Complicated case of ptsd

[Sideways]

@joeylittle - I totally hear you.

There was a movement recently where people were promoting the concept that PTSD was a psychiatric "injury", rather than an "illness". That really horrifies me. The stigma towards mental health issues that aren't PTSD being promoted by that attitude blows my mind.

And I think that's why I took exception to the comments about ptsd "purists" earlier in this thread. Promoting correct diagnosis doesn't make me less compassionate than the person who readily assigns the ptsd label to anyone who's had a hard time.

I'm not saying "STFU" (as it was so eloquently put earlier on!) if I say "That's not PTSD". All I'm saying is... "That's not ptsd".

 

[Deleted member 42783]

I suffer from depression too. Its a family trait. Probably would've had it regardless of the PTSD.

Better to be part of the something not yet named - because that's how it ends up being named. If there were not enough instances of people who almost met the criteria for bipolar I, but had some distinctions excluding them - there would never have been bipolar II.

I appreciate this as truth. I do. I just look at it from a person centered viewpoint rather than a macro viewpoint. I want to meet the needs of the individual in the here and now rather than wait for that someday accurate diagnosis and help. So often, doctors are just winging it when there isn't a diagnosis, research or funding behind it. Occasionally diagnostic criteria changes based upon the need for it to be more inclusive.
Is it right, Nope. Is it reality. Yes. Hence we have therapists who state an incorrect diagnosis on paperwork so that care will be covered.

 

[Deleted member 42783]

There was a movement recently where people were promoting the concept that PTSD was a psychiatric "injury", rather than an "illness". That really horrifies me. The stigma towards mental health issues that aren't PTSD being promoted by that attitude blows my mind.

I feel the same way about this. My depression isn't an illness while my PTSD is an injury. They are both have a cause. One less known than the other. Neither should be stigmatized.

 

[lostforgottensoul]

there are other mental illnesses that arise from trauma.

Yes! This! There are PLENTY of mental health disorders that arise from trauma that would fit better and also validate the person's symptoms and give them that answer as to "what's wrong with me". I honestly think PTSD is the one everyone picks as its the most well known due to veterans. At least in the US. Whenever you hear about PTSD on tv, it's generally about a verteran. Sadly, many want AN answer, they don't much care if it's the right answer. Speaking generally. At least what I have seen.

And, I also hear you @joeylittle and thank you for the post as that sort of answers a lot for me, around this topic, personally.

I think stigma also plays a huge role in it. But, I also think that the "publicity" (for a lack of a better word) of PTSD also plays a big part. At least in the US anyway. It also validates their struggle. PTSD is viewed as 'really bad' and so if there are really bad and hard struggles, PTSD validates that.

Problem is, there could be a much better fit for those struggles which could have completely different therapies which could help much better and much faster. Some people just want to fight for PTSD. That I have seen anyway. I will never get all of it but I appreciate the discussion around it and the oppurtunity to vent some frustrations about it. So thank you all for that!

 

[anthony]

why do people do this? What is the allure of this disorder?

Because they're just f*cked up beyond mental healths control IMHO. Anyone who things mental health diagnosis, physical health diagnosis, should be haphazardly applied to anyone who deems themselves necessary, or it seems worthy in their twisted minds, probably should be locked in a padded room for a severe case of idiocy, never to be let near the public again.

 

[anthony]

If someone's spouse leaves them, that's traumatic. It is. It doesn't fit PTSD objective criteria but it's still traumatic.

Absolutely agree. But PTSD should not be used with trauma exclusively, is the growing issue.

I also think that many psychiatrists, and psychologists diagnose PTSD because symptoms FIT PTSD.

And that is what, IMHO, makes things worse. You have a system of sympathy and empathy (human behaviour) behind a diagnostic manual of best guess, all allowing absolutely personalisation from the treatment and treated sides. Its scary IMO just how messed up mental health diagnosis is. It's all we have, but scary nonetheless.

There was a movement recently where people were promoting the concept that PTSD was a psychiatric "injury", rather than an "illness". That really horrifies me.

Why? How people refer to it doesn't really change anything. If they want to call their trauma an injury, let them do it. That does not change the diagnosis being a disorder by definition. That movement attempted to infiltrate this community, it failed. People should respect how a person chooses to view something, yet the same person should respect that their views are not indicative of the reality of mental health itself. Especially if they have very limited understanding of a diagnostic system.

I want to meet the needs of the individual in the here and now rather than wait for that someday accurate diagnosis and help.

I do too. Yet its also not my job to lie to people, hold their hand for that relationship breakup, and tell them, or encourage them, that they have a mental health disorder that they just don't have. Don't even come close to fitting diagnostically. That to me is distrust from the get go. They're going through enough shit, should I really be adding to it with lies and deceit in order to meet their current needs via sympathy / empathy? Neither of which have any part in diagnosis!

 

[Deleted member 42783]

Yet its also not my job to lie to people, hold their hand for that relationship breakup, and tell them, or encourage them, that they have a mental health disorder that they just don't have. Don't even come close to fitting diagnostically. That to me is distrust from the get go. They're going through enough shit, should I really be adding to it with lies and deceit in order to meet their current needs via sympathy / empathy?

No? I don't think I implied that anyone should be lied to. Or told that they have a mental illness that they don't have for that matter.
I'm really unsure why you ask that? I only acknowledged the way the system runs in the U.S., why people desire that diagnosis and that many individuals fall through the cracks because they don't fit the PTSD criteria.

 

[Deleted member 42783]

I wish I could edit posts but since I can't I'll add this here.
My frame of reference is that of a nurse. It's my job to be patient centered. It's my job to understand patient needs. I hope to god that empathy will always be a part of medicine. There will always be an art to it along with the science. Dr. House doesn't exist in real life and there are a lot of intangibles we are working with. Especially is psych medicine. Research is limited because of that.

 

[lostforgottensoul]

I only acknowledged the way the system runs in the U.S., why people desire that diagnosis and that many individuals fall through the cracks because they don't fit the PTSD criteria.

Wait, I'm confused. Why do people fall through the cracks due to not meeting PTSD criteria? There are a boat load of mental illness trauma caused in the same area as PTSD that people could fit into if not PTSD. The trauma of this thread included. Yes, there are a few oddities as @shimmerz pointed out but those are rare. PTSD is NOT the only trauma caused disorder as people like to think. Not even close.

So, why again do people desire a PTSD diagnosis?

I hope to god that empathy will always be a part of medicine.

Me too. But empathy does not mean dishonesty. Telling someone they cannot have a certian disorder due to not meeting its criteria is not being non-empathic and you can advise someone of bad news even with empathy. Maybe I am confusing the post and please tell me if I am but I am very confused on how empathy even plays a part here.

 

[Deleted member 42783]

So, why again do people desire a PTSD diagnosis?

Because it's recognized, it offers validation, it is a better funded and researched diagnosis, it is more likely to be covered by private insurance. None of these are a reason to be diagnosed. But they are reasons that people seek the diagnosis other than its a "cool" diagnosis to have.

Yes, there are a few oddities as @shimmerz pointed out but those are rare.

Ya know, when it's you or your loved one that has a rare disorder, it doesn't feel that rare. There are cases when a doc has no idea what diagnosis to use and so has to find one with the best fit in order for a patient to receive care. Again, its not a perfect system , and I don't necessarily agree with it but its better than telling these people to wait until we come up with something better. Insurance companies want to know what they are being billed for. I know for a fact that care on my unit has not been paid for by insurance companies because the diagnosis was not a clear one. Seriously, the hospital just takes a loss.

Me too. But empathy does not mean dishonesty. Telling someone they cannot have a certian disorder due to not meeting its criteria is not being non-empathic and you can advise someone of bad news even with empathy. Maybe I am confusing the post and please tell me if I am but I am very confused on how empathy even plays a part here.

I'm confused too. I think my comments are being understood in ways I did not intend and I can't figure out why. I DO NOT think people should ever be lied to. That's actually a big deal with me so I don't know why my saying that empathy in medicine is a good thing is being conflated with saying that empathy means patients should be lied to.
All I've tried to do is point out some possible explanations as to why things are the way they are. I'm not preaching that PTSD diagnostic criteria should be bent to fit everyone with a trauma.

 

[lostforgottensoul]

I DO NOT think people should ever be lied to. That's actually a big deal with me so I don't know why my saying that empathy in medicine is a good thing is being conflated with saying that empathy means patients should be lied to.

If you tell someone they have or may have PTSD or do not correct them or not tell them that doesn't fit the diagnosic criteria for PTSD then you are lying to them. I was saying that you do not have to do that to show empathy.

There are cases when a doc has no idea what diagnosis to use and so has to find one with the best fit in order for a patient to receive care.

Rare meaning not many.

There are MANY diagnosis in the DSM in the same area as PTSD in the DSM currently which means it is a known diagnosis with a code number for the insurence to pay out from. That is the case with this thread. Many other disordets, besides PTSD, can fit where it would explain it all, one would get insurence coverage on, and there are treatments for.

The others, Shimmerz advised, are rare. Few. The unlucky few and in those cases I would advise to put the closes label insurence is needed but they CAN stay undiagnosed because things like GAD exist and insurence pays on GAD. Actually, my therapist says its what most use if the actual condition is unknown, the patient has anxiety, and they need insurence coverage. You do not need to wrongful misdiagnose, or fight for, PTSD for insurence in most cases that i have heard of as there are other things the insurence can use like that.

 

[Deleted member 42783]

If you tell someone they have or may have PTSD or do not correct them or not tell them that doesn't fit the diagnosic criteria for PTSD then you are lying to them. I was saying that you do not have to do that to show empathy

Agree with you 100% here. I never mentioned telling someone that they have a diagnosis that they don't have. It's nowhere in my comments.

The others, Shimmerz advised, are rare. Few. The unlucky few and in those cases I would advise to put the closes label insurence is needed but they CAN stay undiagnosed because things like GAD exist and insurence pays on GAD. Actually, my therapist says its what most use if the actual condition is unknown, the patient has anxiety, and they need insurence coverage. You do not need to wrongful misdiagnose, or fight for, PTSD for insurence in most cases that i have heard of as there are other things the insurence can use like that.

Did you see where I typed "None of these are a reason to be diagnosed" cause that kind of implies that I agree with you here.
I'm getting the impression that people are just reading into my posts what they want to read.
For the record, GAD can be used as a catch all by some but where I work it is not good enough.