Tell patients the diagnosis and how confident you are in it, explain what the loaded terms really mean, and ask whether they agree. Withholding a personality disorder while everyone pretends to treat depression sets up bad outcomes; the only reason to hold a diagnosis back, at least for now, is that saying it would clearly hurt the treatment.
Why share it
Part of the treatment frame is that you and the patient are on the same page about what the diagnosis is and how confident you are in it.
“part of my treatment frame is that me and the patient are on the same page in regards to what the diagnosis is and my degree of confidence in that diagnosis”
19:48The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 If it is important enough to be your primary treatment diagnosis, or to go on a bill somewhere, you should at least explain it.
“If it's important enough to be your primary treatment diagnosis, if it's important enough to go on a bill somewhere, you should at least explain it”
22:40The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 The diagnosis ought to be communicated to the patient. We should not withhold the diagnosis or avoid mentioning it.
“I take the approach that the diagnosis ought to be communicated to the patient, that we should not withhold the diagnosis or mentioning the diagnosis. First off, I mean, it's hard to comment sort of broadly about this because I do”
33:26Understanding Borderline Personality Disorder with Dr. Mark L. RuffaloDec 2024Guest episode For some patients a BPD diagnosis is a relief: finally a way to make sense of what has been so confusing for them, and for everyone around them, for years.
“I've seen patients who, when they receive a diagnosis of BPD, you know, they start to feel finally there's a way to make sense of what has been so confusing for me and basically everyone around me for years”
35:38Understanding Borderline Personality Disorder with Dr. Mark L. RuffaloDec 2024Guest episode
How to share it
Many of our terms are loaded and carry an inaccurate lay meaning, so spend time explaining why you reached the diagnosis. You are showing your work.
“A lot of our terms are loaded and have lay person understanding that's inaccurate. you need to spend some time communicating why because you are uh showing your work to the patient number one”
52:11How to Do a Psychiatric Intake | The Art and Science of the First HourSep 2025 Invite disagreement: "I really want to know if you disagree or you're not sure. How do you feel about my impressions? Does that make sense to you?"
“i say and i really want to know if you disagree or you're not sure about this okay i want to make sure we're on the same page how do you feel about my impressions does that make sense to you do you agree or disagree”
53:57How to Do a Psychiatric Intake | The Art and Science of the First HourSep 2025 Encourage an internal locus of control about the diagnosis, so the person has a healthy relationship with the idea that they have this problem.
“I think it's important that we encourage the person to have an internal locus of control with regard to their diagnosis so that they have a healthy relationship with the idea that they have this problem”
34:14ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024 Agreement is not required. Better a patient who says "I don't have schizophrenia, but I take my clozapine" than one who accepts schizophrenia but refuses antipsychotics.
“I'd rather have a patient who says, doc, I don't have schizophrenia, but I take my clozapine than a patient who says I have schizophrenia, but I hate antipsychotics and refuse to take them”
23:49The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025
When to hold back
The purpose of a diagnosis is to further the treatment. If disclosing even a confirmed diagnosis would definitely hurt the treatment or the patient, or interrupt it in a way that cannot be repaired, that is a reason to withhold it, at least for now.
“the purpose of a diagnosis is to further the treatment. So if disclosing a confirmed diagnosis, even one that you believe, would definitively and you know would hurt the treatment process or the patient or interrupt it in some unrepairable way, that is a reason to at least temporarily withhold it”
24:06The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025
Pitfalls
Patient and providers pretend the treatment is for major depressive disorder while everyone knows, in the back of their mind, that there is a personality disorder nobody says out loud. That sets up bad treatment outcomes.
“the patient and the providers making pretend that treatment is major depressive disorder in the back of their mind know that there's a personality disorder, but don't communicate it. And it's really setting up for bad treatment outcomes”
25:20The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 Some clinicians apply a personality disorder diagnosis to mean "person I don't like" or "unpleasant person." That is not what it means.
“Sometimes I've run to clinicians who don't even really fundamentally understand personality disorders. They really apply the diagnosis like person I don't like or unpleasant person. But that's really not what it means”
25:43The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025
From these episodes
- How to Do a Psychiatric Intake | The Art and Science of the First HourSep 2025 · 2 points
- The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 · 6 points
- Understanding Borderline Personality Disorder with Dr. Mark L. RuffaloDec 2024 · 2 points
- ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.