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Diagnosis Quotes

“The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.”

“A diagnosis is not a prediction. It doesn’t tell you what’s possible. It doesn’t change you, your colleague, your child, or your friend. It just opens up tricks and tools to thrive.”

“Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.”

“Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.”

“There is clear evidence from internal investigations in the past that some raters actually see themselves as adversaries to veterans. If a claim can be minimized, then the government has saved money, regardless of the need of the veteran. Just recently, the press exposed an official e-mail from a high-level staff person who stated in essence that PTSD diagnosis was becoming too prevalent and offered ways to delay and deflect ratings in order to save the government money.”

“Although the terminology implies scientific endorsement, false memory syndrome is not currently an accepted diagnostic label by the APA and is not included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Seventeen researchers (Carstensen et al., 1993) noted that this syndrome is a "non-psychological term originated by a private foundation whose stated purpose is to support accused parents" (p.23). Those authors urged professionals to forgo use of this pseudoscientific terminology. Terminology implies acceptance of this pseudodiagnostic label may leave readers with the mistaken impression that false memory syndrome is a bona fide clinical disorder supported by concomitant empirical evidence.(85)... ... it may be easier to imagine women forming false memories given biases against women's mental and cognitive abilities (e.g., Coltrane & Adams, 1996). 86”

“the importance of experience, critical thinking and the self-confidence to be a good doctor. Call it intuition but sometimes subliminal influences produce a conviction that the perfectly reasonable diagnosis suggested by a colleague may be wrong even when their diagnosis is supported by preliminary investigations.”

“What daily life is like for “a multiple” Imagine that you have periods of “lost time.” You may find writings or drawings which you must have done, but do not remember producing. Perhaps you find child-sized clothing or toys in your home but have no children. You might also hear voices or babies crying in your head. Imagine that you can never predict when you will be able to have certain knowledge or social skills, and your emotions and your energy level seem to change at the drop of a hat, and for no apparent reason. You cannot understand why you feel what you feel, and, if you are in therapy, you cannot explore those feelings when asked. Your life feels disjointed and often confusing. It is a frightening experience. It feels out of control, and you probably think you are going crazy. That is what it is like to be multiple, and all of it is experienced by the ANPs. A multiple may also experience very concrete problems, even life-threatening ones.”

“I am truly crazy, I told myself. It's over. I am not fixable. I cannot tell Tom. I cannot even tell Francisco. So I won't tell anyone. My brain seemed out of control. Tom does not deserve a crazy wife and my children do not deserve a crazy mother. I finally get it. This is not just repressed memory. This is dissociative identity disorder.”

“DID may be underdiagnosed. The image derived from classic textbooks of a florid, dramatic disorder with overt switching characterizes about 5% of the DID clinical population. The more typical presentation is of a covert disorder with dissociative symptoms embedded among affective, anxiety, pseudo-psychotic, dyscontrol, and self-destructive symptoms, and others (Loewenstein, 1991). The typical DID patient averages 6 to 12 years in the mental health system, receiving an average of 3 to 4 prior diagnoses. DID is often found in cases that were labeled as "treatment failures" because the patient did not respond to typical treatments for mood, anxiety, psychotic, somatoform, substance abuse, and eating disorders, among others. Rapid mood shifts (within minutes or hours), impulsivity, self-destructiveness, and/or apparent hallucinations lead to misdiagnosis of cyclic mood disorders (e.g., bipolar disorder) or psychotic disorders (e.g., schizophrenia).”

“My own studies on the natural history of DID indicate only 20% of DID patients have an overt DID adaption on a chronic basis, and 14% of them deliberately disguise their manifestations of DID. Only 6% make their DID obvious on an ongoing basis. Eighty percent have windows of diagnosability when stressed or triggered by some significant event, interaction, situation or date. Therefore, 94% of DID patients show only mild or suggestive evidence of their conditions most of the time. Yet DID patients often will acknowledge that their personality systems are actively switching and/or far more active than it would appear on the surface (Loewenstein et al., 1987). R.P. Kluft (2009) A clinician's understanding of dissociation. pp 599-623.”

“It’s true that AI can mimic the human brain, but it can also outperform us mere humans by discovering complex patterns that no human being could ever process and identify.”

“You can't compare men or women with mental disorders to the normal expectations of men and women in without mental orders. Your dealing with symptoms and until you understand that you will always try to find sane explanations among insane behaviors. You will always have unreachable standards and disappointments. If you want to survive in a marriage to someone that has a disorder you have to judge their actions from a place of realistic expectations in regards to that person's upbringing and diagnosis.”

“Given the central place that technology holds in our lives, it is astonishing that technology companies have not put more resources into fixing this global problem. Advanced computer systems and artificial intelligence (AI) could play a much bigger role in shaping diagnosis and prescription. While the up-front costs of using such technology may be sizeable, the long-term benefits to the health-care system need to be factored into value assessments. We believe that AI platforms could improve on the empirical prescription approach. Physicians work long hours under stressful conditions and have to keep up to date on the latest medical research. To make this work more manageable, the health-care system encourages doctors to specialize. However, the vast majority of antibiotics are prescribed either by generalists (e.g., general practitioners or emergency physicians) or by specialists in fields other than infectious disease, largely because of the need to treat infections quickly. An AI system can process far more information than a single human, and, even more important, it can remember everything with perfect accuracy. Such a system could theoretically enable a generalist doctor to be as effective as, or even superior to, a specialist at prescribing. The system would guide doctors and patients to different treatment options, assigning each a probability of success based on real-world data. The physician could then consider which treatment was most appropriate.”

“I recently consulted to a therapist who felt he had accomplished something by getting his dissociative client to remain in her ANP throughout her sessions with him. His view reflects the fundamental mistake that untrained therapists tend to make with DID and DDNOS. Although his client was properly diagnosed, he assumed that the ANP should be encouraged to take charge of the other parts at all times. He also expected her to speak for them—in other words, to do their therapy. This denied the other parts the opportunity to reveal their secrets, heal their pain, or correct their childhood-based beliefs about the world. If you were doing family therapy, would it be a good idea to only meet with the father, especially if he had not talked with his children or his spouse in years? Would the other family members feel as if their experiences and feelings mattered? Would they be able to improve their relationships? You must work with the parts who are inside of the system. Directly.”

“The Yellow Wallpaper" seemed to me now to be the story of what can happen when you listen to a doctor-when you buy into your "case-history construction." When you don't listen to yourself, when you place your trust and authority elsewhere. The narrator loses her mind completely, becomes the madwoman, the identity they've given her. The "rationale" for their treatment of her is now confirmed; she is sick, indeed. This is what can happen: You are seen as mad, you begin acting mad.”

“I knew I could get help and, more importantly, get better. Because suddenly I wasn’t bad, it was bad. It was no longer me, it was something else. I wasn’t schizophrenic, or psychotic, or any of the other things I thought I was. I had Obsessive Compulsive Disorder, or OCD. In that unforgettable moment, I took back some of my power – chunks of it flooding into my psyche, called in from afar, returning home to me.”

“Over-simplifying mental health and illness does a disservice to all. We all have the potential to fall apart, but it is the ability to put ourselves back together, that is the foundation of mental strength. Misinformation and ignorance around mental health leads to both generalization and stigmatization. Understanding, diagnosing, and treating mental health issues is immensely difficult and is deserving of respect.” Excerpt From: Sarah Voldeng. “The Art of an Enlightened Woman.” Apple Books.”

“Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.”

“300.1 Hysterical neurosis This neurosis is characterized by an involuntary psychogenic loss or disorder of function. Symptoms characteristically begin and end suddenly in emotionally charged situations and are symbolic of the underlying conflicts. Often they can be modified by suggestion alone. This is a new diagnosis that encompasses the former diagnoses "Conversion reaction" and "Dissociative reaction" in DSM-I. This distinction between conversion and dissociative reactions should be preserved by using one of the following diagnoses whenever possible. 300.14* Hysterical neurosis, dissociative type* In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality. DSM-II (1968)”

“The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR. While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false. Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.”

“The categories used in psychiatric diagnosis are based on observation of signs and symptoms, rather than on pathological processes. One can make use of a few signs, such as facial expressions associated with depression or the flight of ideas associated with mania. But what clinicians mainly use for diagnosis are symptoms, the subject experiences reported by patients. Psychiatrists have little knowledge of the processes that lie behind these phenomena. Thus psychiatric diagnoses, with very few exceptions, are syndromes, not diseases.”

“300.14* Hysterical neurosis, dissociative type* In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality.”

“There is a clear difference between the objectivity and subjectivity of the physical diagnostic criteria, such as that used for Parkinson’s, and the symptomatic diagnostic criteria used for mental disorders in the DSM. Brain diseases, like Parkinson’s, Alzheimer’s, Frontotemporal lobe degeneration, Prion disease, Lewy Body dementia, and many others mentioned in the DSM-V, are diagnosed through objective physical tests, such as MRI scans, detection of misfolded proteins or identification of certain genes. These tests, and therefore the diagnoses of these disorders are objective; the MRI scan either does or does not show a physical indicator of biological dysfunction, misfolded proteins and particular genes are either biologically present or not. In this way, the diagnoses of such brain dysfunctions are objective, they either exist as a matter of fact or they do not. The need for these tests might be brought about because a service user is experiencing symptoms such as ‘postural rigidity’ or ‘tremors’, but these symptoms are not enough alone for a diagnosis of physical brain dysfunction, objective tests must be carried out. In contrast, the diagnosis of mental disorders rests on clusters of symptoms alone. If we are assessing whether someone is displaying ‘childlike silliness’ or ‘excessive emotionality’, we have no objective tests to aid us, our assessment is made solely on our subjective interpretation of the service user.”

“To achieve a diagnostic assessment, it is important to remember that diagnosis does not hinge on the subjects answer to any single question on the SCID-D. A positive response regarding one dissociative symptom often has several possible ramifications, which must be explored through persistence with related questions. Isolated dissociative symptoms may occur in a number of different psychiatric syndromes, both dissociative and nondissociative. An isolated dissociative symptom, such as use of an alternate name or an amnestic episode, is insufficient grounds for diagnosis. To provide evidence sufficient for an accurate diagnosis, the symptom must exist in combination with other symptoms that, as a group, conform to the characteristic pattern of one of the five disorders oudined in the Diagnostic Work Sheets in Appendix 2.”