Seeking A 2nd Opinion

[GWhizz]

Not too sure what exactly to post this under.

Basically, I was referred by my gp and therapist to a psych service to assess me for a formal diagnosis, namely ptsd as per their initial opinions.

However, since I 1st met with them and brought up the idea of my thoughts on what was going on - I was outright dismissed.

1st of all, it could only be depression. When I stressed how, whilst I did feel low at times and even suicidal, I did not feel this was a primary issue moreso an ongoing response to the anxiety around constant unpredictable nightmares, flashbacks and resurfacing memories I couldn't bear to live with indefinitely. Nonetheless, my meds for depression were only increased, I was told I'd be referred to a 'dealing with depression' group (even though I'd expressed my unwillingness to attend group therapy at this particular time). I was then told I was being referred back to my gp without a full assessment/diagnosis, that I couldn't meet a ptsd diagnosis as my trauma was over 6 months ago and it was more than a single isolated traumatic event. I literally begged and pleaded to have some form of assessment and so they agreed to do some tick-the-box format like tests. These came back with: ocd traits, moderate-high anxiety, some ptsd criteria (but apparently I can't fit the diagnosis as I didn't score high on dissociation, oh and also avoidant behavior even though I was asked to complete the forms as I couldn't speak about my trauma and do everything to avoid it or a flashback), but mainly bpd traits but not high enough to constitute a formal diagnosis. Also I am officially not depressed, moreso anxious and instead they now have referred me to their 'dealing with anxiety' group, despite my continued expressed reluctance to undertake group therapy and requests for one-to-one cbt.

I feel that the bpd traits picked up on (my willingness to be a people-pleaser and never say no apparently, or my apparent need to control and avoid talking about things - probably compensating for my lack of control over the nightmares etc) have been totally misread. But who am I to argue with their test scores? That is, until the clinical psychologist who gave me the tests, stated she cannot give a full assessment report in the absence of a clinical interview. I then asked her to conduct an interview. She responded that she didn't do one as, apparently, I showed reluctance. Yes, because 5 minutes into meeting her she asked me to spill my deepest darkest and I had requested on that occasion, that she maybe wait a little while (even in that one hour time scheduled for our 1st meeting), before expecting me to rehash everything about my past.

Anyway, long story short, she refused to conduct an official clinical interview, as did the psychiatrist I attended who just bumped up the depression meds. Now I'm off the meds (as I'm not actually depressed and I feel a lot better off them in fact), the psychiatrist has no need to see me, and the psychologist just tells me I had this preconception about ptsd and I can never meet the criteria, for the reasons mentioned already. I told her she's wrong and my partner asked her to define ptsd to which she refused outright. He even asked her 'are you dodging my question' and she replied 'yes, I am'! So frustrating.

So after 6 months - it's taken this long to get nowhere - they tell me I'm not in the right service. I had asked them if this was the case months ago and they said no. They are my only psych service in my catchment area and I cannot afford privately. My only option is to switch teams in this service if they'll approve it, and hope that the 2nd team I meet won't have this closed view about trauma.

I mean her report did not even refer to my sole reason for seeking their services - nightmares and flashbacks! She basically told me all of my issues were personality related as that's the closest match-up from the written tests. So I asked her if everything that happened to me as a child/teen was my fault because of my personality, and she looked at me blankly and shrugged her shoulders.

I don't know what to do. Am I crazy and hopeless for even seeking a formal diagnosis (it was only to get appropriate treatment which I could avail of for free at this service if deemed suitable)? Am I crazy to suggest that I may have ptsd because I fit all the criteria as per the dsm and my gp/therapist felt it was plausible? Do my current psych team just suck or am I just a pain-in-the-*** patient?! And finally, should I bother seeking a 2nd opinion after this one has left me so disillusioned and questioning whether it's all personality-based problems I've always had? One thing is for sure, the nightmares aren't letting up (it's 2.15am right now and I can't sleep though I'm exhausted). I'm no wiser and feel about ten steps back from 6 months ago. Honestly, I don't even care for an official diagnosis anymore - I just want sleep and a half-normal life whereby I'm not constantly on edge, in fear of the panic a flashback/memory may bring up.

Sorry this is so long and probably a bit all over the place.

Thanks for reading if you made it this far!

 

[joeylittle]

The one thing that strikes me is that you might get some relief starting to happen if you go ahead and treat symptoms, and not get too stuck on anything else right now. I think you are dealing with a real pain-in-the-ass system, it sounds horrid; but it also sounds like you can access some resources there to at least address some symptomology, if not the root cause (trauma).

I also think you are deeply in need of validation from these people, but it sounds like its not going to happen. Switching treatment teams would be a good way to start over and see not if they will give you the diagnosis necessarily, but at least if they will hear you out on everything.

Anyway - group CBT is something that could really help; in groups like that - at least in the US - there's not much time spent on talking about individual traumas or experiences. It's about learning this whole new vocabulary, and then taking responsibility for applying it to yourself. I think everyone can benefit from a bit of it.

And learning skills to manage depression - whether you have it under PTSD, as you think, or on its own (which I agree with you, sounds not quite likely) - is going to always be helpful.

The piece that you aren't going to get without the diagnosis is the trauma counseling, right? Can you get that even if they consider it PTS, not PTSD?

(Sorry, am a bit tired and my typing is kind of loopy. I really am trying to help)

 

[anthony]

that I couldn't meet a ptsd diagnosis as my trauma was over 6 months ago and it was more than a single isolated traumatic event.

Whoever the assessing physician is, obviously hasn't picked up either the DSM or ICD, because its called PTSD with delayed onset, being a sub-type of PTSD. The majority of people with PTSD are delayed onset, a minority actually meet PTSD immediately after a traumatic event, and recover the normal symptoms within a few months to go on with their lives. PTSD statistically as a majority will strike beyond six months.

 

[Chava]

It sounds like you'd feel better if you looked for a second opinion. Also, I'm not sure how it all went down in terms of assessment and tone, but if you are going in specifically for a diagnosis, you maybe do have to spill some stuff you don't want to, especially if it's the stuff that meets the ptsd criteria. I did this once and was just sort of walled off or numb as I objectively said the least bit possible. But in the end I didn't like the treatment for PTSD at the time, or the person I was working with (creepy), and simply wasn't willing or able to deal with lots of stuff. And even at the time I was confused by the fact that I was so messed up BEFORE a recent assault (just added suicidal after) and frankly didn't want to focus on that one event. Many years later c-ptsd makes more sense to me, even if not an official diagnosis. But that's more because the treatment is in line with my "stuff."

So, if you're looking for treatment for your symptoms, have you considered a trauma therapist who doesn't need you to have the official PTSD diagnosis? Maybe that's not an option though? Or anyone who can help you with your symptoms, regardless of diagnosis type? Or if you need an official PTSD diagnosis to work on your symptoms, look for a second opinion. But whether out loud or in writing, it sounds like you're looking for a sort of quick assessment and might need to tell them more versus feel like you have PTSD based on trauma you won't tell them about. ??? Not sure if I'm reading you right here.

The 6 month thing is confusing. They don't think you can have PTSD because your trauma was more than 6 months ago?? It's the reverse, right? Like you can't really diagnose PTSD if the trauma was less than about 6 months ago (since trauma is trauma and some people recover while others go on to develop PTSD).

Finally, if there's any chance you don't have PTSD, is there a way for you to work with a trauma therapist anyway? Complex trauma can be muddy, and there is no set diagnosis yet. But there are people who work with complex trauma.

 

[KwanYingirl]

I think where psychiatrists go, it is valuable to get two or more opinions. You have been tossed aside by this group of goobers. My trauma therapist has a poster with PTSD in the center with lines around it ending at all the effects of PTSD. Such as BPD, major depressive disorder, avoidant personality, ocd, etc. his point being look at the core condition. Treat that and the collateral quirks can get worked out.

 

[anthony]

People wonder why the system is so broken... globally... it starts at the physicians.

 

[darrenS]

it took about 8 years of therapy and several changes before i was properly diagnosed...at first they thought i was bi-polar and the meds nearly killed me, then i was depressed and again the meds sent me loopy , then it was anger management and on and on and on , it was not until a abuse situation occured which triggered me, sent me overseas into extreme danger and trauma for a long period, and it wasnt until i got back and discussed these , did they diagnose ptsd, after 4 more years and a few moves and therapists - it is deemed far more serious. It took a lot of hoops and misinformation and its fairly common. just deal with what you can and most importantly look after you - every doc has a different opinion.

 

[Seagreen]

Yes seek a second opinion! This is your life. It is important

 

[Seasounds]

• Something that may be very helpful, because it will be factual, logical, and sequential (just what Providers relate to) is to:
• Write a chronological history, from your earliest symptoms to the present, citing your age, symptom and life circumstance. Bring in two copies, one for you and one for the Provider, so you can logically go through your condition. (For example, at age 22, at my brother's wedding, for the first time since I was 5, all of my family members were in one room. At that time I had my flashbacks; or depression started when I started to flirt-had flashbacks that made me cry, etc.)
• A private practice Psychiatrist will take more time to diagnosis you and has more depth of diagnostic experience than a psychologist or masters level therapist.; a good diagnosis is based on a few things: your reporting symptoms, the things you've done (therapies or meds) that have helped or worsened your condition, and the 'sense' that the Provider gets, while spending time with you. Finding the right diagnosis, may be a work in progress; it can take a while to find the diagnosis that fits most of your symptoms most of the time.
• It is probably most important that you feel heard and that your uncomfortable symptoms are treated, in the process of finding a diagnosis.
• Know that many Providers tend to be leery of new patients who are really anxious (it makes them anxious), or who ask for meds..
• I think a second or even a third opinion is a good idea.
• I found that many Providers really hate for the client to come in with the diagnosis that they want. It is kind of like, the Providers want to come up with it, themselves.
• And, personally, I think it is a great thing, to share your ideas; I'd do it as a suggestion, just be laid back about it. (Politics are everywhere.)

 

[Deleted member 1860]

I agree with much that has already been posted.

Given that your assessor was woefully uneducated about PTSD, I'd say that you should indeed seek out another opinion by someone who is qualified and has experience with treating the disorder. This man clearly does not.

PTSD can definitely come on after 6 months. Mine came on after 25 years. I have the subtype "delayed onset".

Not high enough on the dissociation scale? That's pure bunk. I took one of those tests (MID? DES? one of those two) and my therapist told me I actually scored lower than normal non-PTSD people! I re-took it 3 years later when I was in a MUCH better place and this time I was told that I had DDNOS (I don't think that's accurate, either, as my dissociation does not rise to the level of causing issues in my life). The test itself is flawed b/c it goes by percentages, in increments of 10. So of course I answered "zero" for many dissociation symptoms b/c if I circled 10 that meant that 10 percent of the time I had that symptom, 1 out of every 10 minutes.....that's a LOT of dissociation if you think about it.

Please seek out a second opinion. No, you're not crazy AT ALL for wanting an accurate assessment! A diagnosis is important, and then again it isn't. It is important in that it can help you get the right kind of treatment, but it isn't in that it is not needed in order to heal.

I have the PTSD/depression diagnosis, too. But, I can honestly say that I do not have typical "major depression" symptoms. Mine is pretty much all anxiety fueled and when my stress cup overflows, my system shuts down. I go numb and my functioning hits the floor. Treating the depression does nothing, and depression meds make me SO much worse (hypomania, increased anxiety, and EXTREME rage). Anything that hits those serotonin receptors affects me like this. But, if I attack the anxiety, the depression automatically gets better. Maybe that's what's happening with you? Just a thought. (I know we're all different.)

I wish you the best. I know its not easy.

 

[Seasounds]

To know you aren't crazy, granted PTSD was not ascribed to sexual trauma victims, until in the past thirty years, openly. I went through 20 years of therapy before someone put the "whole picture" together, and before I could really speak through my frozenness, and before my symptoms got so much bigger (because I joined the real world and got exposed to more triggers) that my symptoms were finally obvious to someone outside myself (we all can feel a pimple before someone else can see it.)

But inside, all the while, I knew my symptoms were PTSD, when I was in junior high. My feelings and symptoms were mentioned, while listening to Vietnam Vets share their stories. I'm so grateful for Vets, in that way.

 

[GWhizz]

@joeylittle you're typing wasn't loopy - I appreciate your response even more if you took the time whilst tired. I will continue to try to consider the group thing though for now I just don't feel it's right right now if that makes sense.

@Chava they said that because now it's over ten years since my last trauma it can't be ptsd - they apparently won't even consider delayed onset or the fact that I did have symptoms years back which were just never picked up on because I was far far too avoidant back then to seek help. I spent the past year with a therapist and the furthest I managed was writing. I never refused to discuss my past with the psychologist, simply asked she try take it slow (a reasonable request in my opinion), and apparently she took that as 'I'm never talking about it or writing it down or so on'. I begged her to do a verbal interview actually when I last saw her but she refused saying now she thinks I'm not ready to do one - because she knows better than me of course sigh. They do acknowledge there is complex trauma, only on what my gp told them though I doubt c-ptsd would be on their minds when they dismiss ptsd already!

Yes @anthony I had a thread related to this a few months ago where I asked if ptsd couldn't be delayed onset as I was being told this straight off the batt. I was given some useful UK and irish links which show 15-20% of cases present as delayed onset and so I brought this up with my team, but hey I guess they don't like me speaking unless spoken to - they have a good way of shutting me down into that muted child again, making it near impossible for me to broach any of my issues even when I will myself to do so.

@KwanYingirl yes they seem to be a sewn together team of bottom-half-of-the-class-ers, so frustrating trying to get anywhere.

@darrenS yes I feel like I have a lot more hoops to jump through. Also, that incident I previously mentioned about self-harming, was mainly down to an erratic mood fuelled by upped serotonin meds I never felt good on and also had a compulsion to self-harm on - I have since come off them altogether thankfully and feel so much more level-headed and like myself.

@Seagreen yes a 2nd opinion is most likely what I'll seek though it's so draining all these rigorous tests.

@change thanks for the list idea I will try that, and while I know a diagnosis isn't everything, I really do just want help with my current symptoms and how they affect my life now. And yes, I agree with the politics and see in hindsight I was silly to ever suggest what I thought maybe wrong - but then I only did so because they kept pointing to depression full-stop.

@Solara yes I agree my anxiety is the primary problem here too.

Thank you all for your purposes and sorry I don't have time to give more thorough replies.