Took DD to a neuropsych eval…. Was diagnosed with a personality disorder instead

[Anonymous]

DD (21 years old) is currently taking a year off from college (has five semesters under her belt at UVA in a scholarship program FWIW). I’ve long suspected that she has ADHD/ASD, as she has many symptoms:

- Inability to focus on things that don’t interest her
- Has never had close friends…. Sometimes has one or two friends who she intensely pursues but usually turns them off from her intensity and her desire to be “best friends”
- Adding on to the second point, DD has never been in a friend “group” and has never done well in group activities (hated team sports as a kid, as well as church youth group and Girl Scouts)
- Inflexible, rigid mind that doesn’t easily compromise -- DD has a lot of "black and white" thinking
- Extreme rejection sensitivity; tends to see herself as a victim quite frequently
- Suffers from executive functioning problems, has bad time management skills
- Bad at regulating her emotions and interacting with others, as well as making eye contact
- Seems very extroverted and talks to others easily but is so in a rush to contribute to conversations that she doesn’t listen to what others say, or pause to think if what she’s saying is appropriate
- Misses social cues
- Has long struggled with severe depression and anxiety
- Frequently binge eats (DD is 5’6’’ and 160 lbs)
-Seems behind in maturity compared to her peers

DD has never been tested for ADHD or ASD because my husband (Taiwanese immigrant) doesn’t believe in neuropsychological evaluations. The Asian stigma against these things is real. However, this past winter, DD’s depression got so severe that in January, she took a year-long leave of absence from college. She has been working a retail job in the meantime and going to therapy, but she only got a neuropsych evaluation a few weeks ago because it took three months to get off of the waitlist.

The neuropsych (a well-respected one that was commonly recommended on DCUM) told DH and I that DD does not have ADHD or ASD. Instead, she told us that DD has both Narcissistic Personality Disorder and Borderline Personality Disorder.

I asked the neuropsych what led her to diagnose DD with not just one, but TWO different Cluster B personality disorders. She told us that DD is a “vulnerable” narcissist (also known as a covert narcissist), and that explains her social difficulties. She also mentioned that the binge eating is a symptom of Borderline Personality Disorder. She referred us to a therapist in DC who specializes in personality disorders, and she mentioned that we NEEDED to get her in expensive, specialized therapy for Narcissistic Personality Disorder or else DD has a good chance of ending up as a “Failure to Launch” case.

DH thinks that this is fear-mongering, and that there is no chance that DD is a narcissist. I definitely think that the neuropsych is unnecessarily scaring us into seeing this other expensive therapist, and that she’s using the scary future of ending up as a “Failure to Launch” to get DD to therapy.

I don’t know what to think. For the past week, my world has been thrown upside down. Has anyone else been in this situation?

[Anonymous]

This is not adding up to me. My DD is still in middle school but she has never been given any tests during her neuropsych testing that would even allow for those diagnoses.

Has your DD seen a psychiatrist or psychologist in the past for her depression?

Btw I don’t think 5’6 and 160 is at all alarming. What makes you think she’s binging?

[Anonymous]

If you’re uncertain about the diagnosis then seek another opinion. If you think this therapist might be helpful then go see them. A diagnosis one way or the other isn’t going to change who your child is.

[Anonymous]

Anonymous wrote:If you’re uncertain about the diagnosis then seek another opinion. If you think this therapist might be helpful then go see them. A diagnosis one way or the other isn’t going to change who your child is.

OP here. You have a good point, and we're planning on meeting with the psychologist who specializes in personality disorders to really see if DD has BPD/NPD. I do think that a diagnosis isn't going to change DD, but being diagnosed as a narcissist is not pleasant for any parent, to say the least.

[Anonymous]

Anonymous wrote:This is not adding up to me. My DD is still in middle school but she has never been given any tests during her neuropsych testing that would even allow for those diagnoses.

Has your DD seen a psychiatrist or psychologist in the past for her depression?

Btw I don’t think 5’6 and 160 is at all alarming. What makes you think she’s binging?

They don’t typically diagnose personality disorders in people under 18, so I wouldn’t expect them to do any testing for those in a middle school neuropsych.

[Anonymous]

I too see lots of red flags for autism in your description. Does the evaluator have experience with autistic girls? I would only trust Dr. Henderson at Stixrud or Dr. Black at CAAT.

[Anonymous]

This is very strange, OP, because:

A. All the symptoms you list are classic, textbook cases of ADHD/ASD;
B. You can have ADHD/ASD WITH personality disorders! My son has ADHD/ASD, and my husband clearly has narcissistic traits with his ADHD/ASD. The former is a lot more pleasant to live with than the latter...
C. This matters, because even though there are underlying disorders that cannot be treated easily, and which will cause problems throughout her life, you can treat the ADHD with meds, and enroll her in social skills groups, or targeted therapy for the rest.

I would re-read the written report and bring it to a different psychologist, in a different practice, and have them do a special intake based on the existing report and your observations. This is worth paying extra for. Perhaps first see if the first practice is open to a re-examination of the results of the tests by a different psych on staff, based on your contesting the result.

Regarding some cultures' resistance to psychiatric diagnoses. Some people are more progressive than others. I'm Asian, but well integrated in Western culture. My husband's family kept to their community of origin when they came here and he was extremely resistant to evaluating our son until I had a fit and told him I'd pay for it regardless of his thoughts on the matter. Then my husband was diagnosed by a psychiatrist, but refused to take ADHD meds (even though they worked well for our son).

Hang in there, OP. It's going to be tough for a while.

[Anonymous]

Anonymous wrote:I too see lots of red flags for autism in your description. Does the evaluator have experience with autistic girls? I would only trust Dr. Henderson at Stixrud or Dr. Black at CAAT.

Yes, we went to a neuropsych who specialized in women.

[Anonymous]

Anonymous wrote:This is very strange, OP, because:

A. All the symptoms you list are classic, textbook cases of ADHD/ASD;
B. You can have ADHD/ASD WITH personality disorders! My son has ADHD/ASD, and my husband clearly has narcissistic traits with his ADHD/ASD. The former is a lot more pleasant to live with than the latter...
C. This matters, because even though there are underlying disorders that cannot be treated easily, and which will cause problems throughout her life, you can treat the ADHD with meds, and enroll her in social skills groups, or targeted therapy for the rest.

I would re-read the written report and bring it to a different psychologist, in a different practice, and have them do a special intake based on the existing report and your observations. This is worth paying extra for. Perhaps first see if the first practice is open to a re-examination of the results of the tests by a different psych on staff, based on your contesting the result.

Regarding some cultures' resistance to psychiatric diagnoses. Some people are more progressive than others. I'm Asian, but well integrated in Western culture. My husband's family kept to their community of origin when they came here and he was extremely resistant to evaluating our son until I had a fit and told him I'd pay for it regardless of his thoughts on the matter. Then my husband was diagnosed by a psychiatrist, but refused to take ADHD meds (even though they worked well for our son).

Hang in there, OP. It's going to be tough for a while.

OP here. Good suggestion. I will look into this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you’re uncertain about the diagnosis then seek another opinion. If you think this therapist might be helpful then go see them. A diagnosis one way or the other isn’t going to change who your child is.

OP here. You have a good point, and we're planning on meeting with the psychologist who specializes in personality disorders to really see if DD has BPD/NPD. I do think that a diagnosis isn't going to change DD, but being diagnosed as a narcissist is not pleasant for any parent, to say the least.

I get that it’s difficult but treat it like a preliminary diagnosis until you know more. Use it as a bridge for getting more information rather than focusing on the label. Nobody ever has to know what diagnosis she has unless you tell them. Even future doctors can’t have that information unless you choose to share it. Read up on the diagnoses and see if you notice things that do or don’t fit and talk to the therapist about your concerns.

[Anonymous]

i have an audhd boy and i see how the asd traits mixed with the rejection sensitivity dysphoria could come across as NPD or BPD and maybe they could even become that or are that... it's very very hard to parse all these things out.
I would get a second opinion if i were you. the difference would be if the evaluator thinks your dd can absolutely turn on the charm if needed and has social fluency, but doesn't want to. npd is notorious for being socially fluent as needed.

[Anonymous]

Get a second opinion! Also what does your daughter think?

[Anonymous]

This sounds off to me as well. Did they consider PDA as well?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re uncertain about the diagnosis then seek another opinion. If you think this therapist might be helpful then go see them. A diagnosis one way or the other isn’t going to change who your child is.

OP here. You have a good point, and we're planning on meeting with the psychologist who specializes in personality disorders to really see if DD has BPD/NPD. I do think that a diagnosis isn't going to change DD, but being diagnosed as a narcissist is not pleasant for any parent, to say the least.

I get that it’s difficult but treat it like a preliminary diagnosis until you know more. Use it as a bridge for getting more information rather than focusing on the label. Nobody ever has to know what diagnosis she has unless you tell them. Even future doctors can’t have that information unless you choose to share it. Read up on the diagnoses and see if you notice things that do or don’t fit and talk to the therapist about your concerns.

The concern isn't so much that personality disorders were found... it's possible, given the description. They are quite common in the general population, it's just that people usually don't get the relevant tests done and don't know they have them. The problem is that the psych IGNORED the very obvious (to us) signs of ADHD and autism. It's a glaring red flag that the psychologist may be completely off base on everything.

OP needs a second opinion, not from the same office, because treatment will be very different!

[Anonymous]

Treatment for whatever this young woman really has, that is.