In Search of My ‘Label’ – Rethinking Diagnosis and Identity

Do you want a ‘label’?

As you browse this website, you may come across various ‘labels’, or diagnoses— gifted, intense, highly sensitive, BPD, Quiet BPD, or ‘high functioning autism’. Some of them seem more ‘loaded’ than others; Some may resonate with you, while others might feel alien.

We all feel differently about labels and diagnosis. For some people, finding a label that resonates with their life experiences can be such a relief— finally, there are answers; there is something that could put a name to their life stories, and tell them they are not alone. At the same time, a potential diagnosis can become a source of terror, triggering more questions and doubts: “Does that mean I am ‘disordered’? “Am I crazy or a bad person? “

Historically, primary healthcare providers and GPs have faced criticism for being unaware of the signs of genuine mental health struggles. At the same time, some mental health professionals are criticized for being overly eager to render all forms of human suffering as psychiatric diagnoses. Meanwhile, most people find themselves in ambivalence—yearning for some form of recognition of their suffering but fearing the potential consequences a formal diagnosis may bring.

If you identify with some of the trait descriptions on this website, reading them can evoke a lot of complex feelings. In light of this, I would like to offer some perspective and share my thoughts on the value of labels and diagnoses.

Essentially, I neither believe nor disbelieve in labels. They can be useful, but they are arbitrary categories that have their limitations. While labels may offer some answers and validation, not one label can fully capture the entirety of who you are as a unique person.

If you’re wondering, “Am I considered ___ ?”, “Do I ‘qualify’ as such?”, or if you’re thinking about seeing a psychologist for an assessment, I would walk you through the following process:

 

 “People assume you aren’t sick 

unless they see the sickness on your skin
like scars forming a map of all the ways you’re hurting.

My heart is a prison of Have you tried?s
Have you tried exercising? Have you tried eating better?
Have you tried not being sad, not being sick?
Have you tried being more like me?
Have you tried shutting up?

Yes, I have tried. Yes, I am still trying,
and yes, I am still sick.

Sometimes monsters are invisible, and
sometimes demons attack you from the inside.
Just because you cannot see the claws and the teeth
does not mean they aren’t ripping through me.
Pain does not need to be seen to be felt.

Telling me there is no problem
won’t solve the problem.”
― Emm Roy

Step 1. Dig deeper

Before you jump into attaching yourself to any label, the first step might be to reflect on the deeper psychodynamic reasons behind your search. Dig deeper: What is it that you truly hope to achieve? What is it that you desire? Is it a need for validation, a longing to be seen and understood in an isolating and confusing world? Or maybe it is a way to find clarity amid stormy thoughts and emotions?

You could be doing this for practical reasons. For instance, if you are trying to navigate the public healthcare system, such as the NHS in the UK, or to access specific resources or treatments, a formal diagnosis can open doors.

However, more often than not, I find that clients are motivated not by practical reasons but by a deeper desire for validation and understanding. When we have suffered unverbalized pain, it is human to want to put a name to our traumatic experiences. We want our pain to be acknowledged and validated, and we want the reassurance that we are not alone in our struggles.

If your suffering has been dismissed and denied for most of your life, maybe because you were a parentified child, traumatized in an ‘invisible ways’ just by being neurodivergent, or grew up with a narcissistic parent, your desire for a diagnosis may come from a place of deeper trauma and loneliness. Perhaps, from childhood, you were conditioned to believe that your feelings were invalid and you were told your memories of trauma were ‘made up’. When you have been gaslit by your family, even if you know you carry deep pain in your psyche, you might still find it challenging to trust your intuitions and constantly doubt the validity of your thoughts, feelings, and memories. It can be an incredibly painful and isolating position to find oneself in.

Therefore, by seeking a formal diagnosis, you may be looking for that external validation to confirm the realness of what you deeply know inside. Perhaps your inner self needs to hear the words “Yes, you have been hurt, and your pain is real.” If you’ve spent your entire life hiding your pain and were pushed to carry on with a brave face, having someone validate your trauma could be profoundly transformative and potentially life-saving.

The desires for validation and recognition are valid and fundamental human needs, so they should be embraced and not suppressed. As long as we acknowledge and honor the underlying drivers behind the quest for a diagnosis, including the longing of your inner child to be seen and heard, we can then approach this process rationally and practically.

Step 2. Rationally consider the pros and cons 

The next step is to assess the pros and cons of obtaining a diagnosis or label and then consider the degree to which you would attach your identity to it. Do you want it to be noted in your official medical records? To whom would you choose to disclose it, and to what extent? How much of your sense of identity or social circle will be impacted by it? This assessment can cover various aspects including psychological, practical, and economic implications, as well as potential future impact on both yourself and those you care about.

Pros 

On many occasions, having a label that accurately describes your struggles and life experiences can be highly beneficial.

From a practical standpoint, obtaining a mental health diagnosis can provide valuable resources such as medication, support groups, and specialized services. It can significantly enhance the effectiveness of your treatment, especially if you can find a supportive practitioner whose approach you like. Moreover, if you are dealing with multiple health challenges and consulting with professionals from different fields, having an accurate label can facilitate effective communication among them and improve the overall quality of care you receive.

Furthermore, a diagnosis offers a common vocabulary to help you articulate symptoms and convey your needs to friends, family, and even employers.  As long as they have access to accurate information (rather than misinformation), your diagnosis can help them understand you, offer you appropriate support, and ideally, extend deeper empathy for what you are coping with.

Understanding your diagnosis can be empowering as it validates the realness of your experiences. It allows you to take charge of your mental health, make informed decisions about your next steps, and develop personalized coping strategies.

Sometimes, a label can be a handy way for you to seek the community you need. When you find others who identify with the same label, even if it is just through online platforms, you come to the liberating realization that you are not alone. Finding a community that ‘gets it’ alleviates you from the lifelong sense of loneliness and existential dread that comes from feeling like nothing in your life makes sense.

Another aspect worth considering is that a label can offer you, and possibly your therapist, valuable insights into the roots of your trauma. While relating to descriptions on a website does not replace an official diagnosis, it can offer significant clues about the potential origins and causes of your “symptoms.” For example, if you find resonance with descriptions of BPD or Quiet BPD, it may point to experiences of childhood neglect, invalidation, or complex trauma. Understanding this can hopefully bring you more self-compassion and guide you toward healing. An important reminder here would be to approach this exploration with kindness towards yourself. Trauma is the result of circumstances beyond your control, and should never be a reason for self-blame or shame.

Cons  

While securing a mental health diagnosis can offer validation, not everyone wants to be labeled. Concerns regarding stigma or the fear of being solely defined by a diagnosis are equally legitimate.

One of the most practical concerns is that a diagnosis in your medical records can have lasting consequences. In some countries, such as the UK, this information remains almost permanently accessible to your future healthcare providers, which may impact their perception of you. It may also affect things like insurance coverage, where disclosing your mental health history to insurance companies can lead to higher premiums or even denial of coverage. When it comes to job search or career advancement, despite the progress made in de-stigmatizing mental health, there is still a persistent stigma surrounding mental illness that you rightfully worry about.

Another drawback of seeking answers from a ‘label’ is that, sometimes, you might end up feeling more bewildered and confused. Unlike physical conditions, which can often be measured objectively through laboratory tests or imaging scans, mental health diagnoses are made through a highly subjective and fluid process. While conditions such as schizophrenia may have more definitive neuro-biological underpinnings, most mental health assessments today rely heavily on patients’ self-reports and clinicians’ interpretation of their symptoms. These assessments are inherently subjective and can be influenced by various factors, including the clinician’s background, theoretical approach, and personal biases. It is not uncommon for two clinicians evaluating the same patient to arrive at different conclusions or diagnoses; Not to mention that your mood and the circumstances on the day of the assessment can also affect the results you get. In addition, mental health conditions often manifest differently across individuals and can overlap with other disorders, which further complicates the diagnostic process. Because of all these factors, the diagnostic process may lead to more questions than answers, and at the end of a long and drawn-out process, you may end up feeling more helpless and befuddled.  

 

‘I don’t feel very much like Pooh today,’ said Pooh.- AA Milne

 

Step 3. Consider an expanded perspective

As you embark on the journey to find a label that fits, you may also want to stay updated on the rapid changes in the field of mental health and health science, as they significantly affect what a diagnosis means and how useful it is in the long run.

Recent advancements in neuroscience, increased awareness of neurodivergence, and cultural factors have made diagnosing mental illnesses more complex than previously believed. The lines between disorders are becoming increasingly blurred, making it challenging to definitively determine whether someone “has” or “does not have” a mental disorder.

The ‘Spectrum’ framework for personality disorders

An example of a shift in diagnosing personality disorders is the transition from a categorical approach to a more flexible “spectrum” framework. In the past, diagnoses were based on rigid criteria, often involving checking off boxes that place people into distinct categories. Patients would be assessed based on predetermined criteria, and if they met a certain number of those criteria, they would receive a specific personality disorder diagnosis. However, this approach had limitations as it failed to capture the complexity and variability of personality.

To address this, the panel behind the diagnostic manual DSM-5 introduced a “spectrum framework”, which organizes personality pathology based on dimensions that cut across traditional categories. Instead of rigid classification, this approach evaluates individuals along various trait spectrums. The five domains used in this framework are negative affectivity, detachment, antagonism, disinhibition, and psychoticism. This approach recognizes that personality traits exist on a continuum and even sub-threshold traits can significantly impact a person’s functioning. It also acknowledges that symptoms can change over time and that people may exhibit traits that overlap across different domains. While the spectrum model is still evolving, it is a crucial step towards a more comprehensive and dynamic approach to diagnosing personality disorders, and potentially other mental health conditions.

More and more research has shown that personality disorders are not uniform diagnoses, as each person’s experience of the same disorder can vary significantly. This understanding has led to the development of customized treatments tailored to individual needs. An example of such an approach is Radically Open Dialectical Behavior Therapy (RO-DBT), which focuses on addressing specific tendencies such as an excessive need for control and perfectionism.  Looking ahead, there is potential for your doctor or psychologist to work with you on specific behaviors rather than base their plan on a broad category label. This shift would capture the diverse range of experiences and enable even more personalized care plans for each person. 

Acknowledging neurodivergence

Our understanding of mental health conditions becomes even more nuanced and dynamic when we consider the concept of neurodivergence; which recognizes the diverse ways our brains function and highlights the potential correlations between different mental health conditions. In the past, neurodivergent traits typically refer to learning difficulties, ADHD, and autism, but there is a growing movement to expand the scope of neurodivergence to include diagnoses like bipolar disorder and personality disorders.  

However, identifying the appropriate label for any person’s unique form of neurodivergence can be complex due to overlapping traits between conditions. For instance, exceptionally gifted children may have intense focus, interests, or thought patterns that resemble traits associated with ADHD or autism. Similarly, autistic individuals may be mistaken as gifted due to their attention to detail or rote memorization skills. It is common for traits to coexist across diagnostic boundaries, making it challenging to arrive at a definitive clinical label that fully explains an individual’s strengths and challenges.

Culture

Cultural differences can also complicate our understanding of labels. The way mental health symptoms are expressed, understood, and interpreted can vary greatly across different cultural contexts. Traits that are seen as normal variations in one culture may be viewed as problematic in another.

Cultural norms can shape which types of traits tend to be brought to clinical attention. For example, the emphasis placed on independence versus interdependence across cultures can affect what is deemed abnormal. More collectivist cultures may be more accepting of dependency. Language and idioms of distress also vary, so direct translations of diagnostic labels may not capture indigenous concepts or symptom presentations.

In a nutshell, within the field of human science and mental health, there is a growing recognition that definitions and labels fail to fully capture the complexity of human experience. Rather than trying to fit diverse thoughts and emotions into narrow categories, adopting a more holistic view of ourselves is perhaps a more inclusive and productive approach. Diagnostic science and categories can be useful, especially in the realm of research. But in terms of your human journey, instead of fixating on finding the perfect label, it may be more valuable to prioritize understanding your unique life experience, the trauma you have been through, your specific emotional needs, as well as what we can do to harness your strengths.

Step 4. Rethinking label etiology

A lot of us have been on a quest for answers to the many ‘why’ questions – why do I feel so different all my life? Why am I so intense? Why do I think and feel the way we do? This is a very human and understandable pursuit. However, relying solely on a diagnosis to explain who we are comes with risks. While receiving a label can provide insights,  the roots of any condition or neurodivergent trait are often complicated.  Multiple factors, including social, cultural, and biological influences, interact in complex ways. Especially with the rapid advancement in technology, neuroscience, and artificial intelligence, the answers to ‘why we are the way we are’ is evolving every day,

Genetics, the microbiome, neuroplasticity, and physiological factors are now considered alongside psychological influences when it comes to the study of etiology in mental health. For instance, genome-wide association studies have pinpointed genetic variants as linked to certain illnesses. Epigenetic modifications such as DNA methylation also play a role in regulating gene expression and may contribute to mental health conditions or neurodivergent traits.  For example, some professionals believe that under-methylation may contribute to conditions like seasonal depression, OCD, and oppositional behaviors. Overmethylation, on the other hand, may lead to high anxiety and sleep difficulties. 

As knowledge expands, new treatment approaches emerge.  For instance, explorations into the connection between the gut microbiome and the brain have revealed the influence of the enteric nervous system on cognition, mood, and stress responses. Some clinical trials are investigating the use of probiotics and nutritional science as complementary therapies for depression and anxiety.

Even more complex procedures such as vagus nerve stimulation (VNS) have emerged and are now used for treatment-resistant depression. A VHS device delivers regular electrical impulses to the vagus nerve in the neck, which connects to brain regions involved in mood regulation. VNS received FDA approval in 2005 as an adjunctive treatment for severe, treatment-resistant unipolar and bipolar depression due to its demonstrated efficacy and safety in clinical studies.

In recent years, controlled clinical trials have shown promising results regarding the therapeutic potential of certain psychedelics like psilocybin, MDMA, and ayahuasca in treating conditions such as PTSD, depression, and anxiety when administered in therapeutic settings. Small trials utilizing MDMA-assisted therapy have demonstrated significant reductions in PTSD symptoms for participants, and psychedelic psychotherapy has generally been found to be safe and well-tolerated when administered by trained therapists. However, further evidence from large randomized controlled trials is necessary before these therapies can be widely implemented in clinical practice.

As you can see, emerging research continually expands our knowledge. As our understanding of mental health expands with advancements in technology and health science, it becomes increasingly clear that a more open perspective is required to adapt to the complexities of individual experiences. Just as with psychedelics and VNS, technologies and perspectives once dismissed can gain credence with further exploration. Maintaining an open and flexible attitude allows us to incorporate novel techniques as evidence accumulates.

 

“There is no standard normal. Normal is subjective. There are seven billion versions of normal on this planet.”
― Matt Haig Reasons to Stay Alive

My search for a ‘label’

Looking at all of the above, you can see that behind any ‘label’ can be a complex web of bio-psycho-social factors; it is not simply a matter of whether you do or do not have a disorder. In reality, no one can give you an absolute and definitive answer.

In the spirit of transparency, I’ll use myself as an example— From a young age, I have felt like a misfit; I seemed to behave in a way that others found peculiar or excessive, but as I had assumed others were just like me, I didn’t even notice I was different until I was later rejected or silently punished. This led me on a lifelong quest for the perfect ‘label’ to explain my experience. I wanted to at least know if there is a ‘descriptor’ somewhere that can tell me why I was the way I was; so I was exploring everything from horoscopes to personality tests like MBTI, concepts like Highly Sensitive Person, and various mental health diagnoses.

Even now, I’m uncertain if any single label can perfectly describe me. Characters from popular culture like Sheldon Cooper and Daria have intuitively resonated with traits I recognize in myself, even if I lack their specific talents. Although I likely do not have ADHD, I see many traits of high-functioning autism within myself. Through it all, one truth has become clear: I am neurodivergent. My mind seems to operate in a way that diverges from societal norms. I seem to ‘think’ and ‘feel’ more than others.

Ultimately, I’m uncertain if finding the right ‘label’ is that important if I understand what I’m truly seeking behind it: I know I want to find people like me; I want to belong to some form of community. I want people who would laugh at my jokes and enjoy being my friend. I want to be surrounded by those who would, if not celebrate, at least tolerate my quirks.

Labels can be useful in helping us find our tribe, but beyond that, I’m not sure it’s very useful to get obsessed with finding the ‘absolutely correct and accurate’ label.

As a coach or consultant, or whatever I choose to call myself these days, I strive to extend this same understanding and empathy to my clients.

I am not medically trained to prescribe medication, nor can I provide you with any definitive answers regarding a psychiatric diagnosis. However, I wholeheartedly support your quest for answers and insights into your life story. If a diagnosis provides you with the right information, resources, and answers, there is no reason not to seek it.

At the same time, we should not let a simple label define our entire identity. Even if that label is called a ‘personality disorder,’ it does not mean you, as a person, are ‘disordered.’ It simply means that under stress, certain aspects of your personality take over and may lead you to behave in ways you may later regret.

And if you identify with any neurodivergent traits, I would love for you to know that you are not ‘too much’ or ‘too little’ in any fundamental sense. The label simply indicates that your unique and beautiful human quirks have yet to be fully accepted and understood by mainstream society. But I hold onto the hope that you can always, somewhere and sometime, find your people. Even if it takes a while or if it is just a community of one or two, you deserve not only acceptance but celebration for who you are.

If we can approach any label with deep self-compassion and intellectual curiosity, learn to appreciate complexity, and avoid reductionism, labels can be a life-saving tool.  But ultimately, rather than allowing labels to define or confine us, we would do well to embrace the uniquely individuated character of our experiences.

Ultimately, you have the power to define who you are.

 

“There is hope, even when your brain tells you there isn’t.”
― John Green