Does everybody get diagnosed anymore?

[Neverthesame]

for PTSD to be over-diagnosed there are only two possible scenarios: The diagnosing party doesn't know how to do their job. Or the patient is lying about their symptoms.

There's a bit more to it than that. There are several reasons why this can happen. Doctors and their patients are human. They make mistakes and are capable of giving an incorrect diagnosis or presenting symptoms and behaviours not associated with PTSD.

• Some doctors are inexperienced, 8+ years of medical school is alot to absorb. PTSD is a fairly rare disorder, there is also alot more to diagnosis than checking boxes off a list.
• Patients can be their own worst enemy. Google doctoring is a horrible thing, it goes beyond lying about symptoms and history. There's a very good reason why doctors bang their head's off tables groaning "why, why, why, why?" The instant the patient says "WebMD says I have..." Even when a patient tries to keep an open mind and stay honest, they still omit details thinking it isn't relevant because it didn't appear in any of the possible conditions they researched.
• Never underestimate the power of the hypochondriac. People can and do present symptoms because they read about them. You can easily give yourself a headache just by thinking about it hard enough. It still hurts, even though nothing is causing it.
• Doctor hopping. While it's a good thing to seek a second opinion, some people won't take a hint and go from doctor to doctor until one gives them what they want.
• Catastrophising: Some people make incredible mountains out of mole hills. You wouldn't believe how many people are admitted into emergency wards each year for sprained ankles and hang nails. Some of them want meds, others actually think they're suffering a life threatening boo-boo.

But I do think it's neither of us's place to doubt the diagnosis of someone else (unless, of course, it's very obvious that the person is self-diagnosing or doesn't meet all the diagnostic criteria).

Right. Though I'll tell you what I think is the most helpful thing to do when this comes up. I'd suggest worrying less about what that person might be thinking and more about what the person that comes after them later will think.
Arguing with anyone over the internet is seldom going to impact the person you disagree with. (Lord knows I've tried it often enough, I'm hardly perfect at practicing this bit of preaching.) You are however more likely to reach someone else. Providing actual fact to be read and considered is what you can do. Changing minds, not so much.

Just something to consider, not telling you what to do.

 

[MyWillow]

I see my psydoc weekly for therapy and meds. She diagnosed me with PTSD pretty quickly yet I dissociated at the drop of a hat and had no memory of anything that I could identify as t***** (sorry but the word freaks me out). But there were bizarre flashbacks, mostly to unknown events, but some known. Severe panic attacks when she named stuff as abuse. I am so fortunate that she is so very experienced and skilled. I’m still in denial so I’m totally on the side of any doubters lol.

 

[TheTwinlessTwin]

Of course we're not talking about self-diagnosis!

To be over-diagnosed, there needs to be a diagnosis, first. So, for PTSD to be over-diagnosed there are only two possible scenarios: The diagnosing party doesn't know how to do their job. Or the patient is lying about their symptoms.

Both of them are very possible and I'm sure do occur. But to an extend of causing over-diagnosis?

I do know all that you mentioned, about differential diagnoses etc. But I do think it's neither of us's place to doubt the diagnosis of someone else (unless, of course, it's very obvious that the person is self-diagnosing or doesn't meet all the diagnostic criteria). But symptoms can very in extend (one does not have to have ALL symptoms that are listed under the diagnostic criteria) and severity (who are we to judge what impairs another individual? for example, since you specifically mentioned that) and with all the stigma that mental disorders are still facing, I really do think essentially denying someone their diagnosis, "just because" (and particularly while suffering yourself), has not only an aftertaste, it's really harmful in my opinion.

It's just not our place, because it's essentially the opposite of self-diagnosis. But it comes down to what I mentioned in another post, some (affected) people make it seem like some people are "worthier" of a diagnosis than others. NOT saying this is what YOU're saying/implying, but some approaches and comments do feel like that.

And then people wonder why people question their diagnosis, there's even a thread about that on here ....go figure.

You were and still are boldly implying that we are all talking about professional diagnosis and not self diagnosis as well.

There are more than two possibilities to misdiagnosis, what you are saying is conjecture. Third option: the patient can easily misattribute their symptoms to another issue, this causes a reporting bias and the evaluating clinician confirms the patient's uneducated suspicion. I don't think many people lie about their symptoms unless attempting to commit fraud for financial gain. It seems much more likely they are not sure if they have PTSD, panic disorder, generalized anxiety disorder, adjustment disorder, bipolar disorder, or normal everyday anxiety. They hear about PTSD on TV, then hear that it is super common and anything can be traumatic, and falsly attribute their problems to PTSD. The mentality that malingering and lying about symptoms is commonplace has caused more harm than anything else. That builds stigma more than stating the diagnostic criteria.

I'm not saying we should judge people's diagnosis. Even the diagnosing clinician does not "judge" the level of impairment in someone's life. You simply must have ANY impairment for it to be considered a disorder.

The stigma of critical, objective reasoning is what we should focus on. Pathologizing everything because it is more comforting to be "safe rather than sorry" is not something we should be ok with. That is doing a disservice to both those who truly suffer and those who do not understand what true suffering is.

 

[Fadeaway]

Something I see both on the form and off, labiling something as a qualifying trauma when it isn't. People are suffering from distressing events and labeling them as traumatizing instead of distressing. An affair is distressing, a physically violent spouse is traumatizing.

 

[lostforgottensoul]

Something I see both on the form and off, labiling something as a qualifying trauma when it isn't.

Yes! I was gonna quote someone else and bring thing up but you brought it up first. Criteria A! We don't have to tell someone they are faking their symptoms (which they most likely aren't) or exaggerating symptoms (when they probably aren't) or are being over the top (when they probably aren't) in order to say "your trauma does not fit criteria a therefore it is not possible for you to have PTSD". That is black or white. Either it fits or it doesn't. I see so many trying to turn it every which a way trying to make it fit when it so clearly doesn't. Square peg trying to be shoved into a round hole calling the peg round when it's actually square. Basically. The science is clear on this. Criteria A = PTSD is possible or not Criteria A = PTSD is not possible. Period. You can have all the symptoms and even more suffering and it not be PTSD. You can have trauma and not have PTSD. Even many with Criteria A trauma don't have PTSD since not all with Criteria A trauma will develop PTSD. It's really about the hippocampas and amygdala and if the changes happened to them or not.

But on the internet when speaking about PTSD or not, it's best, in my humble opinion, to stick with Criteria A. Don't call what clearly isn't Criteria A, Criteria A. Don't try to turn it until it looks like a round peg because it's still square. And it's ok to tell someone that their trauma doesn't fit Criteria A thus PTSD isn't possible but personally I would stop there because they probably aren't faking anything or exaggerating anything or being over the top about anything. Their just trying to turn their trauma till it looks like criteria A when it still isn't. But, that's just me.

 

[Gs172003]

Yes! I was gonna quote someone else and bring thing up but you brought it up first. Criteria A! We don't have to tell someone they are faking their symptoms (which they most likely aren't) or exaggerating symptoms (when they probably aren't) or are being over the top (when they probably aren't) in order to say "your trauma does not fit criteria a therefore it is not possible for you to have PTSD". That is black or white. Either it fits or it doesn't. I see so many trying to turn it every which a way trying to make it fit when it so clearly doesn't. Square peg trying to be shoved into a round hole calling the peg round when it's actually square. Basically. The science is clear on this. Criteria A = PTSD is possible or not Criteria A = PTSD is not possible. Period. You can have all the symptoms and even more suffering and it not be PTSD. You can have trauma and not have PTSD. Even many with Criteria A trauma don't have PTSD since not all with Criteria A trauma will develop PTSD. It's really about the hippocampas and amygdala and if the changes happened to them or not.

But on the internet when speaking about PTSD or not, it's best, in my humble opinion, to stick with Criteria A. Don't call what clearly isn't Criteria A, Criteria A. Don't try to turn it until it looks like a round peg because it's still square. And it's ok to tell someone that their trauma doesn't fit Criteria A thus PTSD isn't possible but personally I would stop there because they probably aren't faking anything or exaggerating anything or being over the top about anything. Their just trying to turn their trauma till it looks like criteria A when it still isn't. But, that's just me.

I'm constantly debating with myself on whether my "trauma" qualifies.
That said....do a Google search and see how many different variations you get of what "crit a" is. Anything from what is posted on here to "anything that is overwhelming".
No wonder people are confused.

 

[somerandomguy]

I'm constantly debating with myself on whether my "trauma" qualifies.
That said....do a Google search and see how many different variations you get of what "crit a" is. Anything from what is posted on here to "anything that is overwhelming".
No wonder people are confused.

No, Crit A is not negotiable. It is very clear what is and what isn't Crit A. It's not confusing at all.

 

[MyWillow]

And then the other issue is dissociation. I didn’t even know that I dissociated through most of the first 6 months of seeing my original T. Was having flashbacks and dissociating the content. I am only just beginning to realise what was happening. No way in hell I suspected (and barely accept now) that I had experienced Crit A. Because I remembered very little before the age of 12 and no Christmas or birthdays until I was in my 20s. But now stuff is leaking out in nightmares, flashbacks and memories. It’s a very, very strange place to be. My psydoc gently informed me that I had experienced relational trauma - in what form she had no idea - in our first session based on my dissociative responses when simply taking a family tree history.

 

[Gs172003]

Here
are four examples of sites that have different things listed than what I'm used to seeing.

Post-traumatic stress disorder (PTSD): Symptoms, causes, and risk factors

PTSD Symptoms in Women: Unnoticed and Undiagnosed

Causes

Causes of PTSD | Mind, the mental health charity - help for mental health problems

 

[somerandomguy]

Ok, since we're discussing Crit A, let's see Crit A.

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Nothing in the first article says anything that's not Crit A and goes on to discuss the other Criteria as well, then lists various PTSD symptoms. Having PTSD symptoms is not in itself a sign of PTSD since other disorders share the same symptoms.

The second article is wrong.

Basically, any kind of scary or disturbing event that overwhelms our ability to cope falls into the PTSD category.

Wrong.

The third and fourth articles, based on UK NHS guidelines, cite two causes of PTSD not strictly listed in Crit A.

• admitted to intensive care
• childbirth experiences, such as losing a baby

These are Crit A events because they could fall under "serious injury" for the first, and serious injury, death, "relative was exposed to trauma," or all of the above for the second.

 

[digger]

The third and fourth articles, based on UK NHS guidelines, cite two causes of PTSD not strictly listed in Crit A.

Also worth noting that criteria A in the ICD-10 (which is what is used in the UK) is worded differently than it is in the DSM

A. Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

ICD10 PTSD – ESTSS

Which, while not quite as tightly worded, Is still not the same as saying it can be

"anything that is overwhelming".

 

[Gs172003]

Also worth noting that criteria A in the ICD-10 (which is what is used in the UK) is worded differently than it is in the DSM

ICD10 PTSD – ESTSS

Which, while not quite as tightly worded, Is still not the same as saying it can be

I didn't find the article that named the overwhelming circumstances again. I figured these would suffice.
The first one I didnt mean to link. Sorry you all.