General Diagnosis Wrong?

[quietpool]

So generalized anxiety does not seem to include dissociation, nightmares/terrors, triggers. Yes spouse has these other symptoms but I don't feel like they come out of nowhere I always feel like they are triggered versus operating out of a constant place of overall anxiousness. At the very least I am not convinced that GAD is the complete picture.

"Signs & Symptoms
People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress.

When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe."

 

[Justmehere]

Hmmm. Since you have told the therapist about some of the symptoms, and the therapist has the training they do, then something is amiss! It could be that the therapist is totally blind to it, but I'm still hesitant to believe it - but it is very possible this could be a very clueless therapist.

Maybe at a time when your husband and you are on good footing (not in a heated or frustrated moment) you can sit down with him and ask to go with him to talk to the therapist about your concern about the diagnosis being incorrect? In the end, it's his denial that has to change in the long run. If he believes he has PTSD and he is ready to get help for it, then that would be ideal. He would be more willing to share it with the therapist himself and/or find a new therapist or (preferably a psychologist or doc) to more properly diagnosis and treat him. Perhaps on a good day, when things are already going well, you can show him the list of symptoms of GAD and PTSD and ask him which you think fits better and share your concerns with him that the diagnosis is incorrect? Ask him what he wants to do about the diagnosis? Or has he already said?

I was diagnosed with GAD before I was diagnosed with PTSD as an adult. They are both anxiety disorders, but you are very right that GAD does not include night terrors and flashbacks and etc. CBT can help both, but it's much better if it is trauma focused CBT if there has been trauma in the mix.

I also shut down with people at times. A lot of people with PTSD do. The thing about pushing is that it tends to make some people shut down more and more and then the other person pushes more. It's a very tough cycle that happens all the time. It's extra hard when someone we love is in pain - as a supporter or sufferer. It is a very lonely place to be when I am shut down. I have also been on the outside of someone else being shut down due to PTSD. Oh my goodness, it is very tough. Makes me almost want to scream. I admire your patience and endurance through this.

It's very pro-active of you to seek out this therapist and meet with him before your husband did about your concerns he has PTSD! That is a great step that you took.

Maybe it's time for a new way to approach it? Instead of focusing on his diagnosis and his treatment (which are very important) it might be helpful to focus on what you need and want from him. When I am shut down, and/or highly symptomatic, sometimes when someone gently tells me what they need in the relationship, I am more motivated to figure out how to make it work and get the outside support I need to manage my symptoms to make it work better for the other person.

In the end, no matter how much advocating you do, he has to be the one to want to change, and to do the hard work of changing. The only person you really can change is you. Which is the very hardest thing about being a supporter.

My heart really goes out to you. GAD really doesn't fit, and it's hard when no one seems to be listening. :hug:

 

[shimmerz]

I don't feel like they come out of nowhere

They don't. T-doc and I have spoken about this over and over again. It was the foundation of digging for my truth which we had no way of knowing but I trusted that he trusted that there is a basis for all of these experiences and subsequent behaviours.

 

[quietpool]

@Justmehere I really hope they are not clueless, but I'm feeling pessimistic! I have run into the occasional clueless therapist.

We did talk about the GAD diagnosis and I mentioned that PTSD is not always so black and white, but I had to be careful not question them too much or offer to many of my thoughts. Maybe later on when things kind of settle again we can address it. I am going to connect with my therapist in the interim to help me out a bit too.

That makes sense that he needs to be the one to come to that conclusion ultimately, and decided he wants help. Maybe he takes his time with this therapist, gets some confidence and then finds someone more specialized if that's what he ends up needing.

I was diagnosed with GAD before I was diagnosed with PTSD as an adult. They are both anxiety disorders, but you are very right that GAD does not include night terrors and flashbacks and etc. CBT can help both, but it's much better if it is trauma focused CBT if there has been trauma in the mix.

Thanks, this is helpful to know. I think it would be better if things were trauma focused too, especially in light of his deployment and other things.

I also shut down with people at times. A lot of people with PTSD do. The thing about pushing is that it tends to make some people shut down more and more and then the other person pushes more. It's a very tough cycle that happens all the time. It's extra hard when someone we love is in pain - as a supporter or sufferer. It is a very lonely place to be when I am shut down. I have also been on the outside of someone else being shut down due to PTSD. Oh my goodness, it is very tough. Makes me almost want to scream. I admire your patience and endurance through this.

I know the pushing makes it worse, but as you said you get caught in this tough cycle especially when this feeling of helplessness kicks in! I forget that spouse might actually feel lonely too when the shut down because looking from the outside it seems they want to be as far away from people as possible.

It is tough :(! Thank you, I am not always sure how I am really doing in the patience/ endurance department at times, sometimes I feel like I just fail!

Thank you, I wanted to get a better perspective on things so I would be less frustrated overall!

Maybe it's time for a new way to approach it? Instead of focusing on his diagnosis and his treatment (which are very important) it might be helpful to focus on what you need and want from him.

This is a really good idea, especially because at the core spouse does care about me and the relationship. And I think they might feel similarly to you about feeling more motivated with honest communication based on needs. When I communicate that way, I think they don't feel helpless but like they have a goal and something they can do.

In the end, no matter how much advocating you do, he has to be the one to want to change, and to do the hard work of changing. The only person you really can change is you. Which is the very hardest thing about being a supporter.

Yeah I know that is true, it is the hardest part of being a supporter :(

I have to find a way to let go a little bit so I don't drive myself into the ground and try and focus on myself. Your right, I can only change me.

My heart really goes out to you. GAD really doesn't fit, and it's hard when no one seems to be listening.

Thank you! :) I appreciate hearing your thoughts and perspective, GAD does not seem to be the complete picture to me either and it is frustrating. Yeah I am not sure I am going to get spouse or their therapist to listen at this point. We will have to see.

 

[quietpool]

@shimmerz thanks, that's validating to hear. I just couldn't see how spouse just being anxious in general makes sense, especially when there were all these things that seem to connect to the trauma, the basis like you are saying. I think it makes sense to use those things as the foundation/starting point for figuring things out.

 

[quietpool]

update:

So I had a support session with my therapist, and they are in office with spouses therapist. They asked them if spouse had mentioned the nightmares etc. and they said not that they could recall but they would keep that in mind going forward. So it sounds like spouse did not tell them, and is not telling them everything. Either because they don't think its an issue or because they don't want to yet. Sounds like it might be a while for them to really open up or figure out things. I am just going to have to leave things be for now, and hope doing couples work helps.

 

[Justmehere]

That makes a lot of sense. I hope the therapist continues to assess and ask about all possible symptoms, not just the ones he is offering to tell her about, and that your spouse continues to grow in comfort in sharing what has been so tough for him.

I am really glad you are reaching out to your therapist for support too. It has to be tough to see him struggle so much but not be ready to share more about it.

One note: since you are in the US, in order for his therapist to share any info with your therapist to share with you (even acknowledge the fact he is a client) he must have signed a release form for them to talk to you... Maybe it's worth talking to him about you calling the therapist and sharing concerns with his therapist. Maybe not.

 

[Friday]

When my emotions switch off, when I go hard & cold or cheerful & cold, I don't fit the diagnostic criteria for PTSD. As self reported. Even when my emotions fully up? If someone doesn't know the intervening steps? I'd probably ghost under the PTSD radar, as well.

Why?

Wasn't afraid for my life or anyone else's. It's just a part of the job. Death is a hard thing, for sure, but no. It doesn't haunt me or bother me. Did what had to be done. Action kills fear. Blah blah blah blah.

Anthony wrote a 'Dear god, thank you!' piece about how it's not (usually) killing that messes with your head. Killing is fairly easy to justify most of the time. It's all of the other stuff that messes with your head. And that other stuff? If a T isn't super familiar with vets & PTSD? Will often misdiagnose. Being late, waiting, being out of position / in the wrong place, following orders not to act, following orders you disagree with, in any way not acting as you're trained to do or against your own morals, not being prepared, being unorganized... Dozens and dozens of things that on the surface look like generalized anxiety. Until you put the dang thing into context and "being late" = people die. Being out of position = people die. Following orders you disagree with = people die. Waiting = who's going to die? Following orders not to act = people die (and are raped, tortured, robbed, etc.). The list just goes on and on and on.

I know what I and a lot of others focus on are the steps. Furious about being late, or being in a crowd, or terrified of being disorganized, or, or, or, or. If the T doesn't take it a few steps further?

 

[quietpool]

@Justmehere thank you! Yes it is hard to see him struggle and I am naturally empathetic which makes it worse sometimes. I am glad to have the therapist too!

Good point about the sharing information with the other therapist. I think how it currently works is that they often collaborate on cases in office and that is why my therapist talked to his about it. But I want to be careful and respectful and I don't want me or my therapist to tread into his territory because that would not be good boundaries.

 

[quietpool]

When my emotions switch off, when I go hard & cold or cheerful & cold, I don't fit the diagnostic criteria for PTSD. As self reported. Even when my emotions fully up? If someone doesn't know the intervening steps? I'd probably ghost under the PTSD radar, as well.

@FridayJones

That is really interesting to hear, and actually makes sense to me. I think I can understand this from my own trauma issues.

Your example of why is also really interesting and a helpful perspective to hear. I guess therapists screening veterans would often be coming from the perspective of the PTSD being from having to kill, the stress from being shot at etc. And not that those things do not cause PTSD but I can see how they could miss this other perspective. I actually wonder if spouse did feel that way, he tends to feel super responsible when things go wrong anyway and if you add in the fact that others could die if he did not do his job, that would be a lot of pressure.

I know what I and a lot of others focus on are the steps. Furious about being late, or being in a crowd, or terrified of being disorganized, or, or, or, or.

I am going to keep this in mind for when spouse has a hard time and see if that pattern makes sense.

If the therapist does not take it farther there is not much I can do, maybe gently suggest things to spouse but other than that I am going to have to hope they start having their own "aha" moments.

Thank you for sharing your thoughts on this!