Are Mood Disorders Actually Personality Disorders?

Anyone who has spent time with the DSM knows how many diagnoses psychiatry recognizes. In practice, though, only a handful get used with any regularity: Major Depression, Bipolar Disorder, and Schizophrenia. Major Depressive Disorder has quietly faded from the conversation. Most of the people moving through the mental health system walk out labeled bipolar, with Schizophrenia showing up now and then. A case of ordinary clinical depression tends to get folded into bipolar depression, or bipolar type 2. What I want to look at here is whether these mood disorder labels are being handed out in place of personality disorders, conditions that might respond to therapy rather than pills, and whether insurance billing is part of why that happens.

Think about the diagnoses that used to come up often and rarely do now. Asperger's, a higher-functioning point on the Autism Spectrum. Borderline Personality Disorder. Decades back these were named regularly. Today you mostly hear about them inside therapy circles, if at all. So what do you do when the label pinned on you is a mood disorder you may not even have?

The medication question is where the two diverge. A genuine mood disorder usually does call for medication, at least for a while, and the drugs tend to actually work. Give that same prescription to someone whose real problem is a personality disorder and you get a coin flip. Maybe it dulls a symptom or two. Maybe it does nothing, because it is aimed at a mood disorder that isn't there.

Part of the problem is time. Doctors today are squeezed by pharmaceutical pressure and hospital throughput, and a careful diagnosis is not something you can rush. In a psychiatric hospital, the average physician gets about five minutes with a patient. You cannot know what is actually wrong with someone in five minutes. You have to get to know a person before you can sort out the right diagnosis and the right path forward.

The other half is on the patient. Someone willing to commit to real self-development, to working the steps of an Emotions Anonymous group and genuinely getting to know themselves, can make progress a prescription pad won't. That work usually means finding a counselor who specializes in mental health. A personality disorder diagnosis may surface here, and while it may carry less official weight coming from a psychologist rather than a psychiatrist, the psychologist can still help you work through the underlying issues toward some kind of emotional wholeness.

Trauma and Genetics

A lot of personality disorders trace back to childhood trauma, or they run in families. Asperger's is a good example of the social and developmental kind. The person may struggle with social skills and with certain parts of intellectual development, and others might read them as slow. Often what sits underneath is a lack of confidence, which gets worse when the individual is actually quite intelligent and simply cannot find common ground with the average person around them.

Triggers and Emotion

An accurate picture requires the patient to take what the recovery language calls a fearless moral inventory and then do some hard personal work. You have to learn your probable underlying issues and your triggers. Doing that raises your emotional intelligence, and people with higher EI tend to bounce back from life more easily because they understand the basic psychology of what makes them react. Commit to that growth and the triggers stop being invisible. The next job is learning to manage them. People who train their minds build a stronger cortex, and that is a big part of what makes them resilient when life gets hard.

Repression

Mental illness, at bottom, is repressed emotion. A person with higher EI has found healthier ways to let those emotions out, which is how they avoid needing medication for the rest of their life just to hold the symptoms down. Symptoms are all the medication ever touches. Drugs manage; they don't cure. The actual healing goes to the people who stay proactive about their own growth.

Diagnosis

Personality disorders rarely get diagnosed anymore for a simple reason: therapy alone handles most of them. They tend to stay invisible until someone lands in a psychiatric hospital, and at that point the label is almost always a mood disorder. The money reinforces it. Insurance pays well for the psych drugs that treat mood disorders, and those drugs do little or nothing for personality disorders.

Both categories are, when you get down to it, labels. Look closely and the symptoms overlap more than the names suggest. From a holistic view, a single underlying issue could be behind everything going wrong in a life, and it might be a personality or developmental disorder, or a mood disorder. It might not be a mental illness at all. Chronic pain, for instance, is purely physical. But once the mind-body connection makes sense to you, the line between mental and physical blurs anyway, since it all begins in the mind. Only Western allopathic medicine split the two apart, and usually it did so for profit.