Identifying with Diagnoses

Diagnoses are a quick way to throw a label on ourselves. It can help us identify with others who may share our experiences or become a heavy burden we lug around wherever we go. It’s important to understand what diagnoses are and what they are not.

Identity and Diagnoses

People can sometimes start to see their diagnosis as their identity. There is a distinct difference between understanding you have symptoms of something and feeling as if that thing represents you.

For example, feel the shift between statements such as

“I am Borderline”

“I have been diagnosed with Borderline Personality Disorder”

“I have difficulty with maintaining healthy relationships with other people.”

If your sense of identity becomes tied to your diagnosis you may not make active steps to learn how to manage your symptoms. You may instead feel like it is your doom or destiny to ‘always’ have certain symptoms. Being tied to your diagnosis in this way could lead you to get stuck in a place where you are not growing or learning how to improve your well being.

Making Connections

When communicating with others we are often tempted to find areas where we overlap to build connections - for example through our interests or shared experiences. Saying that you have been diagnosed with a specific diagnosis could potentially be a short hand way of trying to talk about your own life experiences to make a new connection.

Due to the nature of how diagnoses are defined and given, individuals with the same diagnosis may have vastly different experiences from one another. This can lead to individuals who are not well informed to begin arguing with one another and invalidating each other (particularly on the internet). It can be devastating for someone who began to identify as their diagnosis to be told that the diagnosis is wrong and they do not belong to the community they were attempting to join for support.

Pathology

Not every behavior needs to be pathologized.

Pathologize: To view or characterize as medically or psychologically abnormal

Because of our desire for quick labels and hashtags many people may try to self-diagnose. They want a word to describe their experiences. Just because someone does not enjoy social interactions does not mean that they qualify for a diagnosis of Social Anxiety Disorder. Someone who is having a horrible morning and does not want to get out of bed does not necessarily need to be diagnosed with something like Major Depressive Disorder. Experiencing a nightmare about a past event can be part of the experience of Post-Traumatic Stress Disorder, but is not the only thing that needs to be going on to qualify for it. Many people throughout their lives will experience symptoms/criteria/traits connected to diagnoses yet may not ever qualify for a diagnosis itself. So, when does something become a diagnosis?

What is a diagnosis?

Diagnoses are found in the Diagnostic and Statistical Manual of Mental Disorders which is currently in its fifth edition and is known more commonly at the DSM-V. A diagnosis is only given if a set of experiences leads to an individual experiencing clinically significant dysfunction. These experiences are referred to as criteria in the DSM-V and may be more informally known as symptoms. For each diagnosis, there is a list of these criteria that must be met in order for the diagnosis to be given, but many diagnoses have more criteria listed than are required to be given the diagnosis. For example there may be nine criteria on the list, but a client only needs to meet any combination of five of those criteria to be diagnosed. Many people do not understand that for several diagnoses there are a multitude of combinations of how symptoms can show up or present. This makes attempting to communicate your experiences with the label of a diagnosis potentially more confusing than naming the symptoms you personally experience.

Significant Dysfunction

Dysfunction is a way of describing when things have gotten in the way so much that there is impairment in how you function in areas of life like work or school, getting things done, and maintaining social relationships. Dysfunction occurs when someone’s needs are not getting met. Symptoms often look like someone trying to meet their needs in a way that is not effective or even potentially harmful.

Notice, a diagnosis is only given if there are both a certain set of symptoms and clinically significant dysfunction. Someone may not be making the most optimal choices in their life, but could be functioning in a way that is healthy enough for them. If it crosses the line and becomes dysfunctional, that is when a diagnosis can be given by a trained mental health professional. A diagnosis then becomes a way of acknowledging that something is going wrong so that we can build the skills we need to make things better.

Outgrowing a Diagnosis

After individuals begin to actively practice skills to address their symptoms they may no longer meet criteria for a diagnosis. For example, let’s say someone is diagnosed with Post-Traumatic Stress Disorder (PTSD). They may begin to learn and actively practice strategies to effectively respond to their thoughts and feelings. They may then no longer qualify for the diagnosis of PTSD because they no longer have enough symptoms or dysfunction in their life to meet the clinical requirement for the diagnosis. That does not mean their trauma went away - it means they learned and practiced managing difficult situations in a new and healthy way. They have become someone who ‘used to have PTSD’ instead of someone who still has it. Someone who has built past trauma into their identity may be less likely to actively practice skills to manage their experiences as they have become entangled with this as part of their sense of self.

Note: There are some diagnoses with symptoms that can become more managed and eventually the person will no longer qualify for that diagnosis. There are others that may have very different roots such as a genetic component where the goal is not to get rid of the diagnosis, but to improve functioning and symptom management as much as possible. We may not get to decide what we were born with or the environment we came up in, but we do get to decide how we are going to handle ourselves in the present moment. Ideally, by learning healthy ways for taking care of ourselves.

You Are More

You are more than any diagnosis. A diagnosis is an incredibly limited use of our language to try to explain a specific group of symptoms that are getting in your way. If there is something in your way please know that symptoms can be addressed with training and practice. You do not have to stay stuck. Seeing a professional counselor can be a great strategy for learning the skills you need to grow in the direction that matters to you.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

https://www.merriam-webster.com/dictionary/pathologize

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101504/

Vignette

Some Posts have matching Vignettes, fictitious short stories to illustrate an example related to the topic of the post. This post shares more about what Vignettes are and what they are not.

“I don’t go outside. I’m Agoraphobic.”

“Is that like a skin condition?”

“No”

“What’s it mean?”

“That I don’t go outside.”

“It stops you?”

“...Yes?”

“How?”

“I don’t like being outside.”

“How does that stop you?”

“What are you talking about? Can you just leave now?”

“I don’t understand. Oh. Here. Some cookies. Like chocolate chip?”

“Um. Yeah. Thanks.”

“I can understand not liking something. I don’t understand how that stops you. Do you want to be inside all the time?”

“It’s better in here. I’m more comfortable.”

“Okay, but it kind’ve sounded like you were a prisoner. Like a forcefield was preventing you from escaping or like some tentacle monster was in your tub and would drag you back in.”

“To be honest, it kind of feels like that sometimes.”

“So, if there isn’t a tentacle monster then what’s keeping you?”

“Something could go wrong.”

“Yeah.”

“No, that’s it.”

“So, you’re not doing the other things you’re interested in because something could go wrong?”

“Yes.”

“How did it get like this?”

“School was horrible for me. It got worse over time. Now with the internet and home deliveries I don’t have to leave.”

“Maybe not, but this forcefield thing is awful.”

“I know. I don’t even know why I’m telling you this.”

“I have nightmares about houses.”

“What?”

“I have nightmares. The house I grew up in. You wouldn’t want to know the details. The idea of being stuck in a house like this with what I went through… Yeah, I don’t always feel safe in houses.”

“This is my safe space. What do you do if you don’t feel safe in houses? It sounds horrible.”

“Well, I go in houses. I worked on it and it wasn’t easy, and sometimes I have nightmares or flashbacks, but it’s not like it was.”

“How? You said you had trauma.”

“Yeah, but I don’t respond to it in the same way as I used to. Kind’ve like how you feel about leaving the house. You don’t have to do this in this way. It’s a lot of work but this forcefield is one you put up. Not on purpose! No judgment or blame or anything. But it’s getting in your way. You know?”

“But I’m agoraphobic.”

“That’d be like me saying I’m traumatized. I was. I’m not anymore. It doesn’t mean I didn’t have trauma. I just worked on it. Alot. Therapy wasn’t easy, but now I’m not so stuck. I’m someone who experienced trauma and it got to me more in the past than it does now. You know?”

“Not really.”

“That’s okay. If you ever want me to help you knock on this forcefield I’m up for it. It’s dangerous to go alone.”

“Nice one. I… might think about it. But not today.”

“No problem. Enjoy those cookies. I’ll just be next door, new neighbor.”

“In a house?”

“Yep. In a house.”