Diagnoses and Psych Evals: do they even help?

[adoptivemama]

Hi Again,

I'm struggling with whether to even get a comprehensive psych eval for my 19 year old daughter now. Her intensive outpatient doc said that she "probably has BPD" and I know that she fits the bill perfectly, but I can tell as I interview the docs that I would be able to go to for a more comprehensive eval through our insurance that they don't like to diagnose young people with this disorder. A wimpy and incorrect diagnosis seems even less helpful than no diagnosis. Don't you agree?

Ugh.

Adoptive Mama

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[flourdust]

A BPD diagnosis may or may not be helpful. Does she have any diagnoses right now? One advantage to certain diagnoses is that they open the door to insurance-covered mental health care. Some insurers won't pay for a personality disorder diagnosis, but a diagnosis of depression or anxiety (often comorbid with a PD) is covered, so you can get therapy through the side door, so to speak.

[adoptivemama]

Thanks Flourdust. I was thinking how good it would be to get a full eval, but then I realized  that if they are the sort of evaluator that shys away from diagnosing teens/young adults with BPD it would really be a setback, because my daughter would probably think that she's ok without DBT. So far my insurance is paying for therapy and DBT, because it has been recommended by the first evaluator who is associated with my insurance (Providence) but is not committing to a diagnosis. He says that she's likely to be BP but he doesn't seem willing to put it down on paper. But at least he seems to think that's what she has. If some other expert does a bunch of testing and then says to her that the first guy was wrong, I think it would be very damaging.

[wendydarling]

Hi adoptivmama

As flourdust asks, are you able to share her current diagnosis with us? That may help, further advice.  

WDx

[adoptivemama]

She has PTSD and Depression diagnosed in writing and the intensive outpatient treatment program that she was in told her that she had BPD. They didn't write it down anywhere, to my knowledge, so I've looked into having a more thorough diagnosis that I could have a copy of. My daughter is 19, but she is not very high functioning. She has delays and a lowish IQ. I'm scared to have her rediagnosed because I know from my work as a social worker how reluctant docs are to give a young person a BPD diagnosis. I don't want her to be tossed about by many changing opinions.

[wendydarling]

Hi adoptivmamma

I understand your dilemma.  Does your daughter accept she has BPD as she was told, even though it's not in writing? As she is an adult she's entitled to the truth, what do you think is driving the reluctance to diagnose you describe, if it's not to ensure you gain the treatment through insurance?

WDx

[adoptivemama]

Yes, so far my daughter does accept the diagnosis. If we were to ever need it in writing to get her services or housing, I'm afraid we would not have it. I've gone ahead and scheduled a thorough eval through our insurance to see if we can get something in writing. It could easily backfire since many docs don't like to diagnose young people with BPD.

[wendydarling]

AM  

Good for your DD so far she accepts and you've gone for a full evaluation, my DD and I did that too.

My approach has been bottom up approach, health care first.

WDx