General Diagnosis Wrong?

[quietpool]

It's been a little while now that spouse has been doing therapy, which ultimately has felt really positive.

However their therapist apparently does not think they have PTSD, and for the second time spouse has been diagnosed with generalized anxiety.

But here I am waking up at five in the morning with them because they bolted upright in bed from a night terror or flashback, and I wish the therapist could be there for those moments.

The therapist they are seeing is supposed to be really proficient in understanding PTSD, and working with prior/current military. But I am flummoxed as to how the think the symptoms are just anxiety. Maybe I am really wrong and don't understand why that diagnosis makes more sense. I had really thought though that PTSD is often complex and variable and that made sense to me, because it does not have to present as classic shell shock to still be a factor.

Even my therapist listening to me describe spouse though that it was trauma or PTSD. They tend to take the viewpoint that when trauma is involved things can be very complex and so they don't like to make specific diagnosis's but treat me from an overall trauma perspective. So I could understand if spouses therapist felt similarly but that doesn't sound like it's the case. It sounds to me like they have shoved everything onto general anxiety.

This is super frustrating :(

If they are wrong (and I am worried they are) it means navigating things with my sufferer without the proper support.

 

[Justmehere]

Maybe your sufferer doesn't tell the therapist about these symptoms? That could especially be the case if they are current military and harbor any fears that PTSD could lead to job loss.

I'm not current or ex-military, but it took a long time for me to share all my symptoms and bring up my trauma history with my first therapist. It also took a long time for me to admit that I had been diagnosed with PTSD.

The criteria for PTSD are rather specific, and being diagnosed with generalized anxiety twice by two different professionals suggests that more than just a therapist not correctly diagnosing symptoms is going on. It could be that they are not aware of life threatening trauma or current symptoms in your spouse's life.

Is this therapist specifically a trauma therapist? Where they are trained in and treat trauma with various trauma therapies? Many therapists claim to be well versed in PTSD, but are not actually trained in it.

 

[quietpool]

@Justmehere

Spouse is no longer in the military thankfully, or I agree that would make sharing much harder. It's good to hear perspective/experience about the sharing process, thank you. I can see how it might take time for them to really open up. I had thought that they were not sharing everything, but they tell me they are. I even asked them this morning if they told the therapist about the nightmares/nighterrors and they said yes. Yeah it would seem unlikely that two therapists would be completely wrong, but I don't know if they really are getting the full picture.

I don't think they are a trauma specialist... just veteran focused. I am concerned that they are not as well versed in PTSD/Trauma.

I think what gets me is that spouse is a twice deployed vet who did have to work under fire fight conditions at one point, and it seems so over simplified to me to say they have generalized anxiety given their experiences- but I don't really know.

 

[shimmerz]

Sometimes we don't fit the criteria because our memories do not indicate that we fit. That is the problem with deeply buried memories. If you feel he fits by his symptoms then treat it as such and learn as much as you can - both of you - to help him.

 

[Justmehere]

It does seem a little baffling that he hasn't been diagnosed with PTSD - and twice.

Being veteran focused sort of implies a lot of experience working with trauma. I would give it time. I would probably back off from pressuring your spouse to share too. It is with very good intentions, but it may be leading to them shutting down more. It could be that PTSD has been suggested as a diagnosis to your spouse by the therapist, but your spouse could be in denial about it. They could feel like so many others went through "worse" so they really are not that bad off as to have a PTSD diagnosis. It could be a bit of survivors guilt coming into play. Your spouse could feel that his symptoms are not that bad. He could be sharing all of it from his own perspective, but yet not sharing the full objective picture because he is in denial about his own symptoms. It happens a lot. Many therapists are good at breaking through such a wall of denial. It takes time though. They are at least both admitting and realizing he has some serious anxiety issues.

If the therapist focuses on working with veterans, then that does imply some experience with combat trauma. You could check and see if the therapist uses any therapies like emdr, or trauma focused cbt, somatic experiencing, or exposure therapy or etc - using any of these therapies would mean they have training in trauma. If they have that, I would especially give the spouse and therapist more time to build a good solid safe relationship and to figure out what the diagnosis and treatment is. As your spouse begins to feel more safe in therapy, his wall of denial (even denial to himself) will begin to come down.

If symptoms seem to get worse at some point, this could be due to bad therapy, but it's more likely due to the fact that when beginning to work on this stuff, things usually get worse before they get better.

A veteran with anxiety seeing a therapist with experience with veterans suggests to me that your spouse may actually be in good hands, and the process just needs more time and space to work itself out.

If your concerns remain, then you could ask your spouse if it would be ok for you to talk to the therapist about your concerns and observations, but if your spouse resists at all - don't push. At all. Give him time to feel comfortable and ok, and eventually they should work past the denial together. Pushing
may make the process take longer.

The only exception I would make is if he is suicidal or in danger of severely harming himself or others. Then it's ok to push.

He is lucky to have a spouse like you that cares as much as you do. I hope his symptoms gets better soon. :hug:

 

[quietpool]

@Justmehere I wish I could say I am not guilty of the push. But I am, I totally am. I feel a bit of self loathing at this because logically I know things take time.
It has taken almost seven years for them to get into therapy. That is seven years of me trying everything I could think of to engage with an emotionally distant spouse who just continued to have some tough obstacles thrown at them. Things are better in many ways, and I am relieved they have connected with this therapist, which is huge.

I think I am just worn out, and I have felt kind of desperate in the past to find out what was wrong. Now that I am here and they are in therapy I have a lot of fears that the important things will get missed and throw us back into some of the really frustrating cycles/ problems from the past.

I think I felt like if the therapist understood everything, I could let go, I could let that process happen on spouses on time. I am afraid of waiting, and afraid that I have already waited so long and that nothing is going to change. I think this is slightly irrational when I examine the facts, that spouse is in therapy and they are working on the anxiety and they currently seem willing. But I think the fear is understandable, no one wants to be shut out of their loved ones life and you do want them to be able to be fully themselves.

You might be right, the therapist may have suggested it and spouse may be in denial or disagree. I have been trying to leave them alone about therapy for the most part, because I do know it makes them feel claustrophobic/ invaded if I ask too much. I did poke them a bit the other day because we were discussing relationship issues and their therapists response was "oh this is all normal" and I asked them if they were sugar coating things. That is when they told me about the diagnosis, and even that I tried to not pick apart with them. I asked questions but tried to make an effort to support.

The big relationship kicker is the emotional distance and lack of connection, they shut down. There are times when I can't even talk to them about daily things like how the neighbors have decorated their yard- they just don't respond to chit chat.
I can't tell them anything anymore it seems and it is wearing and tearing on me. So knowing that whatever is majorly contributing to these things is understood and not being missed by the therapist would be hugely comforting, and I can tell myself that spouse will work through things eventually.

It is good that they both see the anxiety issues, and I should feel more hopeful.

I will have to look and see if they do EMDR etc., and yes I think if they have worked with any combat veterans they should be experienced with trauma but I am not sure to what level.

I would especially give the spouse and therapist more time to build a good solid safe relationship and to figure out what the diagnosis and treatment is. As your spouse begins to feel more safe in therapy, his wall of denial (even denial to himself) will begin to come down.

That is a really good point, maybe the anxiety diagnosis is a starting point and as they are in a more solid place maybe the other things will come up, and spouse will be able to process better.

A veteran with anxiety seeing a therapist with experience with veterans suggests to me that your spouse may actually be in good hands, and the process just needs more time and space to work itself out.

Thank you, I know for me thinking about how slow this can go gives me anxiety, but at the same time I take some level of comfort in your comment because I can try and change how I see it. Maybe the therapist has not missed any of the issues and is being careful with spouse not to just hit them with the big stuff.

Spouse suggested going in together to voice my concerns but it was coming from a place of frustration with me so I choose to decline for the time being.

He is lucky to have a spouse like you that cares as much as you do. I hope his symptoms gets better soon. :hug:

Thank you, that is very sweet of you! :)

I hope things change a little bit too, and gives us more flexibility in our relationship.

 

[quietpool]

@shimmerz

Thank you, that is a good point. Spouse doesn't like to talk about the nightmares and also some parts of their deployments. So I really don't know how much more that is there, but at times they treat it as if they didn't have enough bad experiences to warrant their symptoms as justmehere suggested. It's possible there is things that are not appearing on the surface and make it look more like anxiety.

 

[shimmerz]

@quietpool I feel like as a whole doctors and the system are trying to minimize the PTSD thing in combat soldiers. This is easy to do with PTSD repression tendencies. I found a T-doc who looked at my somatic symptoms because I had absolutely no knowledge that anything had gone wrong prior to my adoption at 2 years. Have you looked at the diagnostic criteria yourself? You may have a better grip on your husband's behaviours than he does!

I know my spouse has to tell me when I am grunting and groaning because my breathing is off - I don't notice it. There is very little self awareness at times and on top of that a problem with noticing new behaviours for a sufferer because there is so much hypervigilence and flashing back and usually we are so exhausted we can't think right let alone put it across to a doctor.

Keep fighting for him hon!

Love and Light
Shimmerz

 

[Deleted member 1860]

Who is diagnosing him? Social worker, PhD, MD?

 

[quietpool]

@Solara

I looked up the therapists page, and they are an MA, LMFT that has received additional consultation in trauma focused cognitive behavioral therapy, cognitive and behavioral therapy, pro-longed exposure therapy. It says they have a passion working with military families and veterans and are a military spouse themselves.

 

[quietpool]

@shimmerz I agree, the military has not handled soldiers mental health well! And when those things are repressed it does make it easier to pass it by. I have been doing a little searching today as I am re-evaluating what I thought. I have to work through a lot of trauma issues myself so I perhaps wrongly assumed I had a grip on what those things looked like and how spouses symptoms were similar/different. For instance I have things that trigger me, but I can handle the fourth of July fireworks and sudden loud noises, he cannot. Our local area actually sounds like a war zone around the 4th, so to me it made sense that this would be hard for him.

I know my spouse has to tell me when I am grunting and groaning because my breathing is off - I don't notice it. There is very little self awareness at times and on top of that a problem with noticing new behaviours for a sufferer because there is so much hypervigilence and flashing back and usually we are so exhausted we can't think right let alone put it across to a doctor.

I actually do see this with spouse, I seem to catch that they are triggered before they do and will ask them if they are okay and even then sometimes the don't consciously recognize it until later. I don't think for him its constant flashbacks so much as things that trigger him and he dissociates or has to shut down, take a pill (fire works). Spouse has described loud noises as if someone were screaming in their face.

Keep fighting for him hon!

Love and Light
Shimmerz

Thank you very much shimmerz :)

 

[quietpool]

I have actually met spouses therapist way before they ended up going in for therapy, and I had gone to them to see if I could get a better perspective on being a support because they were supposed to be familiar with the military and PTSD, so that means I have actually told them some of these things. Seriously I feel like a crazy person that I think I see all spouses symptoms differently.