General Question

RachScott's avatar

Is this a serious mental health diagnosis?

Asked by RachScott (5points) January 5th, 2011

Letter from my psychiatrist:

This is a 16 year old girl with mild to moderate depressive disorder and traits of emerging borderline personality disorder, being treated with fluoxetine 20mg. She has a 2 year history of chronic feelings of low self esteem, poor self image, dissatisfaction with her appearance and eating disorder. She has lost weight by limiting intake, increasing exercise and on some occasions, has got into a binge-purge pattern. She has also managed her mood by self harming behaviour though less so recently. She is an intelligent girl who sets herself high standards and is critical or herself, compares herself unfavourably to others and tends to predict that others will judge her unfavourably. I think this has contributed to her low mood, some degree of social anxiety and led into her eating disorder and self harming behaviour.

How serious is this diagnosis?

Observing members: 0 Composing members: 0

18 Answers

Skaggfacemutt's avatar

She sounds pretty messed up to me.

Coloma's avatar

All the personality ‘disorders’ have attained major pop psychology popularity the last few years.

Clearly the girl has some issues and her symptoms merit treatment, but, much of what is labeled a PD is really just another term for emotional immaturity.

It is all dependent on how long and pervasive the behavior patterns are, and, ‘recovery’ is an ongoing process for everyone that has emotional issues.

Often this disorder burns out in maturity from what I have read.

Although, I have an ex friend in her 50’s that is still symptomatic.

Often the issues can lie dormant until a ‘crisis’ situation happens.

The sad part of all these ‘disorders’ is the pain and alienation these people bestow upon those close to them.

I may be wrong, but, I thought that a diagnosis like this would not be made until the patient was 18 years old. But, I am not a therapist, just fairly knowledgable after divorcing a raging narcissist some years ago.

He was never diagnosed, but, exhibited all the traits of a pathological narcissist.

I didn’t need a diagnosis to know he was an impossible person. haha

SundayKittens's avatar

Other than the self-harm, this could be a diagnosis for being a typical teenager.

JLeslie's avatar

At 16 this does not have to be serious for the future. Many teens have a lot of difficulties, and go on to be very happy, self assured, productive adults. Being an adult is so much better than being young, trust me. Anything that seems horrible as a child, as we get older we gain perspective, and my best advice is to start looking at the things that have hurt you, or people who have hurt from their point of view. This gets easier and easier, as we begin to realize we ourselves make mistakes and want to be understood. Being able to step outside of yourself and be more objective can give you peace.

This diagnosis does not have to be a forever diagnosis. Look forward, and do not give in to labels. There is proof in neuroscience that the brain is pliable at all ages, and we can rewire ourselves.

glenjamin's avatar

We all know that being a teenager can be tough, for some moreso than others. I wouldn’t say the girl is crazy or anything, but there seem to be some issues that need to be resolved. I’m also not sure how her family life and other social factors play into this. The self-harming is the only thing I could see that could warrant medication, but she may also just be trying to get attention that she is not getting. That said, teenagers can be very moody naturally, and this will probably get better, not worse, with age. So I wouldn’t say this is overly serious, but it is also not to be ignored, because if she is into harming herself this can also lead to suicide attempts if left unchecked. She should be getting therapy from a psychologist, not only medication from a psychiatrist. I would bet money that the therapy would be more effective in the long term than the medication, as long as she gets a good psychologist and wants to be treated. My psychologist doesn’t believe in labeling people with diagnoses, and I agree with him on that. His view is that its all about ability to function in everyday life, and how able or unable the person is.

anartist's avatar

This is more a warning, a wake-up call, that she has/you have the potential to lose control and fall into major depressive psychosis and/or develop serious borderline personality disorder.

Depression, just like many other mental illnesses, including the personality disorders, are just normal feelings driven to extreme and enduring over time because important issues aren’t resolved and adaptive behavior grows up to accommodate those unresolved issues.

Coloma's avatar


Well said. Yes, extreme behaviors of all kinds are just variants of ‘normal’ that have become pathological, unhealthy.

tranquilsea's avatar

Self harm is something that you should definitely get help for. You need guidance on how to deal with your emotions when you start feeling overwhelmed. With therapy you can fill your toolbox with many things you can reach for first without ever getting to the point where you need to cut yourself/harm yourself.

Personally, I think Borderline Personality Disorder is a catch-all diagnosis that gets over diagnosed. I was diagnosed with it myself, even though I had close, long term personal relationships. After finding a psychiatrist who understood me I was correctly diagnosed with Post Traumatic Stress Disorder.

Find a therapist who is willing to do talk-therapy with you. Drugs will only get you so far. I liken them to band aides.

Judi's avatar

Boarderline is a tough diagnosis because it’s so hard to treat.

Sunny2's avatar

YES! It’s VERY serious. Self-harming, such as cutting can increase to a dangerous point.. What bothers me most is the eating disorder. That can kill you without it being considered potentially fatal. Does anyone remember Karen Carpenter, the singer, who died because of it? People with Bulimia (eating and purging) don’t realize the possible results. The one that would have stopped me, if I had had the disease, is that your teeth may grow black from the frequent acid that washes over them with the repeated vomiting.
Let’s hope the young lady in question has a really GOOD psychiatrist.

wundayatta's avatar

I disagree with most of the people who have answered so far. I do think this is serious. Yes, BPD is a catch all, but when we’re talking about depression, self-harm, and bulimia, we’ve got something serious going on. Low self-esteem, hyper self-criticism and who knows what else—a disaster in the making.

You do not do these things without feeling such a strong sense of being worthless and stupid (even though you know you are smart) and unloved that it’s not far to making attempts to completely remove yourself from the scene. It’d probably be doing the world a favor, right? Your family hates you, and expects too much from you and you can never match up to what they want and they’ve never given you a word of praise, and you don’t have a boyfriend, or if you do he treats you like shit, and you think you deserve it.

These are all lies, you know. Lies we tell ourselves because there’s something wrong in our brains. And they make sense to us even if no one else understands (which makes it worse). They tell you it’s just adolescent whatever and you’ll grow out of it, and they just are patronizing and don’t take you seriously and you’ll show them one day.

Sometimes I fucking hate the whole field of psychology or maybe I hate society because so many people don’t get it and offer these ridiculous solutions that will do nothing. But there are also so many therapists out there who don’t get it either. There are good ones, but too many bad ones and it can be so hard to find the people who can actually help.

I nearly died about three years ago. I was ready to go because the pain was so bad I could not imagine it ever ending. People would tell me it would get better, and I knew that the might be right, but I also knew they could not be right, because this fucking molasses and dim world with the heaviness in my chest was so big and so strong, it would be liking trying to play tug of war with an elephant.

It’s even harder when you’re young, because you don’t have the things that keep older people around like children and spouses and whatnot. People keep telling you that it will get better and that you are worthwhile and very smart and they love you, and they just don’t get it, do they? It’s almost annoying that they keep on trying. Why not leave you alone so you can stop cutting up your arms and stop eating and just run yourself to death? Or something like that.

Unfortunately, they are right. And I know you know it, too. Because I knew it even when it was all hidden and locked up under layers and layers of pain that create layers and layers of lies because I was fighting to feel love and I just couldn’t. None of it made sense. Amazingly, I was really good at finding people to fall in love with me and it never took. I never believed it.

Oxytocin. Heard about it on the radio today. Really messes with our heads. Can make us feel great and yet it just doesn’t take.

You hurt yourself because physical pain feels better than mental pain. You starve yourself because…. oh, it’s so complicated. You are punishing yourself, for one thing. Other people don’t understand how bad you are and won’t punish you, so you have to do it yourself. But it’s also about achieving some perfect standard of beauty, so you can be worthy of love. So you can wow the world. So you can be so perfect the world will fall at your feet.

Inside you know you are lying to yourself, but the pain is too much, and so you can’t let that voice come out. Especially if you can’t really trust anyone out there to really take care of you, which is what you need. So the skinniness is a defense against people, and against the risk of love, because if you make yourself vulnerable, it’ll be even worse when they dump you.

The psychiatrist can help, you know. What did it for me was meds at first. I have many friends who had to go through a dozen meds to get to the right one. I was lucky. I got help from the first one. They added two more later, to get it all fixed, but I was lucky.

Therapists, too, are like meds. You may have to go through a dozen before you find one that works. Don’t give up if the first few can’t help. There is some therapist out there who you can work with; who gets you.

There are so many tools you need, though. All these feelings rushing through you and throwing you around like leaves in a wildfire. It seems impossible to deal with, and yet, I promise you, it is possible to deal with it.

It will take a lot of work over a number of years to get everything you need in the right place. You’ll need the right meds, and the right therapy. But I think the most helpful thing is to talk to a group of people who are the same as you are. You’ll be so surprised at how many there are, and even more surprised that they have all the exact same feelings and thoughts as you do.

It’s kind of scary. We think we’re all unique and alone and these feelings are so awful, no one else could possibly understand, and then it turns out there are clubs of us. An underground movement, almost. Because this is a hidden malady—all mental illnesses. The one I have (bipolar) and the ones you have.

My Psychiatrist says there are genetic connections between all the mental illnesses. I wonder if they are all different expressions of what is essentially the same thing. It’s kind of a mix and match thing. I have bipolar and anxiety. She has personality disorder and bulimian. My friend has depression and ADD. It’s like some kind of devils plate of appetizers. Mmmmmm.

The part about the pain you choose for yourself being better than risking happiness turn to pain? That is the hardest. Well, it was for me. It took me the longest time to believe that anything good I did was actually good. Or that anyone who loved me shouldn’t be shoved out the door as fast as possible just to get it over with. The pain was more predictable, and thus preferable to risking happiness. Oh that is hard.

But doable. Really. I promise you. It’s all doable. Even I could do it. Ain’t that a hoot!

YARNLADY's avatar

@wundayatta—I’m at a loss for words – great answer—.

wundayatta's avatar

Thank you, @YARNLADY. The question kind of brought out some pretty raw feelings and frustration. Sometimes I wish I could be a therapist and try to help directly—as if when someone saw me they would believe me or magically be persuaded that what they want is really possible—but that’s not a serious wish. What would be a more serious wish would be to organize a series of group therapy groups around the country and train folks how to run them, and then let all us “sick” people heal ourselves.

JLeslie's avatar

@wundayatta The pain was more predictable. That line means more to me than you know.

beelzebubbles's avatar

The kid is obviously troubled but using only the mental health system to try to help her is not the answer….Beware having your mind and body colonized by the medical-industrial complex…..! Try religion, therapy, exercise, good diet, work, hobbies, creativity, whatever – just be very wary of the psychiatrists who will label and madicate (whoops, Freudian slip there) ad nauseam…. I work in mental health, so I say this with some knowledge of life in the human zoo! Not that I am totally antipsychiatry or psychotropics, but we need much more balance.

wundayatta's avatar

It is true, @beelzebubbles, that even mental patients need to be knowledgeable consumers. We have to watch over our doctors and not let them run over us like we’re idiots. If there’s a med that doesn’t work, and you know it, don’t let them keep giving it to you. Tell them you have to have something different. And discuss it with them. Don’t throw a tantrum.

A lot of doctors are over-tired, and they have too many patients and too little time, and they skimp on people sometimes, maybe not even aware of what they are doing. Make them pay attention. You’re not trash.

The medical system works, but you have to take charge of it. No one else is going to. They won’t talk to each other unless you make them. They won’t change unless you make them pay attention. Of course, some of them do pay attention and really do care. Find a research psychiatrist if you can. They are learning new stuff and they tend to really care. There’s more, but I have to go to bed.

stardust's avatar

@beelzebubbles Couldn’t agree more.

likipie's avatar

A lot of teenagers can be diagnosed with depression, low self esteem, borderline personality disorders, and social anxiety. And all people period compare themselves to others whether or not it’s negative comparison. The eating disorder and self injury is serious. Even if it’s not severe, it still needs to be taken seriously. As do ANY suicidal thoughts, behaviors, and/or threats. In a way this diagnoses is serious, but in other aspects, it could be considered bogus.

Answer this question




to answer.

This question is in the General Section. Responses must be helpful and on-topic.

Your answer will be saved while you login or join.

Have a question? Ask Fluther!

What do you know more about?
Knowledge Networking @ Fluther