Okay, I will ignore that huge elephant in the room. LOL
Me too, for now.
Thank You, Herding Cats. I've learned from you to not take such a simple view of diagnosis. In your initial post about the axis, you mentioned Borderline Personality Disorder, BPD. Where does that fit in with your explanation - is it in the same category as NPD or AS? Then, there's the Cluster traits. Where do they come in to the diagnosis? I was trying to make some kind of visual chart for myself, and didn't know where to put those. No wonder people want to cut to the chase and just say "he's a Psychopath".
Isn't it easier? LOL.
It's easier, in my head, to think about Axis 1 and 2 as together:
Axis 1 schizophrenia, axis 2 cluster A (eccentric, paranoid beliefs)
Axis 1 bipolar, axis 2 cluster B ("All about me")
Axis 1 depression, axis 2 cluster C (OCD, fearful, dependent)
Cluster B disorders are tagged with "all about me"...it's all personally driven, it's all about the person who has the disorder. According to the DSM-IV/TR (latest edition of the book used to diagnose mental illnesses), the characteristics of AS are:
~Failure to conform to the norms of society (e.g. breaking the law)
~lying, manipulation, and/or conning for personal gain
~failure to plan ahead, impulsivity
~irritable, aggressive
~consistent financial irresponsibility
~careless disregard for safety of self/others (mostly others)
~lack of remorse, rationalizing away others' feelings
1. Conduct disorder before age 15
2. Diagnosis cannot be made until after age 18.
3. Antisocial behavior occurring outside of a schizophrenic or manic episode.
So, now let's look at BPD (Cluster B):
~frantic attempts to avoid real or imagined abandonment (may be violent in nature)
~intense, unstable relationships formed and lost repeatedly
~impulsivity
~recurrent threats, gestures, or actual suicidal behaviors (with intent, usually related to an abandonment)
~self-injury (picking at skin, suicidal attempts, headbanging, punching walls)
~inappropriate anger, inability to control anger, explosive rage
~stress related, transient paranoia, psychosis
~Identity disturbance
Please note that it takes many of the characteristics, happening over a period of time, to develop a diagnosis. And also, there are a lot of overlapping areas between all the Cluster B criteria (as you can see by those above).
If one looks at JAG, several of these criteria are met:
AS:
Lying, conning, manipulation
Careless disregard for others
Irritable, aggressive
Impulsivity
Lack of remorse
BPD:
Intense unstable relationships
Impulsivity
Inappropriate anger (recall the argument with the relative)
Identity disturbance (recall the radical weight changes)
Background for JAG which contribute to the BPD thought is percieved or real abandonment by his father, real or percieved abandonment by his mother, real or percieved abandonment by his girlfriend/mother of his children. The last also goes to the intense, unstable relationship aspect. Inappropriate anger, apparently, has been part of his makeup for a while - he was diagnosed as an SED child, which is often based on a violent emotional reaction/outburst. And we can't ignore the hospitalization when he was a child; it was probably involuntary, which means that he posed a danger to self/others; we also know he was diagnosed with bipolar and took lithium to control that but stopped after the s/e developed. We do not know if he was given any other medication, or if he simply stopped taking the drug on his own (which often happens...).
What we don't know is when the bipolar diagnosis was made, was it 1 or 2, and for how long he was hospitalized (different lengths of time will tell me a lot about the legal aspects of his illness...). What we do know is that one psychiatrist advocated the strongest possible sentence, and warned JAG would continue the behavior if he was released, while a different psychiatrist said completely otherwise.
"Duelling shrinks" are not uncommon in the legal end of things...what is uncommon is that a judge did not split the difference, and sentence JAG to a longer sentence (but not the longest one). Further, it's interesting to note that JAG did not get a civil commitment post sentencing.
How diagnoses are made is difficult. There are a lot of interviews, meds, and a lengthy history taken, all which point to what it should be. Some people come in very clearly psychotic; others come in appearing to be normal and fine. Some folks don't tell you the truth when it comes to the history, so families are called; most families are willing to give information, but some are not. If this is a new hospital/dr the patient comes to, there is no previous history to work from. It can be a bit difficult to accurately diagnose right off the bat, and things are compounded when no-one wants to talk about it.
In essence, the diagnosis for Axis 1 is relatively clearcut. Schizophrenia, Depression, and Bi-polar are the three catagories; if there isn't a clear one, it's 'psychosis NOS', meaning not otherwise specified. Then cluster A, B, or C (Axis 2) traits are identified, through oral histories from patient, family, friends. Hopefully, any medical history (Axis 3) has been gotten already (e.g. diabetes, hypertension, and so forth), and Axis 4, the psychosocial support is determined; then the Global Assessment Functioning (Axis 5) is done, which yeilds a numerical score. If you're in society, your score is likely 68 or above. Below, and you tend to be unable to care for yourself. I've seen patients with scores of 12 and 15 while they were acute, but who rose to the 50s and 60s once medication was properly administered and enough psychotherapy was done.
There is a lot of putting the pieces together, a lot of observation, and a lot of talking/listening (and knowing what you're hearing...two different things) that has to happen for an accurate diagnosis.
Good grief, I wrote a novel. Sorry. As you can see, this is a fascinating topic for me...
Best-
Herding Cats
