My therapist (MD) won't tell me a diagnosis

[rumor18894]

Or maybe he did at one point and I conveniently forgot it. I've hinted that I'm not sure what I've got to him a couple of times, but he doesn't really address it. Should I ask him outright? What if it is that he told me a couple times and I just keep forgetting (or blocking it out)? I don't know if I want to analyse why I keep forgetting (if that's what it is) or why I require labels because... I dunno. It's like it's embarrassing for me not to know? Something like that? Like when someone told you their name and it's too late to ask them and now you've been working together for two years. But having a label would help me find a community and also let me talk about it more openly without being afraid of being called a liar. I don't know why I feel so unsure about talking about it with him.

 

[bellbird]

What qualification does your therapist have? It may be that they are unqualified to make a diagnosis.

A range of professions fit under the umbrella term of "therapist", some have the skillset to make a PTSD diagnosis, such as a clinical psychogist, while some, such as a counsellor, do not.

Alternatively, if they have diagnosed you and you've forgotten, there's really no harm in asking directly. :)

 

[rumor18894]

He's an MD.

Is it normal for him not to have told me a diagnosis and to keep it from me?

 

[bellbird]

As a patient, you have a right to access your own medical records.

So if you did request it, it would be against medical protocol/possibly the law to withhold it from you.

If he hasn't told you but you didn't request it, it may just be that he feels that focusing on your treatment is more beneficial? I'm not sure, I can only guess.

When I got my depression diagnosis, for instance, my doctor never formally announced it to me; we focused more on talks about my symptoms and treatment. But if I'd have asked, I know she would have told me.

With my PTSD diagnosis, I've been diagnosed independently by the 3 psychiatrists I've seen. 2 told me, 1 I asked.

 

[Teamwork]

The way you wrote this initial thread, came across to me, that if he has told you, you may have forgotten and that you have hinted. So, neither of those are withholding scenarios. Try direct communication on the topic. Have you diagnosed me, if so what is your assessment of me and what treatments are we doing, long term goals. if you are paying for a service, you want to know what the goods are. You don’t need to justify wanting to know something, you need more so to communicate a desire to learn what your diagnosis is and how it plays out in your life.

 

[Muttly]

Can you print out this post and show him. It's a worthwhile conversation. Not just that you would like to know but your concerns around asking.

 

[Friday]

Should I ask him outright?

Yep.

What if it is that he told me a couple times and I just keep forgetting (or blocking it out)?

Also feel free to ask him that, as well.

I don't know if I want to analyse why I keep forgetting (if that's what it is) or why I require labels because

Seperate issue(s). That you don’t have to be ready to tackle, before finding out if there is a formal diagnosis on file. Much like... but I don’t know if I should learn to drive, because I don’t know that I want to be a race car driver.

Or maybe he did at one point and I conveniently forgot it.

You also might not have asked, or you might not have a formal diagnosis / have several steps to accomplish IF that’s something you want. A lot of people don’t want a diagnosis on file, so providers -who are qualified to diagnose- often use interim/ubiquitous codes, instead. Because a patient/client doesn’t have to have a diagnosis in order to be seen, treated, and insurance billed. For either medical or psych. My son? Spent 2 years with a premier children’s hospital, millions and millions in treatment cost... all without a diagnosis. Because they didn’t know what was wrong. The billing codes used were, instead, this dept. that specialist, this test, that procedure, etc. Psych is much the same. There are generalized codes to be used, if a diagnosis isn’t known, or isn’t wanted, or is wanted but cannot be afforded at this time (in the US a formal Dx is usually around $700 out of pocket, and often goes higher, as specialised medical tests can run into the thousands).

 

[rumor18894]

Is there a specialised medical test for PTSD? I thought that was just the psych diagnosing on their own judgment.

 

[Friday]

(Sorry! Thought ai’d responded to this awhile back)

Is there a specialised medical test for PTSD? I thought that was just the psych diagnosing on their own judgment.

In short? No. Or at least, ideally not.

- There are several hundred medical conditions that can mimic psych conditions, and the most likely of those are ruled out, or possibly ruled in (someone with a hormonal imbalance can also be depressed, or the depression can be caused by the hormonal imbalance, for example.

- Then there are several standardized tests that help DDX (differential diagnosis) between the 300 some odd psych conditions that all share symptoms... between 500-1500 questions, some general (all psych conditions) some targeted (certain clusters/groupings of similar conditions, or individual severity scales). They not only test for different disorders/conditions, but also check for lying, exaggerating, minimizing, and several other tendencies within the test itself (so very very different than the little internet quizzes of 5/25/50 questions!)... but the results on those tests aren’t complete in and of themselves. (For example someone who’s child is dying of cancer, or a doctor? May score just as high on medical anxiety as someone with hypochondria, or medical trauma. But those are 4 very different things. Or a person can test super high for potential alcoholism, but only drink half a glass of wine twice a year... in a family whose religion doesn’t allow alcohol. Just because people are telling them to stop drinking, and that they’re concerned about their drinking, etc.? Doesn’t make them an alcoholic. Context matters, and the tests are designed in such a way as to allow for that. The test flags certain areas for the evaluator to discuss in detail with the person taking it, and the values are altered based on their determination of circumstance/context.)

- THEN there’s the diagnostitician’s best judgement, on top of those two things. How that works varies rather seriously. Many clinicians will refuse to officially diagnose someone without working with them for several months, including not just therapy but also things like med trials and evaluating both symptoms and expression, and several other things. Others are perfectly comfortable with written statements and questionnaires from people in all areas of a person’s life... family, friends, coworkers, teachers, etc. Whilst others want 24hr observation for some period of time, often several days.

So (ideally) it’s a combo of medical, objective/subjective testing, and subjective evaluation.

Of course, there are also doctors -usually medical doctors, with no specialized training in psych or psychiatry- who will meet with you for 15 minutes, run no testing or differential diagnosis of any kind, and slap a diagnosis on you... but those ones are the most likely to be incorrect.

 

[rumor18894]

I ended up having to get a note for class, so my question was answered without me actually asking about it yay for best case scenarios!

I ended up having to get a note for class, so my question was answered without me actually asking about it yay for best case scenarios!

But PTSD wasn't listed, which I guess is a good thing? I don't think I have the right symptoms for it, but reading through this forum has helped me so much that I think it's just the thing where I feel like I'm intruding even when everything here is so relatable. But it's not like having a PTSD diagnosis is something to strive for.

 

[Wonder Woman]

But PTSD wasn't listed, which I guess is a good thing? I don't think I have the right symptoms for it, but reading through this forum has helped me so much that I think it's just the thing where I feel like I'm intruding even when everything here is so relatable. But it's not like having a PTSD diagnosis is something to strive for.

Hi, rumor. Even if you don't have PTSD, there are many things on this site that can help with other things such as depression and anxiety.

Also, keep in mind, if you haven't opened-up to your therapist about any past trauma you may have experienced, you won't be diagnosed with PTSD. That is very different from not having PTSD.

I don't know your specific situation, but I just wanted to throw this out there in the event it might help you, or someone else reading this thread.

 

[rumor18894]

Hi, rumor. Even if you don't have PTSD, there are many things on this site that can help with other things such as depression and anxiety.

Also, keep in mind, if you haven't opened-up to your therapist about any past trauma you may have experienced, you won't be diagnosed with PTSD. That is very different from not having PTSD.

I don't know your specific situation, but I just wanted to throw this out there in the event it might help you, or someone else reading this thread.

I have definitely opened up about trauma with my T ahahaha I think that happened in my first appointment tbh but I do think b/c like I don't get flashbacks or blackouts, he's trying to shy away from a PTSD diagnosis. I mean, I guess I don't know for sure, but I definitely don't have the standout PTSD symptoms.