Dire Consequences Of Unchallenged Diagnostic Labels

‘Angela’ lost access to her 3 children, because a psychiatrist said she had an ‘Emotionally Unstable Personality Disorder’. When challenged he claimed 4 other clinicians had said the same! It is a classic example of the dire consequences of ‘sticky labels’, the passing on of a diagnosis without rigorous critical appraisal.

In submission to the Court I challenged the psychiatrist’s diagnosis thus ‘he seems unaware of the operation of ‘Diagnosis momentum: once diagnostic labels are attached to patients they tend to become stickier and stickier. Through intermediaries (patients, paramedics, nurses, physicians), what might have started as a possibility gathers increasing momentum until it becomes definite, and all other possibilities are excluded’ [ Crosskerry, P (2003) The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78, 775-780]. Further the category of Emotionally Unstable Personality Disorder, Borderline Type is never used for research purposes, because to my knowledge there are no studies of its’ reliability [i.e the level of agreement (kappa) amongst a group of clinicians independently viewing the assessment of the same person] instead use is made of the comparable Borderline Personality Disorder in DSM-5 which has very explicit diagnostic criteria and requires assessment of each symptom in a criteria set, in my book Towards a Mental Health System That Works (2017) London Routledge I reviewed evidence that the kappa for DSM defined Borderline Personality Disorder is 0.54 making it a reliable set of symptoms, further when I assessed ‘Angela’ using the DSM criteria for Borderline Personality Disorder she did not meet the criteria’.
In the event the Expert Witness appointed by the Court agreed with me that the psychiatrist had got it wrong, and neither he or his like-minded clinicians had utilised agreed criteria. But all this did not happen until Social Services looked at ‘Angela’s’ behaviour entirely through the lens of Emotionally Unstable Personality Disorder depriving her of a family life.

Dr Mike Scott

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