Diagnostic hell.


I’ve always aimed to be completely honest on this blog and hold back nothing, but there’s something I’ve been avoiding talking about for about a week.   Now is the time, and I doubt (and hope!) no one judges me negatively for it.

As most of you probably know, I started this blog because I decided I had NPD (covert, fragile type).  It was self-diagnosed and I set about a nutty regimen of self therapy (some of the stuff worked, some did not).  I got stuck and stopped progressing, and decided to see a therapist.  I found a very good trauma and attachment therapist, who works with people with personality disorders and Complex PTSD (C-PTSD).   Still, he hates labels and refused to give me one.  He prefers treating symptoms over “disorders.”

When I told him I thought I had NPD he said there was no way and he even doubted I had BPD anymore or if I even ever had it at all (I beg to differ and have an official diagnosis for that).   He based this on the fact that I don’t play mind games with him, I don’t manipulate him, and I’m not “difficult.”   I don’t overstep his boundaries or act high maintenance or entitled.   In fact, he’s told me several times that he looks forward to our sessions.  I realize there may be a little counter-transference on his part (which is pretty normal as long as it’s not acted on by the therapist), but I also think I do present myself as someone who’s fairly easy to get along with (and truth be told, I am easy to get along with these days and most people seem to like me, even if I still avoid close contact or deep relationships with anyone).

Finally, insisting on having SOME kind of diagnosis (for some reason, this helps me feel less crazy), he toted out his never-used looking copy of the DSM and we looked through it together.   He told me I didn’t fit the criteria for any personality disorder, but PTSD might be a good fit.  He wasn’t aware of Complex PTSD because it’s not a recognized diagnosis, but when I explained what it was, he said that sounded like what I probably had.   So I got a kind of/sort of diagnosis.  I let him borrow my copy of Pete Walker’s wonderful book about C-PTSD, which he is reading now. (For the record, Walker believes personality disorders are complications of C-PTSD, which provides a kind of template for their development).

That was several months ago.

During our last session, he told me something that sent me back down the rabbit hole, at least for a few days.   As long as I’ve had this blog, I’ve suspected I have covert narcissism, because I feel like there’s this very thin false self I’ve developed–a false self as thin as a piece of aluminum foil, as a friend of mine put it–over my BPD. This thin veneer of narcissism kept my BPD rages and lack of control at bay, and also kept me emotionally numb.   Of course, mindfulness training  helped me maintain control, but I suspected my lack of being able to feel much of anything and this way I have of shutting people out or even rejecting them when they try to get too close was definitely pathological and indicated something a bit worse than PTSD.    Like all cluster B people, I’m all too aware of this vast black hole inside that I’ve built many layers of defense over to avoid having to confront.

So we were talking about my “many layers of defenses” and I asked him again if he had changed his mind and did he think I really had NPD.   This time, he didn’t laugh or deny it.   My heart started to hammer away and felt like it was stuck in my throat.   He stayed silent for a few moments, and finally said something that rocked me to my core.    What he said was he didn’t think I qualified for NPD, but because he knew me better now and had a clearer idea of the defensive structures I’d built over time, he thought the top layer was a narcissistic defense developed to protect myself from the pain of BPD craziness.

He went on to explain the difference between healthy narcissism and pathological narcissism.  While he thinks my healthy narcissism (self esteem) has increased (which is definitely good), he thinks my pathological narcissism is beginning to disappear.   That was good news (and I think he’s right), but his admission that I did in fact have a narcissistic defense (and therefore am on the N spectrum) just confirmed what I already knew.  Even though I’ve known it all along. hearing him say it still upset me so much I burst into tears (this was the first and only time I actually shed more than a few tears in session).   Even though I’ve come to realize not all people with narcissism–even NPD– are terrible, unredeemable people,  I still can’t help but associate the term “narcissism” with something bad and evil.   The stigma is pervasive.   Even “healthy narcissism” has a pejorative feel to it.

I tearfully asked him if he was saying this because he thought less of me than he used to and did he think I was a bad, terrible, evil person.   Was this his way of rejecting me?   Did he think I was hopeless and incurable?  My abandonment terror was definitely triggered.

He smiled sympathetically, and then assured me he absolutely did not think any of those things and his feelings toward me had not changed.   He just knew me better now and could see the way my defensive structures were arranged, which was actually a good thing because it meant he had a better idea of how to conduct our sessions.   He also told me he’d seen a lot of progress in me in the year I’ve been seeing him and that I was one of the most motivated and courageous patients he’s ever had.   “Whatever kind of defenses you have,” he told me, “it’s not a judgment against you.   I have no doubt you are going to be successful in working through them, no matter how painful things might get, because I can see that you don’t give up easily and I can see how much you desire to reconnect with your authentic self, and i can see you are already doing so.” He also told me that he saw no problems with my level of empathy, and probably even had an excess of it.

That made me feel better, but I spent a few days depressed anyway, mostly because he no longer thought I was “perfect” (as in not having a personality disorder) and even placed me on the N spectrum.   I guess that in itself shows my narcissism, because one thing I’ve noticed about myself in therapy (and that might hinder it to some degree) is that I’m always trying to “impress” my therapist with my good behavior and easy to get along with personality (charm).

I hope no one judges me for this, but I’ve never regretted being truthful here, and this is no exception.

At the end of the day, the labels are just labels and don’t define an entire person or their ability to become whole, if they want to badly enough and don’t give up the fight for wellness.


33 thoughts on “Diagnostic hell.

  1. I know you are smart enough to already be aware of this, but I just want to remind you that therapists are human too, and psychiatric diagnosis are very subjective. I have a fifty year old cousin who has been a therapist for over twenty years. He is a brilliant man and an expert in EMDR. But ever since his wife left him about a year ago, he has unraveled so bad that I am very worried about him. Right now, I believe he needs to be in a treatment center. My husband and I have discussed traveling to the state where my cousin lives to do an intervention on him; it’s that bad.

    Also, over the years I have been diagnosed with different labels by different therapists, only to be told by the next therapist that no, I did not have that at all, I had something else. Overall, the general consensus is that I have PTSD, so I have decided that I’m sticking with that one. 😀

    Liked by 1 person

    1. You know what? Psychiatric diagnostics and psychology itself is much more an art form than a science. It’s not even a proper social science. If it’s a science at all, it’s almost as hard to show scientific proof and evidence as philosophy is. Really, when you think about it, psychiatric diagnosis is all about conjecture and opinion.
      Heck, I think I’ll write a little post about this. 🙂

      Liked by 1 person

  2. ‘I guess that in itself shows my narcissism, because one thing I’ve noticed about myself in therapy (and that might hinder it to some degree) is that I’m always trying to “impress” my therapist with my good behavior and easy to get along with personality (charm).’

    This is an interesting insight; how you feel towards your therapist on a deep-down level is often indicative of what’s actually going on; borderline, narcissistic etc. Keep in mind that closet narcissistic disorder (or traits) isn’t an official diagnosis despite the efforts to have it included in the DSM. Only clinicians well read in the psychodynamic approach will know how to spot it. I’ve met a significant amount of folk in BPD forums who are told they are ‘treatment-resistant’ but watching how they describe their difficulties I would suspect closet NPD (or traits).

    What would you like/feel you should be diagnosed with?

    (As everyone’s sending hugs, one’s on it’s way! 🙂 )

    Liked by 1 person

      1. How you write in your many of your posts suggests to me closet narcissism (only because I’m a classic case and certain phrases resonate); the manifest/grandiose/malignant narcissist (‘full blown’) is invested in an inflated self image to keep up their self-esteem, a closet narcissist invests in the ‘object’ to keep up their self esteem ie. wanting to impress your therapist. I could be in an absolute state and still feel I have to do what makes me seen in a good way by the other person, a manifest narcissist wouldn’t give a damn!

        Liked by 1 person

        1. Well, damn. I started this blog because I thought I was one.
          Do you have an NPD diagnosis?
          That’s interesting about the closet/covert investing in the “object” (other) as opposed to the inflated/false self. How does it really differ from BPD then? It seems to me both are quite similar.

          Also, what are the phrases you see me using that suggest closet/covert narcissism? I’m curious.


      2. Diagnosed NPD and BPD but after I read this (link below) it changed everything and upon delving into Masterson, Kohut etc. I found what has been wrong all my life. I can’t think off the top of my head the things that resonated but you come across as more worried of rejection (not being seen in a good way) than abandonment, how you react to things etc. don’t suggest to me borderline, but as I say I’m no expert and I don’t know you. There’s also the fact that dealing with trauma/shame produces the same defences/worries and it doesn’t have to mean you qualify for a PD at all.


        Liked by 1 person

        1. The shame is what both BPD and NPD boil down to, at their core they are the same. Just different defense mechanisms that sometimes overlap. But I get what you’re saying, I do seem more afraid of “rejection” or “judgment” than “abandonment” although I fear all of them. It makes sense. I’ve seen a lot of therapists in my life, off and on, and don’t know what most of them even diagnosed me with. With others, I have acted much more narcissistic a/o borderline than I do with my current one, and I used to be rather mean to them and play games with them too. For all I know I might have been diagnosed with NPD by one or more…but never cared to find out at the time. At the end of the day, it doesn’t matter because it’s just a label.

          Thanks for the link and I am familiar with Masterson, Kohut and Kernberg’s theories; I found Masterson the most understandable and relatable as a “lay person”–eg, less scholarly than the others. I’ve read most of Masterson’s books and learned a lot about both NPD and BPD. I’ve read Alexander Lowen too — he actually thinks borderlines are on the N spectrum (and I wouldn’t argue with that ). I think all narcissists are actually borderlines under their “controlled” exterior/false self. When a narcissist starts to get better, and the false self begins to be stripped away, they can start acting a lot more like someone with BPD. The reverse though, is not the case — not all (or even most) borderlines are narcissists.

          Have you ever read BPDTransformation’s blog? Heno longer posts in it, but he was highly educated about BPD (he was diagnosed with it) and came to believe it’s a bogus diagnosis. I don’t really agree with that, but his articles really make you think.


  3. In my four years of writing about mental health issues on my the blog I don’t think I’ve ever had anybody who needs to read my blog as much as you do please understand there there’s so much to it with diagnosis and understand gonna go check on my blog and read the cover page and let’s communicate

    Liked by 1 person

  4. As a matter fact if you do in fact take the time to read it I would like you to give me permission to use you as an example of what labeling can do to people and how deep that can affect your daily thinking. Maybe the information I have and I’ve learned as a social worker and mental health worker can help you while you can help others see how harmful it can get to be assigned labels or convince yourself you have a certain label . I hope you’re aware that the entire DSM V and all the labels in it and disorders are completely made made-up. Purely the work of a few hundred doctors getting together every 4-5 years and tossing their latest name for a disorder in the hat. . They vote. If it’s in it or not. Not one bit of scientific evidence for any of them. What should the people make them up are a group of anonymous psychiatrist every five years or so there’s a lot more to it than people think so check out my blog don’t label my kid

    Liked by 2 people

    1. Interesting. Sure, I’d like to talk more about this , I’d be interested if you want to use my story as an example, even though I’m not particularly bothered by it. I agree with you about the labels being made up though. And they change every few years.

      Liked by 1 person

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