Are there any laws forbidding psychiatrists from testing for personality disorders without consent?

a reply to: Quasiscientist

Afternoon Q

I am licensed as an LCPC who works in private practice under a psychiatrist. As someone who assesses and diagnoses on a daily basis, I'll try to answer as I can.

So I will break down what I can in legal and ethical terms, than in my own professional manner

Legal/Ethical - I don't believe you have much of a suit to be honest. you signed consent to be seen and evaluated. A mental status examination is standard and part of all assessments. The thing is, unless my client has a specific cognitive delay or traumatic injury to the brain, or unless my client has given me some reason to be concerned that there is a serious concern such as psychosis or active mania, then the mental status exam (MSE if you don't mind me shortening) is woven into the assessment without being a specific extra.

An MSE is comprised of the following tests criteria

Orientation (is the client oriented to person, place, time and situation?)
Attention
Recall (can you remember things in short term)
Appearance (age, is clothing appropriate - meaning is it 20 below and you are wearing board shorts?)
Grooming
Language (content and context)
Judgment
Mood
Affect

As you can see, several of these can be checked without asking a single pointed question. I can see if you are attentive, groomed, dressed appropriately. I can tell if language issues arise (pressured speech, etc), I can tell your affect once I ask mood. If you tell me you're depressed, yet acting as if life couldn't be better. Recall I would need to ask pointedly. Orientation I would have to ask pointedly.

NOW...if you come in and I am aware of a pre-existing condition OR thought content or speech seems abnormal, then I might start asking pointed questions about affect, judgment, etc.

So in essence, any assessment will (or should) have at minimum an MSE or mini-MSE involved.

Goldwater definitely does not apply since you sough services. Now if I were to sit here and try to diagnose you without knowing you, being in a professional relationship with you, and treating you, then it applies to me.

Diagnosing of personality disorders likewise takes place while continually diagnosing for mental and behavioral disorders. Meaning, if tomorrow you come to my office and tell me I think I am depressed, and then through testing or assessment, you fit criteria for major depressive disorder, then yes I am always on the lookout for anything else that can EXCLUDE or otherwise EXPLAIN your symptoms. We do this for accuracy. Take for example Obsessive Compulsive Disorder (OCD) versus Obsessive Compulsive Personality Disorder (OCPD). If the criteria meet a diagnosis for OCD, I should naturally be checking for at least 5 other things such as social anxiety, general anxiety, trauma (such as PTSD or ASD), and yes...OCPD as well.

I'll get to my own personal note in a moment regarding personality disorders

What I am confused by, is that you stated in 2013, you agreed to be tested for personality disorders. So if this is the case, then YES you have been tested for PD's. Even if you went in for a normal DSM-5 assessment, you've been assessed for potential of personality disorders.

Again...more on a personal note in a moment

That notice with the three points is easy to explain. First, if you agree to have your info released to other healthcare providers, then yes it will be released. Point three merely states that relevant info would be released IF a signed court order was made. A lawyer CANNOT get the info without a judge

The second point is what causes some people concern. In a physical emergency, such as you stop breathing, your family could be called to tell them the situation and what hospital you went to...however....this all changes in a mental health emergency.

A mental health emergency is deemed an emergency if one of four main criteria are met

1. You are suicidal
2. You are homicidal
3. You are undergoing an ACUTE psychotic break that is dangerous to you or someone else
4. Your current mental health condition does not meet 1-3, BUT it is at such a dire level that you are no longer physically capable of caring for yourself. (this one is exceptionally rare)

IF one of those are met, the entirety of HIPAA and privacy go out the window. If you come to my ER and I assess you and the complaint is behavioral, then I can call anyone I want without your permission AS LONG AS it is relevant to your current state. Meaning, I could call your mother (I have no clue how old you are...just making the point) and ask is this normal, have you ever hurt yourself before, etc. I could NOT call your favorite burger joint UNLESS the specific threat of harm happened IN said burger joint.

Personality type versus personality disorder - NOT the same thing. I am a PTSD-specialist, and as such, I deal with borderline personality disorder frequently. I can explain that someone has a borderline type personality without diagnosing officially. At that point, it's just a process note and not me making it official.

Lastly, if you truly were not informed of your assessment, care, and diagnosis...then you have a case with at least the AMA or APA (depending if it was a psychiatrist or psychologist) All you need to do to start is request all files. Your diagnoses will be included.

Ok....enough of that...now to my personal note

First...no personality disorder should be given until I know a client for quite some time. If you come in with a history of sexual trauma, I am not going to be like "BAM! Borderline." PD's should take a long time and be diagnosed only when tons of evidence have been appreciated over time.

Second, as far as being worried about how people would see you, don't worry. I know it's easy to say but don't. The only "personality disorder" that people "worry" about is what we call antisocial personality disorder. This is where terms get loosely (and in a VERY uneducated manner) thrown around such as sociopath and psychopath. Even if you DID have ASPD, it still does not make you a sociopath or psychopath. But there is one big missing key here...

If you were not previously (before age 15) diagnosed with Conduct Disorder, you CANNOT be diagnosed with Antisocial PD

Finally, no...Adderall is only for ADHD. There are no medications specifically for PD's....I too would love to know why the concern, but that of course is 100% your decision and life.

Hope I helped even a little

PM me if needed

originally posted by: KyoZero
a reply to: Quasiscientist
What I am confused by, is that you stated in 2013, you agreed to be tested for personality disorders. So if this is the case, then YES you have been tested for PD's. Even if you went in for a normal DSM-5 assessment, you've been assessed for potential of personality disorders.

I apologize for the confusion. The way I worded that paragraph made it seem that I agreed to be tested for personality disorders back in 2013. I've developed a more organized chronology timeline of events to help clear things up a bit:

1. July 1, 2013 - Very first time that I met with my first psychiatrist. I did not agree to be tested for personality disorders back then. I'm looking at my copies of the Intake Paperwork that I filled out back then, and there's nothing here that says that I was agreeing to be tested for personality disorders.

2. July 2016 (last month) - Very first time that I met with my psychologist. He works with a completely different practice than that of my psychiatrist's. This time I actually did give my written consent to be tested for personality disorders, so I went in there knowing full well what it was going to be all about.

originally posted by: KyoZero
a reply to: Quasiscientist
I too would love to know why the concern, but that of course is 100% your decision and life.

I could get into that right now, but it's going to take me quite awhile to write such a lengthy post. I just wanted to clear things up a bit real quick.

a reply to: Quasiscientist

fair enough on that....but yeah I don't think you have a case of ethics on this. Now OF COURSE I am not a lawyer or judge so please don't take my opinion on that...but from working with APA and ACA, assessment is assessment as far as personality or mental disorders go. Now more specific testing for PD's such as the MMPI, the 16 personality factor (16-PF), California Psychological Inventory (CPI), or Thematic Apperception Test (TAT) would be more pointed to PD's...but again, just going into an assessment or test battery alone means they will check for all types of disorders.

It goes back to when the DSM-4 Axis scale was still in use. In that cases there were 5 Axes

Axis 1: Principal disorder. This is that overwhelming majority of disorders such as mental health, cognitive, psychotic and anxiety disorders.
Axis 2: Personality disorders and developmental disorders
Axis 3: Medical concerns
Axis 4: Stressors (such as recent divorce, domestic issues, etc)
Axis 5: Global Assessment of Functioning - a number between 1 - 100 to determine how well you are functioning

Granted we don't live in the DSM 4 anymore....but this is interesting in your timeline.

In 2013, you would have been assessed with DSM 4, meaning you would have had a 5 axis scale INCLUDING suspected or met personality disorders.

If you look at your axes from 2013, look at Axis 2. If it says V71.09 then it means they found nothing of value. If it says 799.9, it means they deferred diagnosing anything of a personality disorder

Now, in July 2016, it will look radically different and all of your codes including Axis 1, Axis 2, Axis 4, AND any V or Z codes, will all be in one area. Meaning, if you do not see a code for a personality disorder with the cluster of other disorders, they did not diagnose you with one.

To help a bit, here are the potential codes to look for to indicate a personality disorder on the 2016 records

F60.2 - Antisocial
F60.6 - Avoidant
F60.3 - Borderline
F60.7 - Dependant
F60.4 - Histrionic
F60.81 - Narcissistic
F60.5 - Obsessive Compulsive (PD...not OCD)
F60.0 - Paranoid
F60.1 Schizoid
F21 - Schizotypal
F60.9 - Unspecific PD (meaning they think something MAY be there...but just not sure if it exists or not)
F60.89 - Specific PD (meaning the are SURE something is there, but it does not fit perfectly into the specific models)

I'll keep looking back for more responses

hope this all helps

a reply to: KyoZero

there was an article in the magazine "discovery" a couple of months ago, about brain scans of known psychopaths, where they were able to show "unusual activity" that was different from normal people when asked a series of specific questions....do you know about this, KyoZero?

a reply to: jimmyx

Yup

and I am wondering and hoping that maybe some day a scientific breakthrough occurs and new treatments will be available

Thanks for reminding me :-)

originally posted by: KyoZero
a reply to: Quasiscientist
I too would love to know why the concern, but that of course is 100% your decision and life.

OK. This is what I've managed to type up so far. This isn't the whole story, but here goes:

I went to see my first psychiatrist (let's call him: Dr. Cha) on July 1, 2013. Dr. Cha seemed very tired, inattentive, and possibly falling asleep. However, I remained patient throughout the session under the suspicion that my tolerance was intentionally being tested (possibly assessing me for Narcissistic Personality Disorder.) After attempting to explain my various concerns to Dr. Cha for about 15 minutes, he prescribed me Adderall for the treatment of ADHD. I found it a bit strange that I was prescribed Adderall so quickly, especially after I had read about the side-effects of Adderall and how some people with drug-seeking behavior often seek Adderall for recreational use.

Nearly eighteen months later (on December 28, 2014), I had gone back to see Dr. Cha to be prescribed Adderall again, as I didn't bother taking it before. I tried to make another appointment with him a month later in January of last year (as he suggested) but I was told that he would be busy until March and that I should see another one of the providers. So I ended up seeing a different psychiatrist (also working within those same offices, let's call her: Dr. Nik, saw her on February 9, 2015.) About two months later I tried to make another appointment with Dr. Nik, but I was told that she was no longer with their practice. So I ended up with a Nurse Practitioner (who is the person that I was seeing to sign my prescriptions for Adderall nearly every month for over a whole year, let's call her: Dr. Ude, saw her for the first time on April 15, 2015.)

During this time I had already felt that I was being assessed in some way for Narcissistic Personality Disorder, and one of the most common behaviors of people with Narcissistic Personality Disorder is being “coquettish.” One thing that has made me wonder is if I have been “baited” by certain providers into being coquettish. For example: back in August 17, 2015, I remember that Dr. Ude was wearing a red minidress during our session (in all nine of our sessions together she had never worn dresses or skirts, only pants and office shirts. Except for this one time in August.) And her desk is one of those where one could see everything below the surface. I remember at some point I asked, “how long do these sessions usually last?” to which she smiled and responded, “twenty minutes.” I also remember that on that session I just sort of mumbled about barely-relevant nonsense for nearly an hour, by the end of it she seemed either annoyed and/or bored. Additionally: at some point during my rant, she interrupted me and said, “what would you like to do right now?” To which I awkwardly responded with, “I, uh, well, I guess I'll just wait for you to sign the prescription and then I'll just head out to the pharmacy.”

It had been over two months since I had stopped taking Adderall due to lack of funds, but I eventually received some money to pay for both the consultation ($150) and medication (~$375) and so I made an appointment with Dr. Ude for December 17, 2015. Once I got to the front desk of the office building where I had my appointment, I was asked if I had paid for my consultations for the previous three sessions (amounting to a total of $450) which I had indeed paid for all at once back in August of that year. They told me to wait while they checked on the computer whether or not there was any sort of confirmation of my payment. They then asked me if I remembered the person that was at the front desk when I paid the $450 and I responded with, “no.”

I also remember that as I walked into the office, a man had walked out of one of the other offices on the lower floor, climbed up the stairs, walked into the same office that I was, sat on the couch behind me, and then simply smiled while I waited. His face seemed familiar, like the faces of one of the providers that I saw on the company's web site. The person at the front desk had me waiting at the front desk for about fifteen minutes at which point I had become very late for my appointment. After those fifteen minutes the person at the front desk simply told me “OK. You can go now. This is just weird.”

Once I started walking to the office where I had my appointment with Dr. Ude, I ended up in another room where the person of the front desk told me that there were free bottles of liquid hand soap on the coffee table, and told me, "it's for Christmas. You can take as many as you want" (they had never done this before, not even on my session of the December of the year before that.) I considered for a moment of taking just one, but then realized that there was a security camera and a new bright light right above me and so I wondered if I was being tested for selfishness. I waited for a few minutes more while Dr. Ude finished her session with another patient, even though the time for my appointment had already passed. It didn't really bother me all that much that I had to wait, but I do remember feeling a bit worried.

When I went to see Dr. Ude on March 4, 2016, I told her that I attempted to contact a geneticist to ask them questions regarding testing for the genetic predisposition of any possibly inheritable disorders and/or diseases (such as: Antisocial Personality Disorder, Alzheimer's disease, schizophrenia, etc.) to which I was told that I could only see the geneticist if referred to them by another doctor. Dr. Ude asked me if I had a Primary Care Doctor, to which I responded with, “no.” She then provided me with referrals to two “Primacy Care Doctors” (let's call them: Dr. Gla and Dr. Def.) Dr. Gla's specialties are: Internal Medicine; HIV and Infectious Diseases Consultation; Gay Men's Health; PrEP; Confidential STD Testing and Treatment; Genital and Anal Wart and Dysplasia Testing and Treatment; Travel Medicine and Immunization. Similarly, Dr. Def's specialty is HIV disease. In fact, when I try looking on Zocdoc for Primary Care Doctors within the zip codes of both Dr. Gla's and Dr. Def's practices, neither of those two show up. Dr. Gla does show up, however, as an Infectious Disease Specialist.

When I went to see Dr. Gla on April 8, 2016, I remember that he became somewhat upset and told me: that he couldn't help me, that he dealt mainly with HIV and other STDs, that he didn't understand why it was that Dr. Ude referred me to him when a psychiatrist (such as Dr. Cha) could have been of more help to me with my questions, and that he was upset because both his and my time were being wasted. Dr. Gla even went so far as to calling Dr. Cha's main office to speak with Dr. Ude, while I was still there with Dr. Gla at his office. I'm holding my MedRec right now and I'm seeing here that Dr. Ude wrote for the date of April 8, 2016: “Spoke with Dr. Gla who says he just saw this patient. He states he came in for referrals for genetic testing for autism and personality disorders. He states the patient did not say anything about obtaining a routine physical and blood work to establish care as i recommended nor did he talk to him about a neurology referral which i also stated if he wanted, he should go through a PCP for this...”

originally posted by: KyoZero
a reply to: Quasiscientist
I too would love to know why the concern, but that of course is 100% your decision and life.

Oh, dang. Looks like my entire post didn't go through for some reason. I'm going to try posting the rest:

But then I look on over to what she wrote for the dates of March 4, 2016 and April 2, 2016 and see here that she made no mention of recommending to me any routine physical and/or bloodwork, which only confirms what I can already recall. She added for the date of April 8, 2016: “Genetic testing for autism and personality disorder does not exist.” She did not tell me this on the date of March 4, 2016, in which she provided me with the referral to Dr. Gla.

On my 9th session with Dr. Ude on May 5, 2016, her behavior was particularly unusual. I remember her leaning in front of her desk with her legs crossed and that she was biting her lower lip. I also remember her asking me, “so what are you doing this summer?” (she had asked me a similar question on my previous session on April 8, 2016: “so what are you doing this weekend?”) Additionally, I remember her telling me that she received a call from Dr. Gla, after which I had to explain what happened. After I finished telling her what happened, she just kind of giggled, smiled, and said: “I see...” Then she added: “Right. Well, see, the reason I referred you to Dr. Gla was because I felt that you needed to get some bloodwork done—” then she looked at me, her demeanor quickly changed, she then stopped talking, she sat down, and then proceeded to quietly fill out my prescription for Adderall. Once she was done, she simply placed the prescription on her desk (on my 8th session with her, she had actually gotten up from her desk, walked, and handed the prescription over to me—all the other providers in these offices have handed over the prescriptions to me rather than placing them on their desks for me to pick up), she then started smiling, and told me to let myself out and to close the door on my way out (that was the first time she had ever told me this, she would always open the door for me before.) After I had walked out of her office and closed the door behind me, it almost seemed as if I could hear her laughing.

On May 19, 2016, I decided to ask for copies of my: medical records, Intake Paperwork, and doctors' notes. I showed up in person to the front desk of their main office and asked if I could speak to Dr. Ude. They told me that I would not be able to speak with her without making appointment first. While I was filling out the “AUTHORIZATION FOR USE/DISCLOSURE OF HEALTH INFORMATION” form and the person working at the front desk was busy speaking on the phone, Dr. Ude suddenly walked in. I nodded and politely smiled at her, to which she responded similarly in acknowledgment before walking over to the copy machine. Afterward, she walked behind me and then to the water cooler before walking out of the main office. I later asked the person at the front desk if I could wait until Dr. Ude was finished seeing her patients as their offices would be closing soon, and he just sort of hesitatingly said that it was okay. So I waited outside of Dr. Ude's office for a long while. During that time I remember seeing her new patient who was a tall, muscular, white male with long blond hair walk into her office. Over an hour passed (each session should normally be about 20 minutes long) before I saw somebody who appeared to be Dr. Ude walk out of an office on the lower floor, except she seemed to have changed her clothes. She was wearing a hoodie which was covering her face, and she was wearing jeans (she had been wearing a skirt earlier.) However, she was wearing that same skirt that I saw her wearing earlier, but over her jeans. I stopped to consider for some time whether or not I should stop her to speak to her. Ultimately, I attempted to follow her out of the building but by the time I got out, she had disappeared. I returned to the main office to ask if I could see Dr. Ude, but they told me that she left. That's when I heard somebody behind me chuckling and so I turned to see that it was the patient that I saw earlier.

The next day, I received the copies of my MedRec and found this note from Dr. Cha at the end: “MedRec prepared for patient. Will have patient see me at next session.” I found it strange that all of a sudden Dr. Cha wanted to see me as it had been nearly 18 months since he had last seen me. The next month when I attempted to make my 10th session with Dr. Ude, I was initially told that I'd be able to see her the next day but that: “oh, but she'll be in our *private information redacted* location” (*private information redacted* is nearly 50 miles from here and I have no car) to which I responded: “*private information redacted* is fine. What's the address to her office?” They then put me on hold for a few minutes and when they came back they said: “actually, it turns out that she'll be too busy this whole month” (that's the first time that I was ever told that she'd be too busy for an entire month.) I attempted to make appointments with other providers, but was told that they'd all be too busy (except for the one and only psychiatrist: Dr. Cha.)

On June 1, 2016, I ended up seeing Dr. Cha, and I remember that I walked into his office and he said: “here. Let me close the door for you.” I replied with: “thank you” and then sat down. I remember that during this session he started asking me several questions like: “on the scale of one to ten... one being the lowest, ten being the highest... how would you rate your happiness?” At some point he asked me: “how would you rate your gratitude?” (at this point an alarm went off in my head: “is he officially testing me for Narcissistic Personality Disorder now?”) During this session he also told me that I'd be receiving random drug tests every few months, apparently “to see what's going on with you.” I responded with: “but I'm only taking Adderall right now.” He then gave me a strange answer that barely made sense, but I didn't bother arguing with him. I asked him: “will these drug tests be mandatory?” and he answered: “no. But if you keep denying to get tested, we'll start wondering why that is.” As I was walking out of his office I said to him: “thank you very much. Have a nice day” to which he simply stared blankly at me until I walked out and closed the door.

After that 9th session (May 5, 2016) with Dr. Ude, I managed to find her cell phone number by looking up her NPI number on the NPI Registry web site (I attempted to text to that number a few times to ask her why she had referred me to Dr. Gla, but she texted me back claiming that I had the wrong number.) Eventually it seemed as if she blocked my cell phone number, so I then attempted calling her from other phones. It definitely seemed to be her cell phone number, as it was both her voice and name on that number's voice mail system. Someone did eventually pick up, but it was a male voice and he claimed that I had the wrong number. A few days later I looked up her NPI number on the NPI Registry web site again only to find that her cell phone number on her page had been changed, and the only person who could have done that would have been herself. I then continued calling her for several times throughout the months of May and June.

originally posted by: KyoZero
a reply to: Quasiscientist
I too would love to know why the concern, but that of course is 100% your decision and life.

Oh, wow. The entire post still didn't go through. Hopefully this post doesn't get cut off:

And it was not until June 30, 2016 when Dr. Cha finally explained to me why it was that I was referred to Dr. Gla and why I needed to get bloodwork done. Dr. Cha had called me on that day to specifically tell me that calling Dr. Ude on her cell phone was very inappropriate and that she felt very uncomfortable. He added: “this is a very sensitive situation and if you keep calling her she may put a restraining order on you.” I had already apologized for calling Dr. Ude, but I felt that it was a bit excessive for me to be told that what I was doing was harassment and that she could put a restraining order on me if I didn't stop calling her. I would have stopped calling her if she had simply told me to do so, but she did not. She instead had Dr. Cha tell me to stop calling her, and that I was allowed to neither speak nor see her anymore.

On July 11, 2016, I had no choice but to make an appointment with a different Nurse Practitioner (this time a male, rather than female. Let's call him: Dr. Bal.) Once the session started Dr. Bal asked: “what was the deal with you calling and texting Dr. Ude?” I, of course, had to tell him the truth: “I had several questions that I wanted to ask her regarding what we had discussed back in May. For one, she never really explained to me why she referred me to that Dr. Gla who mainly dealt with things like HIV and other STDs. She told me that he'd be able to refer me to a geneticist, who might be able to answer my questions about the heritability of schizophrenia, Alzheimer's disease, Antisocial Personality Disorder, among other things. He then told me that he couldn't help me and he didn't understand why I was referred to him...” (I went on for a few minutes after that.) So Dr. Bal told me: “okay, I'm noticing that you are displaying some of the symptoms of schizophrenia. Some of the side-effects of Adderall actually do mimic some of the symptoms of schizophrenia. I will be lowering the dosage of Adderall from your current 60 mg a day down to 40 mg a day. I will also be prescribing you Abilify, which is an antipsychotic. The Abilify could help you calm down.” I asked him: “what symptoms of schizophrenia are you noticing?” Dr. Bal stuttered a bit and said: “ah, uh, a-hem, y-you can't verbalize why calling Dr. Ude on her cell phone was inappropriate. There's also the fact that you're concerned about having schizophrenia.” I quietly thought to myself: “are you kidding me? You're prescribing me a psychostimulant while simultaneously prescribing me an antipsychotic, just because I said that I wanted to get tested for schizophrenia? What the hell?” I managed to convince him to not prescribe me Abilify and to keep prescribing me Adderall for 60 mg daily. When I walked out of his office I noticed a lot of the patients in the waiting room and the workers at the front desk smirking.

On July 13, 2016, I received a phone call from Dr. Cha telling me that he was going to stop prescribing me Adderall altogether based on what I told Dr. Bal. I managed to convince Dr. Cha to keep prescribing me Adderall, and he seemed annoyed, he sighed, but hesitatingly agreed. He told me that I would be exclusively seeing him every month from then on.

On August 9, 2016, I pointed out to Dr. Cha that after reviewing all the forms I've signed with them, there's no rule that states that I can't call any of the providers on their personal cell phones. The only rule that comes even close to describing a situation like that is on the “SERVICE AGREEMENT” which states: “Public Encounter. At times, I may encounter My Doctor in a public setting. He wants to protect my privacy and will not acknowledge me as his patient unless I am comfortable revealing that information and acknowledge that I'm his patient first.” When I pointed this out to Dr. Cha, he said: “right. Well, we assumed that it would be obvious to our patients that it would be inappropriate to be calling their providers on their personal cell phones.” I then told Dr. Cha that I've actually called and texted both my psychologist (let's call him: Dr. Vai) and therapist (let's call her: Dr. Gol) on their personal cell phones, and they've made absolutely no complaints to me. Dr. Cha then said: “well it would seem that different practices have different rules.” Dr. Cha then went on to ask: “how are you feeling now?” (he asked me this question about five or six times during the session.) He then repeated to me that same thing he said earlier in the session: “we assumed that it would be obvious to our patients that it would be inappropriate to be calling their providers on their personal cell phones.” He asked me again: “how are you feeling now?” I replied: “I feel calm.” He seemed shocked for some reason. He then proceeded to ask me several other questions. He asked me if I'd ever been in a relationship, and I told him no. He also asked me if I went to the gym. He even asked me: "so what are you doing this weekend, or, rather, what will you be doing this whole week?" This went on for awhile.

originally posted by: KyoZero
a reply to: Quasiscientist

fair enough on that....but yeah I don't think you have a case of ethics on this. Now OF COURSE I am not a lawyer or judge so please don't take my opinion on that...but from working with APA and ACA, assessment is assessment as far as personality or mental disorders go. Now more specific testing for PD's such as the MMPI, the 16 personality factor (16-PF), California Psychological Inventory (CPI), or Thematic Apperception Test (TAT) would be more pointed to PD's...but again, just going into an assessment or test battery alone means they will check for all types of disorders.

It goes back to when the DSM-4 Axis scale was still in use. In that cases there were 5 Axes

Axis 1: Principal disorder. This is that overwhelming majority of disorders such as mental health, cognitive, psychotic and anxiety disorders.
Axis 2: Personality disorders and developmental disorders
Axis 3: Medical concerns
Axis 4: Stressors (such as recent divorce, domestic issues, etc)
Axis 5: Global Assessment of Functioning - a number between 1 - 100 to determine how well you are functioning

Granted we don't live in the DSM 4 anymore....but this is interesting in your timeline.

In 2013, you would have been assessed with DSM 4, meaning you would have had a 5 axis scale INCLUDING suspected or met personality disorders.

If you look at your axes from 2013, look at Axis 2. If it says V71.09 then it means they found nothing of value. If it says 799.9, it means they deferred diagnosing anything of a personality disorder

Now, in July 2016, it will look radically different and all of your codes including Axis 1, Axis 2, Axis 4, AND any V or Z codes, will all be in one area. Meaning, if you do not see a code for a personality disorder with the cluster of other disorders, they did not diagnose you with one.

To help a bit, here are the potential codes to look for to indicate a personality disorder on the 2016 records

F60.2 - Antisocial
F60.6 - Avoidant
F60.3 - Borderline
F60.7 - Dependant
F60.4 - Histrionic
F60.81 - Narcissistic
F60.5 - Obsessive Compulsive (PD...not OCD)
F60.0 - Paranoid
F60.1 Schizoid
F21 - Schizotypal
F60.9 - Unspecific PD (meaning they think something MAY be there...but just not sure if it exists or not)
F60.89 - Specific PD (meaning the are SURE something is there, but it does not fit perfectly into the specific models)

I'll keep looking back for more responses

hope this all helps

OK. Here is what my psychiatrist put down for the session of July 1, 2013:

*my name redacted* 070113 ie 90792 *my birthdate redacted*. *my phone number redacted* rc
*my home address redacted*
ID: 24 y/o male, *private information redacted*
CC: Needing to know if I need ADHD medication.
HPI: *private information redacted*
Soc Hx: *private information redacted*
PPH: No hospital. No Sa.
Med Hx: Asthma
Subs Hx: Denies
Soc Hx: *private information redacted*
MSE: Feeling OK.
Dx: ADHD, NOS
P: Adderall 5mg 1 to 4 bid, #100.

Not sure if I see anything about axes or codes on here.

originally posted by: KyoZero
a reply to: Quasiscientist
I too would love to know why the concern, but that of course is 100% your decision and life.

I also feel that it should be noted that my psychologist wrote on my psychological evaluation report:

originally posted by: KyoZero
a reply to: Quasiscientist
There were no questions raised regarding his reality testing, no hallucinations reported, and no delusions noted either, failing to support a psychosis hypothesis (including all Schizophrenic disorders).

a reply to: Quasiscientist

So I am working on reading the story

Apologies if I am taking a while on that

What I am reading from the report is that all they necessarily saw was ADHD NOS, meaning they found some level of attention disorder but could not entirely qualify it as full ADHD. Typically we do this in the beginning in order to not saddle up a client with a boatload of diagnoses. Plus it offers us time to personalize and describe what is happening over time

I think the lack of psychotic symptoms is of course a good thing. It's pretty typical for us to ensure other disorders, including psychotic disorders, are not in play

originally posted by: KyoZero
a reply to: Quasiscientist

So I am working on reading the story

Apologies if I am taking a while on that

What I am reading from the report is that all they necessarily saw was ADHD NOS, meaning they found some level of attention disorder but could not entirely qualify it as full ADHD. Typically we do this in the beginning in order to not saddle up a client with a boatload of diagnoses. Plus it offers us time to personalize and describe what is happening over time

I think the lack of psychotic symptoms is of course a good thing. It's pretty typical for us to ensure other disorders, including psychotic disorders, are not in play

I forgot to add in that last post of mine that the psychological evaluation report from my psychologist is from about 1 or 2 months ago (July 2016), which was 3 years after I first saw my first psychiatrist (July 2013). My psychologist and my psychiatrist work in two completely different practices, in two completely different cities. I made to sure make copies of my psychological evaluation report to hand over to my psychiatrist, as both he and that second nurse practitioner guy insisted that I was displaying symptoms of schizophrenia and that they would stop prescribing Adderall as they apparently saw that it was worsening the symptoms. My psychologist also wrote on the psychological evaluation report that Adderall has proven more effective in treating my depression than the actual antidepressants I used to take back in 2013 - 2014. A few hours ago I received an updated version of my MedRec by e-mail and after reviewing it I saw that that second nurse practitioner guy misinterpreted what I told him and put down that I was displaying symptoms of schizophrenia like: "Flat affect", "Illogical thinking", and "hallucinations". When I last went to see my psychiatrist in August (last month, of course) he agreed to keep prescribing me Adderall, without lowering the dosage, and without prescribing me Abilify.

a reply to: Quasiscientist

"Are there any laws forbidding psychiatrists from testing for personality disorders without consent?"

I just gave permission for my little girl to be tested here in the UK because she was misbehaving in class and apparently she may be autistic because she blinks to much and when asked to play with dolls she did not do so in the prescribed manner.

Not received the full 7 page report yet as it apparently needs to be amended but suffice to say i will be seeking a second opinion!

originally posted by: KyoZero
a reply to: Quasiscientist

fair enough on that....but yeah I don't think you have a case of ethics on this. Now OF COURSE I am not a lawyer or judge so please don't take my opinion on that...but from working with APA and ACA, assessment is assessment as far as personality or mental disorders go. Now more specific testing for PD's such as the MMPI, the 16 personality factor (16-PF), California Psychological Inventory (CPI), or Thematic Apperception Test (TAT) would be more pointed to PD's...but again, just going into an assessment or test battery alone means they will check for all types of disorders.

It goes back to when the DSM-4 Axis scale was still in use. In that cases there were 5 Axes

Axis 1: Principal disorder. This is that overwhelming majority of disorders such as mental health, cognitive, psychotic and anxiety disorders.
Axis 2: Personality disorders and developmental disorders
Axis 3: Medical concerns
Axis 4: Stressors (such as recent divorce, domestic issues, etc)
Axis 5: Global Assessment of Functioning - a number between 1 - 100 to determine how well you are functioning

Granted we don't live in the DSM 4 anymore....but this is interesting in your timeline.

In 2013, you would have been assessed with DSM 4, meaning you would have had a 5 axis scale INCLUDING suspected or met personality disorders.

If you look at your axes from 2013, look at Axis 2. If it says V71.09 then it means they found nothing of value. If it says 799.9, it means they deferred diagnosing anything of a personality disorder

Now, in July 2016, it will look radically different and all of your codes including Axis 1, Axis 2, Axis 4, AND any V or Z codes, will all be in one area. Meaning, if you do not see a code for a personality disorder with the cluster of other disorders, they did not diagnose you with one.

To help a bit, here are the potential codes to look for to indicate a personality disorder on the 2016 records

F60.2 - Antisocial
F60.6 - Avoidant
F60.3 - Borderline
F60.7 - Dependant
F60.4 - Histrionic
F60.81 - Narcissistic
F60.5 - Obsessive Compulsive (PD...not OCD)
F60.0 - Paranoid
F60.1 Schizoid
F21 - Schizotypal
F60.9 - Unspecific PD (meaning they think something MAY be there...but just not sure if it exists or not)
F60.89 - Specific PD (meaning the are SURE something is there, but it does not fit perfectly into the specific models)

I'll keep looking back for more responses

hope this all helps

I just had my information released to me by Kaiser Permanente. This information is when I still had Kaiser Permanente as my insurance back in 2014. I currently have no insurance. This is from when I went to see a therapist with them for just one time on June 12, 2014. This is what she wrote for the "DIAGNOSTIC IMPRESSION" section:

DIAGNOSTIC IMPRESSION:
Axis I: (300.23) GENERALIZED SOCIAL PHOBIA (primary encounter diagnosis)
DEPRESSION UNSPECIFIED
RO ADHD INATTENTIVE
RO AUTISM SPECTRUM DISORDER
Axis II: deferred
Axis III:

Axis IV: problems with primary support group
problems related to the social environment
occupational problems
other psychosocial and environmental problems
Axis V: Current GAF: 51-41: Serious symptoms (e.g. suicidal ideation, severe obsessional rituals) OR
Serious impairment in social, occupational, or school functioning. - Highest GAF in the last 12 months: 51

Oh, man. This whole situation is so ridiculous. The other day I had a conversation over the phone with my psychiatrist that was nearly half an hour long. I made sure to record that entire conversation. I tried to tell him everything that happened with this female nurse practitioner (who I referred to in this story as "Dr. Ude".) I tried to tell him all about the inappropriate behavior I've been observing from her for over a year.

I demanded to know what was the deal with her. Why it was that she suddenly felt "uncomfortable" and wanted to neither speak to me nor see me anymore. Why it was that she didn't feel uncomfortable wearing that ridiculously short minidress sitting away from me from a very inappropriate position. Especially considering that I'm taking Adderall at its highest recommended dosage (60 mg), and I'm well aware of the side-effects that Adderall has on some men (similar to Viagra, which, in my case, turns out to be true.) My psychiatrist kept coughing throughout that entire conversation and insisted that nothing of the nurse practitioner's behavior was unusual.

I even told some of this story to my psychologist and told him that I was starting to doubt my sanity, that maybe I imagined the entire thing, possibly as a symptom of a personality disorder (like Narcissistic Personality Disorder, or Paranoid Personality Disorder), or a mental disorder (like schizophrenia.) My psychologist insisted that I definitely did not imagine any of it, that I do not have any personality disorder, nor schizophrenia.

And then there's that second nurse practitioner (the guy who I referred to as "Dr. Bal" in this story) who tried to convince me that I was displaying some of the symptoms of schizophrenia and then tried to lower the dosage of Adderall and prescribe me Abilify. And then my psychiatrist was telling me that he was going to stop prescribing me Adderall altogether.

What the hell is going on?

So, yeah... that's a fairly short summary of what's happened so far.

I've called dozens of different numbers of various different places (asking for attorneys' legal advice) only to be told that they don't know anything about any of this, then I get transferred over to other numbers only to get told the same thing, get referred to a bunch of other different places, been hung up on, and so on. At some point I spoke to an attorney who told me that he could only help me if I showed up to his office with all of my medical records and a check of $950 and that I may later pay him up to $1500 or more. My psychologist is refusing to answer my e-mails at this point, he definitely seems to be annoyed with me now. My therapist seems to be likewise too busy or simply ignoring me, I haven't seen or spoken to her in nearly five months.

So I'm left here by myself with my own theories. I've developed several theories, here's only a few of the ones that I have so far:

1. All of this is some sort of really extended, complex, and weird psychological experiment.

2. Sociological experiment maybe?

3. My psychiatrist and the co-workers of his practice are all really bored people and simply enjoying screwing with their patients' heads because they know that their patients can't do anything about it. This whole thing is a twisted prank.

4. My psychiatrist and the rest of the people of his practice are intentionally trying to get me to lose my temper, so that they could say that Adderall is making me aggressive so that they can get me off of it and put me on antipsychotics for the rest of my life.

5. My psychiatrist and the other providers are all just highly disorganized and incompetent.

6. I've been looking at this female nurse practitioner's page (whom I refer to in the story as "Dr. Ude") on the practice's web site, and I see that one of her specialties includes “sex therapy” (which I realize isn't really what it sounds like.) However, I am aware of such a thing called “Surrogate Partner Therapy”, but that it's not exactly legal in many jurisdictions. So maybe they try not to make it too obvious and hope that the patients figure it out for themselves and keep this knowledge to themselves.

6. I also see on Dr. Ude's page here that she had apparently been exposed to chronic pain along with various co-morbid psychological conditions. This makes me wonder if she had been diagnosed with some sort of personality disorder, such as Histrionic Personality Disorder. And now her practice are trying to back up her side of the story by making me seem crazy.

I was hoping that KyoZero could help me with this, but he also seems too busy. I don't know how many of you here read this whole story... but, uh, yeah. There it is.

So, uh, nobody thinks any of this is strange? At all?

originally posted by: andy06shake
I just gave permission for my little girl to be tested here in the UK because she was misbehaving in class and apparently she may be autistic because she blinks to much and when asked to play with dolls she did not do so in the prescribed manner.

Not received the full 7 page report yet as it apparently needs to be amended but suffice to say i will be seeking a second opinion!

How old is your little girl?

A few months ago I attempted to contact various different geneticists, but I was told by most of their receptionists that I would not be able to get my DNA tested for any genetically inheritable diseases and/or disorders (such as anything within the "autism spectrum", the "schizophrenia spectrum", Alzheimer's disease, or personality disorders like Antisocial Personality Disorder) because I'm an adult, and these sorts of tests are done on pregnant women and/or small children. I don't know if in the UK you'd be able to get a geneticist to run a DNA test on your daughter to look for any chromosomal abnormalities that would be indicative of autism. Maybe they'll be able to find some form of "empirical evidence" to support the hypothesis that your child is autistic, something with more scientific rigor than the purely anecdotal evidence that is observing someone's blinking.

A few months back I paid about $100 to get Ancestry.com to take a saliva sample from me for DNA, so that they could tell me more about my ancestry. They did tell me about my ancestry, but I was hoping that they could probably also tell me about any genetically inheritable disorders. They did send me over 16,000 pages of the "raw data" of my DNA which I'm having trouble interpreting, so I'm hoping that I'll still be able to get a hold of a geneticist to help me out a bit.

I've also been told of something called "23andMe" which apparently also runs DNA tests, but I'm not sure how useful it will be.