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Multiple Diagnosis Labeling With Ptsd

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anthony

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I want to enlighten sufferers to the facts of diagnosis, and why you may think you have more than just PTSD. PTSD is the worst end of the scale when you talk about anxiety disorders. Again, PTSD is the worst end of the scale. If you have been diagnosed with PTSD and another anxiety disorder/s, then your diagnosis was wrong, or your diagnosis was an estimate made before your PTSD diagnosis given, or your doctor / therapist is simply a bit confused with regards to what a PTSD diagnosis is.

The criteria for PTSD do not outline the same criteria for other anxiety disorders, otherwise the criteria for PTSD would be longer than it is. Why PTSD should only be diagnosed by trauma experts (and these exist loosely let me just add), is that PTSD should not be diagnosed in conjunction with other disorders that are already encompassed within PTSD; hence PTSD is the worst end of the scale. Even saying this, many trauma experts love to label, but in fact they are labelling by crossing paths the moment they diagnose a person with PTSD, they should state, these others are cancelled, because PTSD encompasses them already.

You can’t have PTSD and panic disorder, because panic disorder is already part of the PTSD diagnosis. You have to have anxiety attacks (panic disorder) to meet the diagnostic criteria for PTSD, which stems from your trauma. You have to have General Anxiety Disorder to have PTSD, hence from your trauma. You must have Agoraphobia with your PTSD, as Agoraphobia is a social withdrawal disorder caused by, you guessed it, anxiety, and this social withdrawal component is a major must-be-met criteria to be diagnosed with PTSD, as the DSM states: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Again, already encompassed within PTSD, why? Because PTSD is the worst end of the diagnostic scale.

PTSD diagnostic criteria simply outlines other diagnoses in one line because that is what PTSD is – a combination of other diagnostic criteria that when formed together makes PTSD. If you have “panic disorder,” then that is curable; if you have “general anxiety disorder,” then that is curable; if you have “Agoraphobia,” then that is curable. If all these where curable in your case, then you wouldn’t be diagnosed with PTSD, would you! Hence why PTSD encompasses these diagnoses often within one line, or even two diagnoses within one line of diagnostic criteria within the PTSD diagnosis. Why? Because PTSD is the worst end of the diagnostic scale.

Why am I mentioning this? Well, because I am continually seeing people struggling harder to understand why they could have major depression and PTSD, when major depression is already encompassed within the PTSD diagnosis. Though not everyone with PTSD gets the depression side of it, it doesn’t mean that it won’t come out to bite them later down through the years. Does this mean they have not obtained major depression? No…because they already have the characteristics for it within PTSD, caused by the anxiety, social withdrawal, panic, etc., etc.

If you have multiple diagnosis such as these, then in 99% of cases, the diagnosis will be wrong; because if you have PTSD, then your other diagnosis cancels out being encompassed within your PTSD diagnosis.

Let’s make this real simple, and I will show you what other disorders are encompassed within the PTSD diagnostic criteria, as this will give you a more visual aid to help understand.
  • Do you have intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event? Do you have physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event? Do you have recurrent, intrusive and distressing recollections of the event, including images, thoughts, or perceptions? Do you have hyper-vigilance? Do you have an exaggerated startle response?
    • Acute Stress Disorder (ASD)
    • Generalized Anxiety Disorder (GAD)
    • Depression Disorders reside here also
  • Do you avoid thoughts, feelings, or conversations associated with the trauma? Do you avoid activities, places, or people that arouse recollections of the trauma? Do you have an inability to recall an important aspect of the trauma?
  • Dissociative Disorders
  • Any Substance-Related Disorders applicable here
Do you have markedly diminished interest or participation in significant activities? Do you have feelings of detachment or estrangement from others? Do you mix socially with others outside your family? Do you have strong family relationships? Do you maintain a normal, healthy relationship with your partner? Do you cope with everyday situations? Do you cope with your employment? Social Phobia Agoraphobia Mood Disorders Do you have a sense of a foreshortened future? Do you have a restricted range of affect? Major Depressive Disorder General Depressive Disorders Do you have difficulty falling or staying asleep? Do you have recurrent distressing dreams of the event? Sleep Disorders of various types Do you have irritability or outbursts of anger? Mood Disorder Due to a General Medical Condition Do you suffer difficulty concentrating? Amnestic Disorder Due to a General Medical Condition

Honestly, I am only getting warmed up. As you can see, what people find stressful with multiple diagnoses is that most of those are already encompassed within PTSD itself. Not all are there, but anything generally to do with anxiety, depression, social behaviour, substance abuse, dissociation, sleep, etc. is already in the one big, fat PTSD diagnosis. Thinking, or worse yet, made to think you have more disorders than you really do, is criminal IMHO, and physicians need to have a long look at themselves for going out on labelling binges.

Doctors prove this more and more, with their ties to pharmaceutical companies and kickbacks; you’re in and out in 5, 10 or 15 minutes, you are labelled with as much as they can theoretically find, they then assign you multiple medications for each diagnostic label, thus they get more money, stats look more like the world is crazy, they look like they are doing something important, bottom line figures improved via kickbacks from prescriptions and pharma companies. Lovely little web, but with little to no regard for the poor bastards sitting on the end of their politically and cash driven motivations.

I want people to stop feeling as though they have mountains to climb, when in fact they only have hills to climb. Most of the diagnoses running around in multiple circumstances like this are wrong if PTSD has also been diagnosed. I will be more than happy to break people’s diagnoses apart for them so they can see what they do and do not actually have. If you still cannot see what you really have opposed to what you don’t, post it here and we will pull it apart and show you.
 
I have been diagnosed with clinical depression, bi-polar, obsessive/compulsive thinking. I take 3 different medicines daily to control symptoms. I still have bouts of way low depression, then swing to manic where I sleep little to none. There are nights when my sleep meds don't work even though I am taking larger dose. I also have an eating disorder where I won't eat for days or very little food intake. I was diagnosed by a psychiatrist I saw for 9 years with PTSD. He has since retired and my new psy never mentioned PTSD. I never asked and he has since relocated to another state. I am currently looking for someone in my area with experience in EMDR and PTSD. I have been unable to find that individual and have continued my therapy work here and at the 12 step meetings. It has been helpful in supplying me with new information and things to try to handle symptoms. In the past I have been diagnosed with MPD, alcoholic/drug addict (which I participate in 12 step meetings for last 14 years) accute anxiety (I stayed in the house for 3 years hard to get out of bed and could not walk out my front door), panic attacks, dissociative disorder where I was fragmenting, severe migraines, haven't had sex with my husband in over 10 years (yes that includes anyone else as well, lol). I'm at a point where I don't care what it is called, I just want "it" fixed. I have had CBT for 8 years and went into a rehab for my eating disorder 5 years ago with much growth and relief to my confused mind. I just feel like I need to get a clear answer due to all the different "labels" that I've been given. Thanks for any and all feedback!!
 
I've been diagnosed with MD alongside PTSD by an expert trauma psychiatrist! I work alongside a Consultant Clinical Psychologist Expert Witness who specialises in trauma, and spoke to him about the additional MD diagnosis at the time - and he basically said the same to what you are saying and what I was thinking.

There is little sense in diagnosing somebody who is post traumatically stressed as also clinically depressed. It's pretty much a given! If you are post traumatically stressed... you're life is significantly impaired by anxiety and trauma. Any other personality, anxiety or depressive disorder etc. is going to be a symptom relating to the primary or secondary effects of PTSD and therefore lies underneath this umbrella, right? You're not exactly going to be feeling too happy are you? But I must say, as it was a PTSD expert psychiatrist, I still find myself wondering why he diagnosed me with both as surely he would know this?
 
Lisa,

The reason often why they do that is two fold, being:

#1 - The labels are then transposed from physician to physician an immediately tell a whole lot about a persons mental health, and

#2 - To prescribe medication. The majority of physicians get kickbacks from the pharmaceutical companies for what they prescribe. This isn't conspiracy, this is very well known and an adverse part of the medical industry. This does aid in keeping physician costs to a minimum, however; the problem with human behaviour is that when we have something and don't have to work hard for it, or sacrifice anything, then we take it greedily. It is getting way out of hand nowadays with the amount of medication some physicians are prescribing to patients. Its not them who has to deal with any of the issues, its the patient. They prescribe one medication which the patient tells them isn't working well for them or they are having adverse side effects, so instead of looking at a non pharmaceutical option or a better alternative medication, they begin the process of prescribing medications to treat side effects of other medications. You here lots of people here and elsewhere state they are on five, six, seven or more medications at once. They have the wrong physician usually... one that drives their top of the range Mercedes, lives in their multi-million dollar home and takes themself or their family on two overseas holidays per year without blinking an eye at any of the cost as they have so much income coming in from medications they have prescribed.

When PTSD is diagnosed, nothing else should be diagnosed unless the condition was present and known prior to the trauma itself. It is like when you hear people with CPTSD tell you they have also been diagnosed with multiple personalities, or borderline personality disorder, etc. Part of CPTSD is personality issues, because the trauma has been either during childhood for a prolonged period of one's childhood, or adulthood for a long period under extreme conditions, ie. prisoner of war. Either way, the actual personality has been distorted due to behavioural modification as part of the trauma itself. Physicians know this, but they then would have to justify themselves further if they prescribed 5 medications to a person with only a CPTSD diagnosis. So instead they diagnose them with CPTSD, BPD, Severe Depression, etc etc... then load them up with meds and send them on their way to fend for themselves.

The mental health industry went to shit a long time ago... it is only now just beginning to skim the surface of coming back around full circle to a trusted entity once again. The only reason that has occurred is because of the Internet and ease of access to information nowadays, so people are questioning their physicians a whole lot more than ever before. They now have to step up to the plate with a more open, transparent and honest approach to patients, otherwise the patient goes elsewhere for someone who is more honest and transparent, isn't so willing to just prescribe medication at the drop of a pin.
 
Evening Anthony,

In reading what you have said about over prescribing medications, I have to ask you. My T suggested that I be taken off my anti-depressant med (under my MD'S supervision of course) because I was emotionally numb and he felt I needed to access my repressed emotions. I did as he suggested, but didn't bother going to my MD, I just slowly weaned off. I feel I have gotten much worse as a result. I am almost constantly suffering from anxiety now, am having actual flashbacks as well as emotional flashbacks (which I think I always had) and am experiencing dissociative symptoms (I know that used to happen pre-medication). I am also having suicidal ideation again.

I realize that therapy in itself may make things worse before they get "better", but is it really a good idea for me to be off my medication? If it helps me to move thru this process faster I'm willing to do it, but it is really tough to live with.
 
Sorry Anthony...this was a silly question to be asking you, let alone in this section of the forum. I can't remove the question so please just disregard it.
 
What your experiencing is called withdrawals, and it will occur for months, hence the MD very graduated tapered removal.
 
Hmmm.....hadn't even thought of that Anthony. Thanks for the insight. I think withdrawal combined with the fact that I am really working thru my past makes it all really intense at times. My thoughts can be my own worst enemy in all of this. Time to start focusing on the truth that I am making progress, I have a very good life now and look forward to the time that past issues won't be able to push me around so much! Whether it be depression, anger or panic attacks....I am getting better and I am determined to continue down this path of healing. ;o)
 
It takes months for your system to fully withdraw from prescription medications, especially SSRI's. I do mean months. It will take that long before you actually have a complete perspective on what you truly feel, think, etc, without withdrawals having any effect. It is at that time you can review your own status.
 
My psychologist was sure that I was manic depressive because I was depressed as well as not sleeping, irritable, agitated, and ready to do some dangerous things... All things that are related to my PTSD.

My psychiatrist, a great clinician, told her she was a quack. He has now referred me to a new therapist, who hopefully will not keep piling diagnoses on me. Thank you for this article!
 
Thank you for the this article. I have felt especially burdened as of late. My T suggested I was depressed, and I am.
But now that I think about it she put it into the context of PTSD. All a part of the PTSD package that I deal with. I did
not fully understand what she meant. Now I do. So its as if my troubles have been halved, I have PTSD period.
I now understand that the anxiety, agoraphobia, irritability, sleep problems, panic attacks stem from one diagnosis.
I have a lot of work to do. Yet I feel some comfort in that I don't have multiple "weaknesses" rather I have an explanation
for the mental pain I have endured my whole life.
 
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