The title to today's post was the headline on today's version of Dr Allen Frances blog on Psychology Today - DSM-V In Distress. It has particular relevance for adult survivors of childhood trauma for which there is currently no accepted diagnostic label. Dr Frances was chair of the taskforce for the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and was commenting on the results of field trials of the reliability of diagnostic criteria for the upcoming Fifth Edition of the Manual (DSM-V), which showed that even criteria for "well-accepted" diagnoses such as Major Depressive Disorder are performing well below acceptable standards. This certainly does not bode well for the future diagnostic status for disorders caused by childhood trauma and neglect. Dr Frances, a psychiatrist himself, wasn't speaking "out of turn".
As he notes: "An inaccurate diagnosis can be a disaster- leading not only to inappropriate treatment but also to stigma, ruined self confidence, reduced ambition, needless worries, despair about the future, and a deeply injured sense of self"; This is one of the factors that motivated the National Child Traumatic Stress Network to see a new diagnosis introduced in DSM V "Developmental Trauma Disorder" for child and adolescent victims of abuse and neglect. I would argue that the plight of adults with such disorders is even worse than that children -- adults are much less likely to receive childhood trauma-related treatment, and untreated effects of disturbed attachment, such as caused by childhood abuse and neglect, can last all a person's life, even up to the time they start dementing! (Browne & Schlosberg, 2006). Along the way such adults can attract diagnoses of "Personality Disorder (especially Borderline PD -- a particularly stigmatising diagnosis), "Adjustment Disorder", "Alcohol Dependence", "Addiction", and not just (in fact rarely) the diagnosis "Postrraumatic Stress Disorder" -- all, to varying degrees, stigmatising diagnoses -- not surprisingly, those charged with diagnosing (psychiatrists) are amongst the foremost people stigmatising adults presenting with problems arising from childhood trauma.(Adams, 2010; Jutel, 2009, Lincoln, 2006).
Adult survivors of childhood adversity and trauma are well known to have substantially limited and impaired lives as a result of their childhood experiences (Goodman, Joyce, & Smith, 2011; Smith & Smith, 2010). And that is without the psychological effects of psychiatric diagnosis, and especially without the effects of inaccurate psychiatric diagnosis. It may be "natural" (or lazy and judgemental?) to slot people into categories, and not think of them outside those categories (especially not as people from and within particular contexts), but people ARE people, they ARE not the problem -- best expressed in the title of the article by Michalak: "It's something that I manage but it is not who I am". Yet all too often, that's how adult survivors of childhood trauma are regarded. Why do psychiatrists so stigmatise adult survivors? (for a discussion of psychiatric stigma associated with personality disorder see Nehls, and Lincoln). Well, we don't make "good patients" -- we often have difficulty REALLY talking about our problems (though we can skim the surface and give the appearance that we are when we're not -- we're too burdened by shame to really say what we're doing "wrong" so we can cope), we DO all those socially unpleasant things like abuse alcohol and other drugs, we do things impulsively like commit silly crimes -- my brother stole to try to buy so-called friends -- we're often "not compliant" with the treatments psychiatrists prescribe, we often don't respond all that well to the treatments (usually drugs) that psychiatrists prescribe, we often know more about "the problem" than what they do, we're generally not all that good at so-called therapeutic relationships, or any sort of relationships, especially when those relationships are really under somebody else's control -- something so well described in van der Kolk's 2005 article.
How can we try to avoid the problems associated with "mislabeling" -- first, and foremost, try to avoid the problem of growing up with psychological disorders as a result of childhood trauma. If you already suffer from those, or you're trying to avoid future problems, try to find your own "place of safety" -- especiallly one that's thought "healthy" by psychiatrists, and most importantly, if you can, stay well clear of psychiatrists -- my next post will be on "Finding a Place of Safety".