. I had very loving, attentive parents and no ACE in my childhood, but symptoms present from early childhood.

[@RosalindCosta-vj1zq]

Hi Dr Syl. My diagnoses have ranged from bipolar disorder, to Borderline Personality Disorder, to CPTSD, to Schizoaffective Disorder. And more, to the point where I don't know which way is up! The latest diagnosis (Schizoaffective Disorder), left me feeling desolate, and also, unbelieving. Which of these diagnoses am I to believe? Especially considering the number of different diagnoses I have received, and all of the many, many different medications I have been prescribed (all of which have had detrimental side effects, which I will not list here). During my last psychiatric admission, the ward sister actually wrote in my notes that I appeared to "hide my symptoms" (!!) What the f*!*? am I supposed to make of that?? Either I have the diagnosis, or I don't! After all of these diagnoses, I have lost all sense of self, and all confidence in myself. It is all very well, you telling us that we have to make the best of these diagnoses, and get on with life, but I feel more or less completely undermined, and have lost all sense of self. I have had more than thirty years of psycho therapy (including ten years of Jungian psycho analysis) and I can't honestly say that I am any further forward with my self confidence. I feel bereft. (Of my sense of self).

[@nobodyimportant7804]

Believe in and work on symptoms. Mental diagnosis are 100% subjective.

[@Melon-pn5yt]

Hi Dr Syl, thanks for this interesting video, I guess everyone's story is unique and reactions may differ. When I got diagnosed I freaked out, it was an old fear of mine that manifested later in life. At first I laughed at it totally dismissing my diagnosis, even though I do tick all the boxes when it comes to signs and symptoms, yet I was still in denial. Then I went through a stage of being angry, then sad; it took me many years to accept myself. But here I am. Now I'm learning about my condition and finding ways how to still connect with the world out there. It's hard to love our weaknesses and it takes a lot of strength and courage to admit we're not perfect, but I guess once we accept ourselves then there is a better chance we will be accepting of and accepted by others too.

[@luciachanger6505]

My diagnosis is BPD and I hate that my psychiatrists have diagnosed me with this illness. I think psychiatrists have made up this illness, well they made them all up to label us! I don't identify with any of the symptoms at all, but when I say this, im dismissed. I never tell anyone my diagnosis, because saying you have a personality disorder is a horrible thing to say. There is nothing wrong with my personality, im just a person who has suffered a lot of trauma in life along with neglect in childhood and has responded to that and worked through it the best I can. I don't need this awful label, its a really cruel thing to say about someone. I wish that the label of personality disorder had never been invented by psychiatrists.

[@CHARIOTangler]

Thank you so much for expressing this perspective. We must all take into account that American medical professionals in particular are incentivized to assign a diagnosis and prescribe a pharmaceutical treatment rather than suggest that the patient change whatever aspect of their life has created the issue. In the case of psychological issues, many so-called "personality disorders" are in fact coping mechanisms and/or adaptive strategies that have been developed in response to things that a person has experienced in their life. Unless these strategies have impacted their life or society negatively, there is no real reason to try to change that behavior. The greatest short-coming of psychology is that it seems to be especially malleable in response to shifting cultural whims more so than any other science. The bizarre fact that homosexuality was considered a disorder several decades ago that required treatment and is now not found anywhere in the DSM is pretty solid proof that psychology has less to do with science and more to do with contemporary cultural sensibilities.

[@thebeatles9]

The issue is the stigma, not the diagnosis. We could call it "Zobber Clobber #2". The behaviors you exhibit are indeed brought about through the trauma, it's not an ascription of you or your values, that you are somehow fundamentally "bad." But that your present behaviors (personality) are not caused from xyz genetic or developmental disorder, which is why medication doesn't usually help. You have to separate the colloquial term "personality" from the medical term. Psychiatry can do a better job of branding.

[@thebeatles9]

this isn't news to anyone, any abpsych 101 textbook spends a chapter defining what 'abnormality' is and the fluid nature of it. the entire purpose is healing and a restoration of function, which is indeed heavily influenced by culture. Also the tinfoil hat remark about pushing pills is exceptionally invalid regarding PDs, as medication is rarely ever indicated for them, outside of an acute crisis stabilization unit (hospitalization).@@CHARIOTangler

[@benjamintausheck6368]

Icd 10 codes have a better name for it called emotional dysregulation disorder. I hope that the DSM catches onto this as it better explains the symptoms of BPD (such an esoteric and outdated term with a lot of loaded stigma). A lot of times the folks who have BPD symptoms have gone through horrible trauma and their BPD really aligns more with a CPTSD sort of diagnosis. Of course, there is a lot of overlap and nuance for you and your psych provider to discuss. But at the end of the day, what Dr. Syl said about you being you is the most important thing to realize. The diagnosis of anything doesn't change you directly. What you do with the diagnosis can help or hurt you. You are responsible for what you do with the diagnosis whether you agree with it, love it, or hate it.

[@thebeatles9]

personality disorders are a class of disorders, "emotional regulation disorder" is less complete / accurate since it is not showcasing the class of being in the personality category@@benjamintausheck6368

[@victoriamcdaniel4108]

I agree with the pros and cons you mentioned for diagnosis’. If my side has been painful for weeks but an md cannot tell me why it’s frustrating! It’s settling to know what is or could be wrong mentally to then start on a path of wellness. I do hope that someday brain scans can help in diagnosing specific mental illness and actually be part of people’s annual physical exams. So many people would be helped if this came to pass and imo would change the minds of those that think you can “talk your way out of it”.

[@Wormytoby]

I’m interested in what you’re saying about trauma/neglect as a cause of autism - I was recently diagnosed with autism and a large amount of the assessment involved trying to figure out if I had autism or just trauma. There was an understanding that it could be both (it is), but they were definitely held as two very separate things with no permitted link between the two? Very odd experience.

[@suddenlyautistic]

I was diagnosed with CPTSD and autism and have also been interested in the link. My take so far is that both autism and trauma can inform certain behaviours and relational patterns. As such they can present very much the same. However, I feel that once one unpicks the narrative, a point of deviation and separation can be found. Typically, for autism that's a natural, autonomous attachment and not a withdrawing as a last resort.

[@mamoelgome]

How, as patients, do we stop being obsessed with seeking diagnosis? I know that logically having a diagnosis won't change my experiences for the better, but after about a decade of on and off therapy I still can't stop thinking of a diagnosis as a holy grail that will bring me peace and explain my past decade (even though I know it won't make a difference). Anyways, thanks for the video, your explanation is reassuring.

[@nobodyimportant7804]

A mental diagnosis can not be proven. Focus on symptoms and minimizing those. Work on behavior and mood issues in therapy. There is no wisdom in the made-up labels that they use. Good luck to you, I wish you well.

[@BsktImp]

I think there's still a long way to go with avoiding misdiagnoses caused by ignoring possible organic and exogenous factors that lead to psychological and psychiatric symptoms. From tumours to toxins, mosaicism to moulds, aneuploidy to aneurysms there is a bias in clinical psychology and psychiatry to not investigate physical bases to emotional and beahvioural symptoms, but to restrict intervention to talking and mood-adjusting therapies. Sadly this leads to some individuals enduring a whole lifetime - often unnecessarily cut short through ***cide - of distress with a precious few 'lucky' ones evntually being correctly diagnosed and treated. Until Marshall and Warren unconventionally demonstrated a bacterium was a significant factor in the development of peptic ulcer disease, most physicians insisted that "stress" was the cause along with alcohol or spicy foods. A different approach needs to be taken with emotional and beahvioural symptoms.

[@naba.fatima]

Thank you for talking about this!

[@aspidoscelis]

The explanation of current psychotherapy as based on a responsibility model is very helpful. It tells me not to try it again. That model runs too contrary to my own experience for me to ever expect intervention on that basis to be helpful. Responsibility and control are myths we tell ourselves-specifically that the part of the mind responsible for verbalized cognition & narrative tells itself. Responsibility models are also contrary to my understanding of mindfulness. That helps explain why advocacy of mindfulness within the world of psychotherapy feels hollow and superficial.

[@aspidoscelis]

Phrased differently: It's not that I believe the locus of control is external rather than internal, it's that I don't think there is a locus of control. Or we could say there is one, but it wouldn't be recognizable from its descriptions. (Also, my apologies for making so many comments. These are topics I've spent a lot of time thinking about, and I tend to keep going once I've started.)

[@HeyLetsTalkAboutIt]

Thank you for sharing this video with us! I was diagnosed with PTSD (I’m a first responder) in 2015 and this year I was diagnosed with ADHD. The ADHD diagnosis made my whole life make sense! I’m 43 years old and have struggled my whole life. Currently trying to find a good medication for the ADHD. I’m taking meds for the PTSD and I’ve recently finished a course of ketamine infusions to treat it. My mental health is a balance. I started school in September to become a Clinical Hypnotherapist. My training has changed my life. ❤

[@sofie1065]

Good timing! I am getting my diagnosis tomorrow 😮

[@hayleyprice8345]

Definitely complicated

[@SoulfulMole]

Diagnoses are important, but in my humble opinion the most important factor that influences outcomes in psychiatry is a patient's insight into their illness, more so than how well we can codify their illness. There is an art to working up a good differential list and then delineating between the diagnoses, arriving at a well-reasoned conclusion with an appropriate treatment plan... but what good is a perfectly formulated diagnosis if a patient has no insight into their illness, does not believe they are ill, and therefore does not want treatment? The diagnosis can always be revisited, reformulated. But without insight, or motivation towards recovery, I'm like Sisyphus pushing a boulder up a hill just to watch it roll right back down, so we can start again. I don't think that's a diagnostic problem.

[@tinypixiekitten7806]

I've seen people become self-empowered and gain immense acceptance and understanding of themselves from teceiving diagnoses. I've also seen people have the opposite experience, and identify with it to such an extreme degree, that they couldn't exist without it. Those people taught me not to do tue same. One disadvantage about relying on the subjective experiences and opinions of a patient is that they can lie. Which of course is a symptom in itself. I've had a "friend" recently copy symptoms I could not control (when my mental health fell apart), with professionals, in order to get the same diagnosis I was given - and the attention they believed came with it (which it didn't). The whole situation feels so threatening, unsafe, insulting and infuriating - also like I don't exist. I tried to speak up but it was assumed I was the problem. I had to just leave.

[@GoDsPoWeR71]

Meds save lives!!!

[@boglarkaszoradi4504]

On the other way around!!! Objective report of the patient and subjective observation of the psychiatrist!!!! Your observation is the one that is subjective!!! What the patient feels and experiences is the exact objectivity. What you think of what you see cannot be objective! It is only your PERCEPTION!!! You have to check with the patient whether your PERCEPTION is correct or not!

[@Dave-if5qj]

The DSM is quite challenging to learn ,i think that the spectrum Disorder model makes things More easy as well due to the Unique personality of every individual you will ever treat Also im heard hebephranic Is still used in the UK Im in the US and think The DSM is become a Book of political correcness Rather then a health guide

[@WinterWiorkowski-fv3ph]

Myself, and a lot of other people that I know with mental illnesses, talk about having their brain being ‘bad’ - like it’s almost a seperate thing … like ‘I’d like to go to the movies but my brain is being bad and I can’t leave the house today …’

[@alphadog3384]

Stigma still is a problem with personality disorders..Cluster A, B, C. It takes a community to change this?

[@christurner4878]

Full video?

[@tabatasennadagracalopes5180]

Dr. Syl, is it true that if someone starts a treatment for depression with a ssri medication, and flip to a hypomanic state, is it true or correct to assume that the person has bipolar????

[@EEE-kh3tn]

Great content! When do you become a consultant?

[@kandymich4861]

Being labeled/diagnosed as attention seeking because the doctor, well sucks is having a stamp a on your file saying “watch out this person is not sick but wants to make people believe they are, ignore everything they say and anything they think they’re doing to improve their nonexistent condition.”

[@sherrijennings9309]

I'm so sad that this has happened to you! I hope you find a doctor who will take you seriously and get to the bottom of what's going on

[@GnosticMindTrain]

No one will see this or care, but my whole online presence has been trying to find out what mental disorder I have, I don't believe it's OCD or hypochondria as I really do suffer and can't work or drive, all you need to know is the common mental disorders I don't relate to, so please no trying to guess what I am in the comments, the only thing I relate to is schizotypal, borderline, and maybe intellectual disability, I have trauma too, maybe ADHD, and maybe other stuff, but jumping from doctor to doctor and it seems I don't fit anywhere 100%. There's people who don't fit in one mental disorder, they have like 5 or whatever, see I don't fit in ANY, but I still have dysfunction in life, I don't like labels, I gave up my ego and personality a long time ago, there is no sense of self. Let me just add that my new therapist is anti label and doesn't even want to tell me what I have, just adds more to my "no self" philosophy.

[@marylett2224]

As a person who is still working on getting a diagnosis, thank you for your video. It gave me some helpful insight. ❤🎉

[@yunmin7667]

Hello dr Syl,i want to ask a question. I meet an stranger on online community, but i feel strange toward him. That very person is making a body pillow (Dakimura) based on the leader in my com. My leader is ofc a female,but he often wanted a extreme attention toward her,tagging her account asking a silly question. The worse i ever heard he try to contact her private phone numbers (a fake numbers actually) and said right in front of my face that he have intention to meet her in real life. He often having a moody, once he got angry coz he doesnt get the chance to buy our community merch. He so stubborn to my advice,he only want to listen when my female lead is come out and ofc try to do silly approach toward her. He literally obsessed toward her,he even try to stalking when my female lead is on or off in my community. Does this count as mental problems? Or something else? .Thanks for the answer.

[@thebeatles9]

This is a philosophical debate, tbh, as any absych textbook will talk about famous eccentrics / quirky folk. Severe mental illness varies from day to day psychological struggles. If the person has particular behaviors or beliefs that cause them strife in their life, then they should seek counseling. Lack of happiness and function does not necessiraly always have to be tied to a firm dx.

[@stevejabroney159]

Oof mental health is so precarious. I think you’re wonderful person with a beautiful heart who wishes to revolutionize mental heath. I say this as a mentally ill person 😂

[@stevejabroney159]

But an exceptional fantastic mentality ill person

[@stevejabroney159]

I’m exceptional. All of my paranoia and failures to navigate or do “life” and failures to thrive are dismissed or meaningless because I present well. They are silly girl problems. I’m a white presenting lady, and a reliable narrator. As a student psychologist I’m really interested in dismantling mental health support in Australia to better support intersectional needs, and indigenous health. You’re very involved and devotional, whatcha gonna do for womens and indigenous people? Or not, respect. How do we address mental health and the suicides in Australia?

[@lonetrailchime]

Care more about prognosis, less about diagnosis. They can both change, but attaining an accurate diagnosis is only relevant for improving a patient's prognosis. Just look at cases where a definitive diagnosis can't be made, any available information will still be used to guide treatment and improve their prognosis. Psychiatry is fraught with more ambiguity as a matter of fact.

[@jenshockley805]

Can you include your dog in your videos? She's cute!

[@1111YDROXOOS]

Thanks for your videos. The sound is always too low in your videos, I can't hear anything if I'm not wearing headphones, it's a bit annoying.

[@DrSyl]

Ok, I’ll bump it up a bit - sorry about that!

[@nikhilbhalla6802]

He is so handsome.

[@EricHarris2309]

Do you ever get people telling you that you look like Sean Bean? I know that has nothing to do with the video but I find it very distracting. I have bipolar and severe CPTSD with some very strange presentations like DID but not qualifying for a proper diagnosis. I wish I had a label, but nothing fits. But I don’t feel like I am the same person I was before I was diagnosed with CPSD. Maybe that’s because my illness has changed dramatically over the past three years, but I feel very different. My head mates and I are in a vastly different relationship now that we know we’re all allowed to exist and they are not bipolar psychosis. I’ve stopped trying to medicate them away or integrate them. They’re just imaginary friends now.

[@nobodyimportant7804]

There is nothing objective in what you do. It is your subjective viewpoint combined with what patients tell you. If psychiatry were objective, there would be objective tests to determine and confirm a diagnosis, but there are none. Your profession has value but do not gaslight yourself into thinking that anything you do is objective. That causes damage to patients. Symptoms are what is important, not made-up labels from a committee of pseudo-scientists. Labelling someone with schizophrenia is a terrible shorthand. So many different symptoms are under that label, so it doesn't really narrow it down. All that label does is stigmatize. Diagnoses can be harmful to patients and they take that label and make it their identity and then they will defend that label to the death. How is that healthy? Most psych medication trials end poorly. Dropout is high because of the nasty effects and psych meds are barely more effective than placebo, yet they still get approved and used. Neurology is an actual science despite the brain being mostly a mystery. Psychiatry is just playing darts with a blindfold on. This is why psychiatry is a pseudo-science.

[@elcapitan24]

well it is and it isn't. the diagnoses serve a purpose, it's just one to "society" and the medical professionals, not to the patient. the drugs obviously have effects, but these effects are not good at all. look up laura delano she is a champion of fighting against psychiatry. there is hope for us, it's just a bit hard to find. gotta reject the whole system, and see it for what it is when it shows itself; nothing but gaslighting

[@Twidleythegnome]

You sound pretty sad for some reason Did someone with autism shout at you because of their diagnosis? I found it pretty jarring being diagnosed with asd & adhd at 27 after being told I had Asperger’s syndrome since I was 5, so maybe that’s why, still it’s no reason to swear at someone who’s trying to help, sorry you had to deal with that :/

[@Maverick_Mad_Moiselle]

When you grow up in a family that tells you you're stupid and lazy and a parasite, and you finally after years and a suicide attempt have a doctor explain what's wrong with you, that's when the diagnosis/medical care does good. Also I'm puzzled, in several of your videos you say you're patient and understand because "there is always a reason why a person is this way" and I think I remember you talking about responsibility in another video about psychiatry in prison. You seem to hold self contradicting views. Here you say "you are responsible for what you do" (unless there's psychosis). Do you hold a BPD person responsible for snapping at you despite it being a symptom of their condition and them never choosing to have this condition in the first place? Would it be normal to do something gross like sneezing on their food before someone who has OCD with an obsession on hygiene and expect them to not snap at you because since they are not suffering from psychosis, they are responsible? It's also a bit weird to expect someone with depression or another distressing diagnosis that can feel similar to want to get better or even have the motivation to. Surely they'll wish their life didn't suck, but you do know they struggle to believe it's really going to get better and they struggle with motivation to. I'm glad we do not force them into treatment, but it is weird to hold such expectations. I'm also sure you're aware many do not have the luck to find the kind of care they need and waste years going to psychiatrists and psychologists getting inappropriate care and making little to no progress. Being stuck in such a situation is incredibly draining and I would understand and certainly not blame a person giving up on "getting better". I understand that if someone gets a diagnosis and then starts becoming insufferable and then use their diagnosis as an excuse for their new atypical behaviors, that person is being manipulative and trying to be excused for bad behaviors. But you didn't mention that in this video, you drew the line at psychosis. I think it would be interesting to be clear about how one isn't responsible in the "philosophical/scientific" sense for being the way they are but they are responsible in the "pragmatic" sense. I think the pragmatic sense makes society worse when it is used in tribunals to decide whether a person should get locked up in a mental care facility or in an daily-abuse-and-slavery facility (prison). I think you should also keep yourself from letting yourself think in the pragmatic way regarding your job though I'm not saying you should let yourself suffer abuse, you have the right to be safe and healthy too. Referencing what I said earlier "Being stuck in such a situation is incredibly draining and I would understand and certainly not blame a person giving up on "getting better"." Thinking pragmatically regarding this hypothetical individual (though such cases are many), putting the responsibility for them to get better also does harm. It doesn't address all the variables outside of their control which only society could fix by investing in medical care, training more personnel, tracking medical abuse and neglect seriously, making sure the poor gets all their needs met during and after care because if you treat someone successfully and then you release them back to the "job market" but they don't have the resources to get the training that will help them get the job they need, they don't have the financial resources to pay rent anymore etc. They get exposed to all those inappropriate stressors again which might have been the cause for their illness, what's going to happen? Thinking pragmatically is much easier though, I call them lazy or a lost cause or whatever, I rid myself of the problem. But what of the fact they have no motivation and see no hope? If the medication doesn't help and the psychologist doesn't help either, is it fair to blame them for that? Are they responsible for not trying to change their therapists until they find the right one (that's also easier said than done technically)?

[@BritPopSnob]

Perfect example of the patriarchal attitude of the psychiatric community towards patients. Nothing has changed since the 15th century. We have to deal with people like this who want to give us chemical lobotomies.