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challenging a psychiatrist, i don't think i have bpd

sidptitala

Confident
tomorrow i have a second appointment with a psychiatrist i have seen once. the first one was a disaster. i was a dissociated mess, because the second the assessment started i knew in my gut something was off. the dr hadn't read my referral, which he was skimming as he interviewed me. he was huffing and puffing, flustered. asking random questions about me out of sequence, as if trying to catch me out. i had only ever been interviewed like that when in detention by soldiers and a lot of the room seemed the same, the desk, the closed door, my struggle between wanting to appear compliant but also knowing some information it is wise to hold back. also the same was his questions about my personal life, he assumed i was straight and didn't apologise when i had to correct him about that to answer his questions. he also assumed that the person who abused me is not a family member and is someone i'm not in contact with, which is not true (I didn't correct him because i've already had the police come to find me for questioning about this abuse and i sincerely don't want that to happen again, which it would if i said it was a family member).

he missed the part of my referral that talked about a physical attack on me at 21 (that i believe was what led me to initially develop ptsd). i didn't realise this till afterward. he questioned me a lot, briskly, about new memories of sexual abuse from childhood, details i've never told anyone. and immediately once i told him the age i was, started talking to me about borderline personality disorder. he thinks i have that, i think, but i'm not sure why. i don't meet any of the criteria for it. he told me i was impulsive but i don't think that i am. i have after all coped with suicidal ideas for years now without ever acting on them. i also would never have been hired for or been able to work at what i have if i didn't have stellar impulse control. i over regulate my emotional expression; it takes me so long to convince myself it's ok to confess having a feeling in the abstract because i mistrust everyone. i think what makes him think i am impulsive is having lived in multiple countries and having had different jobs (which is because of poverty, immigration status and just plain needing to work). i didn't get an opportunity to respond to him with these things, just told i definitely have ptsd and maybe underlying bpd. the referral he was sent from another psychiatrist (which i have seen) asked him to assess for ptsd and cptsd. but for some reason i got assessed for bpd instead of cptsd? i looked up the dr and it seems he was educated in the US so is likely using the DSM, but even if he doesn't recognise cptsd and the only tool for complex trauma he has is bpd- i don't believe i meet the criteria for this? i'm not sure i would meet the criteria for cptsd anymore either, because i have improved at a lot of the impairments i had when i was younger (but i would like to know this for sure). what im suffering from is absolutely complex trauma but i have healed some of the attachment wound stuff that the diagnosis of cptsd seems to involve.

getting diagnosed with bpd would likely mean i could never work in my profession again, because i need to provide medical records and also certify my psychological stability before each new assignment. i really want to avoid being diagnosed with something i don't think i have, but i also understand that bpd has a history of being used as punishment for noncompliance, difficult women, abuse victims etc. im worried that passivity, dissociation etc will end up with me getting this diagnosis. and im worried that directly challenging this dr will lead to the same diagnosis as punishment.

does anyone have an experience of correcting a psychiatrist on your experiences? how did it go for you, are there strategies you wish you had followed?
 
tomorrow i have a second appointment with a psychiatrist i have seen once. the first one was a disaster. i was a dissociated mess, because the second the assessment started i knew in my gut something was off. the dr hadn't read my referral, which he was skimming as he interviewed me. he was huffing and puffing, flustered. asking random questions about me out of sequence, as if trying to catch me out. i had only ever been interviewed like that when in detention by soldiers and a lot of the room seemed the same, the desk, the closed door, my struggle between wanting to appear compliant but also knowing some information it is wise to hold back. also the same was his questions about my personal life, he assumed i was straight and didn't apologise when i had to correct him about that to answer his questions. he also assumed that the person who abused me is not a family member and is someone i'm not in contact with, which is not true (I didn't correct him because i've already had the police come to find me for questioning about this abuse and i sincerely don't want that to happen again, which it would if i said it was a family member).

he missed the part of my referral that talked about a physical attack on me at 21 (that i believe was what led me to initially develop ptsd). i didn't realise this till afterward. he questioned me a lot, briskly, about new memories of sexual abuse from childhood, details i've never told anyone. and immediately once i told him the age i was, started talking to me about borderline personality disorder. he thinks i have that, i think, but i'm not sure why. i don't meet any of the criteria for it. he told me i was impulsive but i don't think that i am. i have after all coped with suicidal ideas for years now without ever acting on them. i also would never have been hired for or been able to work at what i have if i didn't have stellar impulse control. i over regulate my emotional expression; it takes me so long to convince myself it's ok to confess having a feeling in the abstract because i mistrust everyone. i think what makes him think i am impulsive is having lived in multiple countries and having had different jobs (which is because of poverty, immigration status and just plain needing to work). i didn't get an opportunity to respond to him with these things, just told i definitely have ptsd and maybe underlying bpd. the referral he was sent from another psychiatrist (which i have seen) asked him to assess for ptsd and cptsd. but for some reason i got assessed for bpd instead of cptsd? i looked up the dr and it seems he was educated in the US so is likely using the DSM, but even if he doesn't recognise cptsd and the only tool for complex trauma he has is bpd- i don't believe i meet the criteria for this? i'm not sure i would meet the criteria for cptsd anymore either, because i have improved at a lot of the impairments i had when i was younger (but i would like to know this for sure). what im suffering from is absolutely complex trauma but i have healed some of the attachment wound stuff that the diagnosis of cptsd seems to involve.

getting diagnosed with bpd would likely mean i could never work in my profession again, because i need to provide medical records and also certify my psychological stability before each new assignment. i really want to avoid being diagnosed with something i don't think i have, but i also understand that bpd has a history of being used as punishment for noncompliance, difficult women, abuse victims etc. im worried that passivity, dissociation etc will end up with me getting this diagnosis. and im worried that directly challenging this dr will lead to the same diagnosis as punishment.

does anyone have an experience of correcting a psychiatrist on your experiences? how did it go for you, are there strategies you wish you had followed?
Ugh. The only thing I can tell you is that personality disorder diagnoses have particularly low "reliability"; that is, they are particularly likely to be diagnosed differently by different diagnosticians. That is fact. This is opinion: mental illness labels are just theoretical constructs based on a collection of presenting symptoms so, to some degree (only in my opinion), it's all a bit of a crap shoot. The good news is the likelihood that another diagnostician will diagnose you differently.
 
It is very much a crap shoot because personal bias is available in mental health diagnosis.

i really felt this. my first thought once the interview started was, 'oh no, something is wrong here.' both because of his manner and because i realised he had barely skimmed my referral to him. my gut feeling is that he skimmed it, and decided what patient profile he thinks i fit based on that- the profile being a hysterical young woman from a stigmatised racial and economic background- i have seen in my work tons of diagnoses of bpd based on these reasons alone and the subjective feeling by the clinician that patient emotions are out of proportion. this is what really worries me.

i am going to do what i can to be polite but assertive today, and not dissociate. to ask him more questions and maybe ask to see a different psychiatrist if i do end up diagnosed with bpd.
 
tomorrow i have a second appointment with a psychiatrist i have seen once. the first one was a disaster. i was a dissociated mess, because the second the assessment started i knew in my gut something was off. the dr hadn't read my referral, which he was skimming as he interviewed me. he was huffing and puffing, flustered. asking random questions about me out of sequence, as if trying to catch me out. i had only ever been interviewed like that when in detention by soldiers and a lot of the room seemed the same, the desk, the closed door, my struggle between wanting to appear compliant but also knowing some information it is wise to hold back. also the same was his questions about my personal life, he assumed i was straight and didn't apologise when i had to correct him about that to answer his questions. he also assumed that the person who abused me is not a family member and is someone i'm not in contact with, which is not true (I didn't correct him because i've already had the police come to find me for questioning about this abuse and i sincerely don't want that to happen again, which it would if i said it was a family member).

he missed the part of my referral that talked about a physical attack on me at 21 (that i believe was what led me to initially develop ptsd). i didn't realise this till afterward. he questioned me a lot, briskly, about new memories of sexual abuse from childhood, details i've never told anyone. and immediately once i told him the age i was, started talking to me about borderline personality disorder. he thinks i have that, i think, but i'm not sure why. i don't meet any of the criteria for it. he told me i was impulsive but i don't think that i am. i have after all coped with suicidal ideas for years now without ever acting on them. i also would never have been hired for or been able to work at what i have if i didn't have stellar impulse control. i over regulate my emotional expression; it takes me so long to convince myself it's ok to confess having a feeling in the abstract because i mistrust everyone. i think what makes him think i am impulsive is having lived in multiple countries and having had different jobs (which is because of poverty, immigration status and just plain needing to work). i didn't get an opportunity to respond to him with these things, just told i definitely have ptsd and maybe underlying bpd. the referral he was sent from another psychiatrist (which i have seen) asked him to assess for ptsd and cptsd. but for some reason i got assessed for bpd instead of cptsd? i looked up the dr and it seems he was educated in the US so is likely using the DSM, but even if he doesn't recognise cptsd and the only tool for complex trauma he has is bpd- i don't believe i meet the criteria for this? i'm not sure i would meet the criteria for cptsd anymore either, because i have improved at a lot of the impairments i had when i was younger (but i would like to know this for sure). what im suffering from is absolutely complex trauma but i have healed some of the attachment wound stuff that the diagnosis of cptsd seems to involve.

getting diagnosed with bpd would likely mean i could never work in my profession again, because i need to provide medical records and also certify my psychological stability before each new assignment. i really want to avoid being diagnosed with something i don't think i have, but i also understand that bpd has a history of being used as punishment for noncompliance, difficult women, abuse victims etc. im worried that passivity, dissociation etc will end up with me getting this diagnosis. and im worried that directly challenging this dr will lead to the same diagnosis as punishment.

does anyone have an experience of correcting a psychiatrist on your experiences? how did it go for you, are there strategies you wish you had followed?

Due to past failed psychiatrist experiences, I have zero belief in psychiatrists for they seem like they're reading tea leaves and have already formed their own narrowed and biased opinions about me and my mental health.
 
I got really lucky because that dr was out sick ( i think) today, so i saw someone else (who seems to be junior, in my experience the junior drs seem much more attentive). it was a woman, and she listened to me.

my gut feelings were right. the man i saw before wrote copious notes when i was talking to him, but didn't write down any information about the traumatic events i was talking about. he wrote about how i am doing and information about my 'social history' without any reference to these events. after hearing them, the psychiatrist i saw today said, 'these events justify a diagnosis of ptsd'. i asked her directly if i am already diagnosed with anything and she just said ptsd- she seemed surprised that i questioned that. no mention of bpd was made at all. she took me seriously as a person who is definitively struggling with the symptoms of ptsd and that alone.

it made such a difference, oh my god. to be listened to, and in a sympathetic manner as well. i really can't believe that the previous psychiatrist didn't write down any information about traumatic events. just looked at my referral and decided i was impulsive and unhinged- an unreliable narrator. i would love to see his pattern of diagnosis- i wonder if every woman or close to it gets bpd.
 
I got really lucky because that dr was out sick ( i think) today, so i saw someone else (who seems to be junior, in my experience the junior drs seem much more attentive). it was a woman, and she listened to me.

my gut feelings were right. the man i saw before wrote copious notes when i was talking to him, but didn't write down any information about the traumatic events i was talking about. he wrote about how i am doing and information about my 'social history' without any reference to these events. after hearing them, the psychiatrist i saw today said, 'these events justify a diagnosis of ptsd'. i asked her directly if i am already diagnosed with anything and she just said ptsd- she seemed surprised that i questioned that. no mention of bpd was made at all. she took me seriously as a person who is definitively struggling with the symptoms of ptsd and that alone.

it made such a difference, oh my god. to be listened to, and in a sympathetic manner as well. i really can't believe that the previous psychiatrist didn't write down any information about traumatic events. just looked at my referral and decided i was impulsive and unhinged- an unreliable narrator. i would love to see his pattern of diagnosis- i wonder if every woman or close to it gets bpd.
I am so very happy for you that you felt heard. Your relief is palpable.
 
it made such a difference, oh my god. to be listened to, and in a sympathetic manner as well.
I always find threads like this interesting. I am glad for you getting recognized.

I was diagnosed by a psychiatrist initially, right in the middle of the Covid shutdown - so the appointment was by phone. The Doc was the head of psychiatry at the local university by some odd chance.

There was no PTSD diagnoses, just GAD and a bunch of other things but I did ask. He said that the PTSD diagnoses would come from my psychologist during therapy, once they found the correct diagnoses for my trauma. He did say it sounded likely but until there is that diagnoses that described my trauma, it wasn't PTSD.

I sure wish everyone getting help knew two things:

1. Your psychiatrist should give you a generalized diagnoses of the conditions that exist that indicate a possible problem, and recommend a course of treatment. No more no less.

2. Your True diagnoses, should come from therapy work. Hopefully with a psychologist who has all the specific information with which to make that specific diagnoses.

IMO, many people are damaged by premature incorrect diagnoses when they should get a general diagnoses of conditions that exist only until they have the specifics to make that diagnoses.
 
@Freddyt that’s fascinating. I had no idea. Now it’s making more sense why It had diagnoses of OCD, Schizoid Personality Disorder, and Borderline Personality Disorder before the diagnosis of PTSD which came from the therapist who uncovered the trauma.
 
@Freddyt that’s fascinating. I had no idea. Now it’s making more sense why It had diagnoses of OCD, Schizoid Personality Disorder, and Borderline Personality Disorder before the diagnosis of PTSD which came from the therapist who uncovered the trauma.
One of my favorite authors, Terrance "Spike" Milligan was in the Royal Artillery in WW2. After an incident during fighting around Monte Cassino he was first diagnosed as "shell shocked".
Months later when he received his first real diagnoses it was "manic depressive, anxiety triggered". Through his lifetime he was diagnosed with many different ailments but in reading his books I can see a clear change in his writing. And in his life. Outside the depression, there are lots of clear signs he had PTSD.
Despite living past the time PTSD became known, he was never diagnosed, likely because everyone focused on his depression, which was only a symptom.

Sometimes Dr.'s get focused on fixing an obvious part of the problem.....but never look at the whole problem. I used to work troubleshooting and repairing printing equipment. I found that focusing on an obvious problem alone was never what you did. Nothing was ever fixed until you found and solved the root problem - the real cause.

IMO, most misdiagnoses happen the same way. Rather than taking in ALL possible information, and then putting all the information together to see the whole problem, they fixate on one part - like Spike Milligan's manic depression - and they never fix the source - anxiety.

People don't know when they visit a psychiatrist they should walk out with a set of symptoms for the psychologist to use to help find the real problem. Because really? You should almost never walk out of a psychiatrists office with a diagnoses of PTSD. That's for the psychologist to find the specific case that IS PTSD. And not just any psychologist, a psychologist who specializes in treatment of trauma care.

I got lucky in that my first contact was with someone who obviously was up to date and who had a very good understanding of the diagnostic process. Problem is - you don't know walking in the door if you are seeing the guy who was first in his class - or last........
 
He said that the PTSD diagnoses would come from my psychologist during therapy, once they found the correct diagnoses for my trauma. He did say it sounded likely but until there is that diagnoses that described my trauma, it wasn't PTSD.
Can you explain more about this? I think that the system of diagnosis in the country i'm in might be different from this. What do you mean by 'diagnoses that described my trauma?'

In general, ptsd diagnoses in my country are incredibly rare (as is psychological treatment for it). I am lucky in that I have a very clear idea of which events led to my symptoms and have always been able to centre those events with doctors.

Usually people here see a general practitioner first, who prescribes medication- and only if this doctor feels out of their depth they refer on to a psychiatrist (this is also pretty rare). Usually the psychiatrist prescribes medication and may diagnose a person, but often doesn't. For eg you can be on antipsychotics for hearing voices for many years before getting an eventual diagnosis of schizophrenia. But the psychiatrist doesn't usually work with a psychologist. In my case, I knew that if i had a diagnosis of ptsd from this psychiatrist I would get referred to a psychologist for CBT. If i got one for bpd, I would not be referred anywhere as that would be seen as an intractable personality issue. Neither a psychologist nor a therapist would have any input into a diagnosis- only the psychiatrist can do that- and his diagnosis determines what type of help i could access.
 
What do you mean by 'diagnoses that described my trauma?'
There is a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Based on what your trauma was caused by, there are specific diagnostic codes.
As an example - Unspecified Depressive Disorder code is F32.A so DSM-5-TR F32.A

The reason is they can if needed provide the reason for your trauma without specifics for say a disability insurer, or in referring to another psychologist, (all with your explicit permission of course.) because "he/she has PTSD" is to broad a brush for most of those to accept as a diagnoses.

It's why I said my psychiatrist didn't diagnose. He found GAD and other conditions that may accompany PTSD but until they found the trauma itself? There is no diagnoses. Because its not A, B, C, or D without finding the specific conditions that are causing it.

As with all things - this is generally and there are exceptions.

Usually people here see a general practitioner first, who prescribes medication- and only if this doctor feels out of their depth they refer on to a psychiatrist (this is also pretty rare). Usually the psychiatrist prescribes medication and may diagnose a person, but often doesn't.

My path was my GP - who got me to the mental health nurse, who made the appointment with the Psychiatrist, then back to the mental health nurse who helped finding a psychologist. Later my GP recommended a psychiatrist. As for meds - that was between the GP and the Psychiatrist. I chose to go with minimal medication - like I said - I made it 45 years without it, I think I'm OK to choose what I need meds for, which is benzo's for medical appointments or stressful events.
 
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