Having worked with children and adolescents for over 6 years I find that each and every one of their family members either mention that they do not believe a diagnosis is correct or mention that they absolutely hate diagnostic labels. With high levels of stigma, social pressure, cliques in workplaces, school, and communities, and media portrayals can you blame them? If you are someone who has received a psychiatric label what were your thoughts at the time and how did you cope with it? Many of my clients often disregard the label and act as if it doesn’t exist, defy treatment recommendations, or accept the diagnosis but become buried in deep depression. This article will discuss the labels that clients often have trouble with to emphasize their challenges and their emotions.
Most people would agree that most diagnostic labels and terms seem to do more harm than good. While this is true, we must keep in mind that labels provide a compass to professionals who are providing mental health care and even medical intervention(s). For example, if a patient ends up in the emergency room of a medical center because of a drug overdose, the medical professional needs to be able to collaborate with a mental health professional who can lend insight into why this patient overdosed. Perhaps the patient is going through a divorce and wants a way out. or perhaps this patient is struggling with post traumatic symptoms. A mental health professional who can tell the medical professional that the patient has been in therapy for over 25 years struggling with depression can lend a lot of insight to the medical professional. Labels help professionals speak a common language and figure out how to treat a patient in need. But for many clients in therapy, labels can truly affect one’s self-esteem, identity, and overall level of comrade with their therapist. Many of my own clients have discussed the negative feelings clients have discussed with me about how they feel about being labeled. Some of the labels they struggle with include but are not limited to:
- Borderline: It’s unfortunate but many clients are labeled “borderline” before they ever receive a formal diagnosis. One reason for this is some client’s who present to clinicians as emotional, dramatic, self-injurious, and suicidal, often come across as needy and clingy. Family members, friends, other patients in the waiting room, and even some clinicians will label these people borderline and prejudge the behavior and feelings of the client before considering a formal diagnosis or course of treatment.
- Manipulative: Some clients are also labeled manipulative if they frequently need others to step in and make decisions for them, ask for favors, or seem to always be out to get something. It is a known fact that some clients are simply needy or clingy because of a history of neglect, abuse, or trauma. It is also not helpful for clients to be labeled manipulative by their own families. For example, many of my young clients are brought to therapy, often against their will (parent brings them or they are court ordered), and told that they are manipulative and oppositional and need therapy.
- Schizophrenia and other psychotic disorders: Research suggests that African Americans and Latinos are more likely to be incorrectly diagnosed as psychotic in clinical settings. It is also a known fact that African Americans are less likely that Caucasians to seek mental health treatment. This means that clients are likely to present to clinicians as “worse off” or “more ill.” However, research points more to racial disparities and discrimination as being the culprit for African Americans being diagnosed as psychotic. Even more, African Americans are more likely to receive lower quality of care or no specialized services. Even more, we have to consider the psychological and emotional affect that labeling someone psychotic has on not just the client but on the client’s loved ones.
- Post Traumatic Stress Disorder: When I worked in a school based mental health program where adolescents were adjudicated delinquent and court ordered to therapy, I noticed that many of those kids (primarily kids of a lower socioeconomic status and ethnic culture) were labeled with post traumatic stress disorder. Why? Because many of these kids came from poor countries or neighborhoods and witnessed a shooting of a loved one or friend, a murder, or some other crime. These kids would leave the school based program and be court-ordered to attend more therapy because of a diagnosis of PTSD. Many of these kids were not “traumatized” and did not need to spend months trying to “explore” their “trauma.”
- Personality Disorders: I also experienced juvenile delinquents being labeled, more frequently than other kids in different clinical settings such as outpatient clinics, narcissistic or a scociopath. These labels are very damaging to young clients. Most kids in juvenile detention settings grow up in impoverished households or neighborhoods and learn to survive by developing a “thick skin” or becoming indifferent. It’s their only survival mechanism in many cases. Just because a kid has developed a “thick skin” does not mean they are narcissistic or sociopathic. We must be careful with these terms. Family, friends, and professionals should use these terms wisely.
- Reactive Attachment Disorder: Having worked with children and adolescents who are struggling with behavioral problems in the home, school, and community due to a severe trauma history, I have seen my fair share of kids labeled with RAD – Reactive Attachment Disorder. RAD is a diagnosis that is rarely given by mental health professionals. However, some kids receive the label informally by a therapist who strongly believes the child is struggling with appropriately “attaching” emotionally to his or her parent/guardian. A child who has been adopted into another family is often labeled with RAD. This diagnosis can truly harm a child or adolescent who may have been moved from foster home to foster home or shelter to shelter and simply cannot trust anyone. It is very sad for me to hear an adopted parent tell me that their child is RAD despite being given this diagnosis formally.
- Obsessive Compulsive Disorder: I’m sure you have heard random people throughout your day say “I am OCD, sorry.” This is the new “fad” for many people who have seen the TV show My OCD Life. Not only do adults claim they have OCD because they are health conscious, rule oriented, or clingy with their hand sanitizer, but so do children and adolescents. According to the International OCD Foundation, between 2 and 3 adults in the United States have OCD. It is becoming a prevalent disorder. We must be careful in how we use this label and when.
As you can see, labels are not only hurtful but destructive to one’s self-concept, self-esteem, and ability to move forward. I encourage you, if you are a friend or family member, to be mindful of how you discuss your loved one’s diagnosis and what you say. You certainly do not want to feel like you are walking on eggshells but you do want to be sure to be sensitive to how your loved one feels about their diagnosis.
What has been your experience with labels? How do they make you feel?
As always, I wish you well
International OCD Foundation. (2016) Who gets OCD? Retrieved on 1/4/2016, https://iocdf.org/about-ocd/who-gets-ocd/.
MedScape. (2016). Schizophrenia may be over-diagnosed in Black patients. Retrieved on 1/2/2016 from, http://www.medscape.com/viewarticle/768391.
NAMI. (2016). Schizophrenia. Retrieved on 1/2/2016 from, https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia.