Twenty Questions To Get You Started, Part 3

Am I Okay?
by Michael B First, M.D., Allen Frances, M.D.

(Page 3 of 4)

Question #10: Is your personality more of a liability than an asset? Do you have patterns of thinking or behavior that keep you from getting what you want or what you need?

All of us have a personality — a way of viewing the world and ourselves, a style of relating to others, and of pursuing our goals. To a large extent, our personalities determine our fate and create expectations about the world that usually become self-fulfilling prophecies. The way we perceive and act toward others strongly influences the way they perceive and act toward us.

The question here is whether one's personality functioning is so inflexible and maladaptive that it can be considered a personality disorder. Do you find that no matter how hard you try to do things differently, you keep falling into the same patterns — the same type of unsatisfying relationship, the same battles with authority figures, the same unfulfilling jobs? Do your personality traits lead to the same vicious cycles? For example, if you are unreasonably suspicious and expect to be disliked, you are indeed likely to act in a way that will turn people against you. If you are excessively dependent and terrified of abandonment, your clinging behavior may well provoke the rejection you so greatly fear. If you excessively control others on the assumption that they will never take the initiative, your micromanagement will itself paralyze their ability to act independently. Finally, excessive demands that people praise you are more likely to result in losing rather than gaining their recognition.

Most people have more difficulty answering this question than any of the other nineteen. Unlike symptoms, which are experienced as unwanted and external to the self, most people remain pretty much unaware of their personality traits because they are experienced as so much an essential part of themselves. It is in the nature of things that your personality traits are probably much more evident to the people you live and work with than they are to you. If you have people in your life whose opinion and good will you trust, it may be helpful to ask them how they experience your personality.

If the Answer to This Question Is Yes, Please Refer to Chapter 10.

Question #11: Have you gone from doctor to doctor with concerns about physical symptoms, your physical health or appearance — without receiving enough help or reassurance?

This question is for people who have recurring physical complaints that cannot be explained by the presence of a medical disorder. This can take several different forms: preoccupation with physical symptoms (e.g., occasional skipped heartbeats, dizziness, pain, or constipation); the belief that one has a serious physical illness; or exaggerated concerns about appearance.

Paying adequate attention to bodily sensations can be an important ingredient in the early identification of illness but some people become hypervigilant about bodily functioning. They spend inordinate and unproductive amounts of time and money in a futile attempt to get to the bottom of every ache or pain. Sometimes visits to multiple doctors may be necessary in the diagnosis of particularly complicated or unusual physical problems. However, if you have been to many doctors, had dozens of tests, and have been frustrated by being told that there is nothing physically wrong, you should consider that these symptoms may be indicative of mental disorder.

Other people become preoccupied with the idea that they are suffering from a serious illness despite being told that there is no cause for concern. A person may interpret a headache as indicating a brain tumor or that fatigue and frequent colds mean a diagnosis of AIDS. No matter how many doctors say that there is nothing to worry about, the person assumes that the medical workup is incomplete and will not end the search until his or her worst fears are confirmed.

Finally, most people are less than thrilled with their physical appearance but more or less manage to come to terms with how they look. In contrast, some people's lives come to revolve around the conviction that something is really terribly wrong with their appearance. They remain unspeakably hideous in their own eyes, despite reassurances from others that these concerns are exaggerated or completely unfounded.

If the Answer to This Question Is Yes, Please Rear to Chapter 11.

Question #12: Do you have trouble controlling your impulses?

From time to time, even the most disciplined person might have a lapse or two in resisting an impulse. The question here is whether you have a pattern of difficulty controlling your impulses that gets you into trouble. Has gambling become the center of your life, interfering with your work and relationships? Do you have a pattern of destructive violent outbursts that are far out of proportion to any provocation? Do you have impulses you can't resist to steal things you don't really need? Do you get a thrill setting fires? Do you have an impulse you can't control to pull out your hair? Are there other impulses that you are having trouble resisting — drug use, binge eating, sexual desires?

If the Answer to This Question Is Yes, Please Refer to Chapter 12.

Question #13: Do you have the strange experience of feeling disconnected from your memories, from yourself, or from the outside world?

Some people develop amnesia for psychologically traumatic events in their past. Are there particular events or discrete periods of time in your life that you cannot recall anything about? Do you sometimes feel as if you were in a dream or a movie, or as though everything around you is unreal? How about feeling like your body is unreal or that you are like a robot? Have you felt like you don't have a coherent sense of your identity? The most extreme manifestation of this would be your feeling that you have multiple personalities that take control of your behavior.

Of course, memory is fallible and not everyone feels totally integrated in identity every minute of every day. Do not answer "yes" simply because you cannot remember all of the details of your childhood — nobody can. Moreover, it is perfectly normal to have occasional periods of feeling "spaced out" or feeling so conflicted that you are not sure who the "real you" is.

If the Answer to This Question Is Yes, Please Refer to Chapter 13.

Question #14: Are you unable to handle the stresses you have to face in your life?

Is there something stressful in your life that is really throwing you for a loop? Stress is an unavoidable part of our lives and will inevitably lead to an occasional bad day. This is not what we are talking about in this question. Instead, the issue is whether you are having symptoms in response to a stressful event that are more intense and prolonged than most other people would have in similar circumstances. Is this reaction maladaptive — that is, does it hurt more than help you in dealing with the stressful event? Do you find that you can't just pick yourself up and dust yourself off? The most common problems caused by stress are feeling down and/or anxious, performing poorly at work or at school, developing physical symptoms, and, particularly in children, displaying bad behavior.

If the Answer to This Question Is Yes, Please Refer to Chapter 14.

Question #15: Do you sometimes lose touch with reality?

Have you had any particularly unusual experiences or upsetting beliefs that seem to puzzle other people or make them think you are strange? For example... Are you convinced that strangers are talking about you, that you are being followed, that you are being spied on, that there is a plot against you, that you have special supernatural powers, that your spouse is unfaithful, that something is terribly wrong with your body or that it is being poisoned or tampered with, that other people can hear your thoughts, or that someone is controlling your thoughts or actions against your will? Have you ever heard voices of people talking when there was no one around, had visions of things that are not really there, or smelled a foul odor coming from your body that no one else can smell?

A "yes" answer to any of these questions suggests the possibility that the person has lost the ability to distinguish what is real from what is a product of imagination. However, before assuming that there is a severe mental disorder, it is important to determine what is really happening in that person's life. Some people seem to act in a paranoid way because there really is someone out there trying to get them. A "no" answer must also be taken with a grain of salt since it may reflect the denial of illness frequently encountered in those who have lost touch with reality.

If the Answer to This Question Is Yes, Please Refer to Chapter 15.

Copyright © 1998 by Allen Frances, M.D. and Michael B. First, M.D.

About the Author

Michael B. First, M.D., is Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons and is a research psychiatrist in the Biometrics Research Department at New York State Psychiatric Institute. He was the editor of the DSM-IV text and criteria, and now maintains a private practice in Manhattan.

Allen Frances, M.D., is Professor of Psychiatry and former chairman of the Department of Psychiatry and Behavioral Science at Duke University. Dr. Frances was chairman of the DSM-IV Task Force and is currently leading an effort to develop expert consensus practice guidelines for the different psychiatric disorders.