Upset over Diagnosis Change

[Nuance]

No longer having a diagnosis is a good thing,not something to be upset over.

Are you upset/worried that you may no longer be eligible for social security @Nuance?

I am a little worried about that and being a "fraud", weirdly. However, I do have some physical limitations so I shouldn't be too worried about it. Haha

 

[joeylittle]

@Nuance - it seems like you might be mixing together a number of different concerns.

As far as your diagnosis no longer being PTSD - that would mean that the symptoms caused by your PTSD have decreased to a level where you may have occasional difficulty, but it's not a pervasive problem. That's nothing but good.

Whether the diagnosis is tied to your disability benefits/status...that's a different thing altogether, and you'd want to look into that.

Feeling like you are losing your identity by having recovered from diagnosable PTSD...that's a great thing to tackle in therapy. Many people who have had a long-term or chronic illness go through a period where they struggle to understand who they are, now that they are no longer "sick" in the same way they were before. In other words, this is a very understandable way to feel.

I think it would be better to address and work through the feelings that have come up for you (invalidation, fraud, etc), rather than try and argue that you should be diagnosed with PTSD, specifically, again.

Or, you could look at it this way - PTSD is (in many ways) made up of a laundry list of other diagnoses.

Depression
General Anxiety Disorder
Dissociative Disorder (not specified)
Sleep disturbance/Insomnia
Intermittent Explosive Disorder
.....and on and on, depending on how detailed one would want to get.

When one puts all those together in a specific way, plus a specific incident the symptoms can be traced to, it's diagnosed as PTSD.

When you stop having serious life-interference problems with one or more of the symptom groupings...then, from a clinical perspective. it no longer meets the criteria for PTSD. But it doesn't mean you weren't diagnosed with it previously, and it doesn't mean those things never happened.

 

[grit]

I was struck by this comment

I am a little worried about that and being a "fraud",

I know it is not the fashion to assume, but sometimes during therapy, the feelings that arise have significance and they need to be explored in order to benefit. This is actually one of the main benefits of the therapy. You are talking to a person who does not know you and will never know you as much as your body memory knows you...you will always have more information than them but they can see your blind spots because you are exposing yourself...

Now why did that line strike out for me?
I think your biggest concern is not that you are recovering (and even disagreeing with the therapist and expressing why is a sign of integration BTW) but the feeling of "fraud". This is a new part you probably need to integrate. This part is fighting the therapist cause you are not nurturing...this part is part of you that knows more but has been pushed to the side by other parts of your experience.
Feeling "fraud" imposter and fake are all very classic trauma related. It is like this part does not know the rest of your story and is feeling like I am alone.

I think it is valid for you to challenge the downgrade of your diagnosis but I also think that is sort of distraction from dealing the "fraud" feeling that you may be avoiding.
That fraud feeling may be just blind to how resilient you truly are from where you came from to where you are today. That fraud part may be just what you need to see the blind spot the therapist is seeing. You do not see how much you have gained to have your diagnosis change. I just feel and I could be wrong of course, I am just an internet person, that the feeling of fraud is super powerful blind spot for you at this junction.

 

[Jade-]

I am a little worried about that and being a "fraud", weirdly. However, I do have some physical limitations so I shouldn't be too worried about it. Haha

It's understandable that you would be a little worried since there's a chance you could lose your monthly income.

How often will your case be reviewed and do you have to inform SSA about the change in diagnosis?

 

[Justmehere]

However, my new one is hesitant to give me the diagnosis and seems to want to downgrade me to "trauma-related" anxiety.

How new is she?
What do you mean by “seems”? Did she point blank state you don’t have PTSD anymore? Did she suggest it’s a condition that is less difficult?
How much does she understand symptoms? She clearly believes you have a trauma history. It’s the symptoms she might not think meets PTSD criteria. It may not actually be a downgrade but rather a change.

Based on what you describe, seems like there is cause to talk to her about your concerns and find out more about what this new therapist is thinking and why.

 

[siniang]

As far as your diagnosis no longer being PTSD - that would mean that the symptoms caused by your PTSD have decreased to a level where you may have occasional difficulty, but it's not a pervasive problem. That's nothing but good.

The thing is and I think that's what Nuance is worried about: DID the symptoms decrease? DID she really get better enough? Or is it just..... a different T interpreting the DSM just a tad differently? Because that is a thing and I don't think that should be disregarded, that different Ts, PsyDocs, .... apply different interpretations. Because if she didn't actually get better, I think her worries might be justified as in she may now cease to receive the appropriate treatment. So, a discussion with that new T about treatment of symptoms (from whatever diagnosis) is probably warranted and necessary.

@Nuance I agree that it's worth discussing your concerns and associated feelings with your T. Question her on that. You deserve explanations you can live with. Start with the "I'm a fraud" one :) Also, go over the criteria list and discuss with her why you think you still meet them and she thinks you don't.

(On a side-note "Trauma-related anxiety" is an actual diagnosis? Genuinely asking).

 

[Gs172003]

The thing is and I think that's what Nuance is worried about: DID the symptoms decrease? DID she really get better enough? Or is it just..... a different T interpreting the DSM just a tad differently? Because that is a thing and I don't think that should be disregarded, that different Ts, PsyDocs, .... apply different interpretations. Because if she didn't actually get better, I think her worries might be justified as in she may now cease to receive the appropriate treatment. So, a discussion with that new T about treatment of symptoms (from whatever diagnosis) is probably warranted and necessary.

@Nuance I agree that it's worth discussing your concerns and associated feelings with your T. Question her on that. You deserve explanations you can live with. Start with the "I'm a fraud" one :) Also, go over the criteria list and discuss with her why you think you still meet them and she thinks you don't.

(On a side-note "Trauma-related anxiety" is an actual diagnosis? Genuinely asking).

Agreed.

 

[Nuance]

How new is she?
What do you mean by “seems”? Did she point blank state you don’t have PTSD anymore? Did she suggest it’s a condition that is less difficult?
How much does she understand symptoms? She clearly believes you have a trauma history. It’s the symptoms she might not think meets PTSD criteria. It may not actually be a downgrade but rather a change.

Based on what you describe, seems like there is cause to talk to her about your concerns and find out more about what this new therapist is thinking and why.

You
I kept saying I had PTSD and how it affected but the way she responds to it definitely sounds she's doubtful of my diagnosis and doesn't want to commit to it. She's only seen me like 6 times and still seems really doubtful of it.

I was hesitant of her assessment because my last therapist (who got deployed to the Middle East in January) saw me weekly for 18 months and was convinced my symptomatogy was very typical with people with PTSD. He had a PsyD with a specialization in trauma and PTSD, works with veterans, and created a statewide network with trauma resources and trauma therapists. He was the first therapist that helped me make sense of my issues.

I got back into therapy because I perceived my "PTSD" was flaring up really bad again so I felt extremely invalidated. But maybe my identity is too tied to the diagnosis.

 

[Nuance]

The thing is and I think that's what Nuance is worried about: DID the symptoms decrease? DID she really get better enough? Or is it just..... a different T interpreting the DSM just a tad differently? Because that is a thing and I don't think that should be disregarded, that different Ts, PsyDocs, .... apply different interpretations. Because if she didn't actually get better, I think her worries might be justified as in she may now cease to receive the appropriate treatment. So, a discussion with that new T about treatment of symptoms (from whatever diagnosis) is probably warranted and necessary.



@Nuance I agree that it's worth discussing your concerns and associated feelings with your T. Question her on that. You deserve explanations you can live with. Start with the "I'm a fraud" one :) Also, go over the criteria list and discuss with her why you think you still meet them and she thinks you don't.



(On a side-note "Trauma-related anxiety" is an actual diagnosis? Genuinely asking).

Thank you for your input!
She said "trauma-related anxiety" was a new diagnosis in the new DSM and I tried to find it. When I couldn't find it online, I started questioning her competence in my head.

She's implied on two different occasions that she isn't sure about my PTSD.

 

[Gs172003]

Thank you for your input!
She said "trauma-related anxiety" was a new diagnosis in the new DSM and I tried to find it. When I couldn't find it online, I started questioning her competence in my head.

She's implied on two different occasions that she isn't sure about my PTSD.

I can't find it either. I suggest a new therapist.

 

[Sideways]

Is it possible she’s just using lay terms instead of hardcore diagnostic ones?

For example, is it possible she saying that you meet the diagnostic criteria of an anxiety disorder (like generalised anxiety disorder - GAD), and that this anxiety disorder is related to your trauma?

The DSM 5 now recognises that trauma-related disorders are a distinct category to anxiety disorders. There’s so much overlap though, that ptsd used to just be a specific type of anxiety disorder.

Now, the 2 have been separated. But, much like mood disorders, an anxiety disorder can be trauma-related.

That isn’t irrelevant. There are specific types of disorders that are caused by trauma (such as ptsd, acute stress disorder and adjustment disorder). But there are other mental health conditions that can also be caused by trauma, that aren’t necessarily in the DSM’s chapter on trauma - like anxiety.

My interpretation of what your T has said, is that she is undecided about whether you still meet the diagnostic criteria for ptsd. Which is awesome news. Doesn’t mean you don’t have the symptoms anymore (maybe you don’t, which would be really good news), just that they don’t rise to the level of clinically impacting your function. That’s a clinical call about your function levels in relation to your ptsd symptoms.

But what she also seems to be suggesting is that your symptoms, and the way they impact your function, are better described as an anxiety disorder, still related to your trauma, but a different kind of disorder to your ptsd.

Lets not kid ourselves - GAD can be just as debilitating as ptsd, and involve just as much suffering. It wouldn’t be unusual for a person to get treatment for ptsd, and get substantial recovery of the re-experiencing symptoms, but at the same time, develop a mood or anxiety condition as a consequence to having had ptsd.

I’m doubtful it will significantly impact her treatment approach significantly. What seems to be being suggested is that your clinical presentation has changed - but not that you ‘never had’ ptsd, or that you have no ongoing, clinically significant suffering and loss of function.

But the person person to seek clarification from? Is her.

Keep in mind that over 6 consults, she may just not be ready to lock in a diagnosis yet, because it’s still early days.

 

[Nuance]

Is it possible she’s just using lay terms instead of hardcore diagnostic ones?

For example, is it possible she saying that you meet the diagnostic criteria of an anxiety disorder (like generalised anxiety disorder - GAD), and that this anxiety disorder is related to your trauma?

The DSM 5 now recognises that trauma-related disorders are a distinct category to anxiety disorders. There’s so much overlap though, that ptsd used to just be a specific type of anxiety disorder.

Now, the 2 have been separated. But, much like mood disorders, an anxiety disorder can be trauma-related.

That isn’t irrelevant. There are specific types of disorders that are caused by trauma (such as ptsd, acute stress disorder and adjustment disorder). But there are other mental health conditions that can also be caused by trauma, that aren’t necessarily in the DSM’s chapter on trauma - like anxiety.

My interpretation of what your T has said, is that she is undecided about whether you still meet the diagnostic criteria for ptsd. Which is awesome news. Doesn’t mean you don’t have the symptoms anymore (maybe you don’t, which would be really good news), just that they don’t rise to the level of clinically impacting your function. That’s a clinical call about your function levels in relation to your ptsd symptoms.

But what she also seems to be suggesting is that your symptoms, and the way they impact your function, are better described as an anxiety disorder, still related to your trauma, but a different kind of disorder to your ptsd.

Lets not kid ourselves - GAD can be just as debilitating as ptsd, and involve just as much suffering. It wouldn’t be unusual for a person to get treatment for ptsd, and get substantial recovery of the re-experiencing symptoms, but at the same time, develop a mood or anxiety condition as a consequence to having had ptsd.

I’m doubtful it will significantly impact her treatment approach significantly. What seems to be being suggested is that your clinical presentation has changed - but not that you ‘never had’ ptsd, or that you have no ongoing, clinically significant suffering and loss of function.

But the person person to seek clarification from? Is her.

Keep in mind that over 6 consults, she may just not be ready to lock in a diagnosis yet, because it’s still early days.

My last therapist had diagnosed me with GAD + PTSD + Depression if we want to get into specifics.