How Much Specific Detail Of Trauma Is Needed In An Assessment?

[Lisa]

Hi everyone :hello:

Okay... I'm in need of a little support and advice from people who know what I'm talking about, which is what brings me here....After years of stubborness, I have given in and am now about to see a private psychiatrist (on Wednesday).

To fill you in... because otherwise I'll feel like I'm lying - I did actually see a psychiatrist last week, and it didn't go well. She uses the ICD-10, and it does not include 'subjective distress' as a part of it's criteria for PTSD... so despite being abused as a young child and thinking I was dying at the time, and abused again later with multiple traumas - because no 'true' danger to life was present in the initial trauma, I'm told it's not PTSD insofar as the ICD-10. Anyway, the diagnosis isn't what's really important here, this woman caused me a whole weekend of terror and flashbacks and I ended up suicidal. She insisted I tell her 'what was involved' in the abuse, and I forced one word out and couldn't say anymore. She said although I show the symptoms of PTSD, because my life wasn't ACTUALLY in danger, it's not PTSD. Fair enough, but there was more than this that upset me. Her attitude stank, and she was the most insensitive professional I have ever seen and I can't be bothered to explain how and why right now. Point is, I couldn't talk to her, or tell her what she needed to know as a result. So, I don't feel I got a true opinion.

I've decided to try somebody else. It's a one-off assessment because I can't afford to see him twice... but may lead to letters to the GP with his opinion and it may, or may not, start some kind of ball rolling. And hopefully, will also result in a letter to my university. Basically, I'm after an assessment, opinion, possible provisional diagnosis, and advice of what next.

I know it's really, really important that I am able to tell him what he needs to know in order to assess me appropriately. I will be kicking myself, and so will my bank account, if I don't use this opportunity to overcome my fear and be totally honest. His opinion needs to be equipped with as much information as he needs, I know that.

But talking about the trauma is my big problem! I can't allow myself to think about it, particularly the first trauma. I don't think I can actually, physically do it... and if I could, I'd space out, like i did this weekend. I lost 5 hours. I can tell him what the impact is, and how long I've been living like this. A general outline of my history, medication etc. But I need to know if he's going to ask for specific details about the trauma? I can do 'factual', like 'were there weapons, were there threats'. Like yes, no questions. But if somebody asks me "what happened", It won't happen, I can't say it all without flashbacks that make me mute and end up in a ball.

Am I going to need to give such detail? Can anyone give me some pointers or advice as to how I could answer such a question should I need to? Or personal experiences of how detailed the questions are in an assessment??

 

[Deleted member 541]

Lisa,

If you have a diary, print out what you need and give it to him...Other than that, IF you can write about it(if you don't have a diary) and give it to him......

Basically if you can't give a descriptive account of what happened, then how can they give you a diagnosis???? I know this is hard, and yes, we all go into a world of shit when we start describing what has happened to us, but it is also important to do so. Not just because of your upcoming appointment, but also as far as your healing is concerned.

You can't change, what you don't acknowledge......Dr Phil's favorite saying, and he is right!!!!!!!

I hope that you can get through this, and open up......The first time is hard, but it does get easier......

Sending hugs....

 

[kers]

Oh, that first assessment sounds ridiculous. I'm sorry that went so poorly.

When I did my evaluation, My therapist wrote his summary of me down and sent it to the psychiatrist, which was a HUGE help to me. It listed my symptoms and trauma as we had discussed. So the psychiatrist asked me, "You were physically abused?" and I only had to give a very bare-bones description--"I was hit and threatened with knives."

I think She Cat's suggestion of writing stuff dwn to take in--a short list of the traumas and your reaction to them--would be really helpful. If you simply say, "I can't yet discuss this in depth," but have it recorded, that will give a lot of information. I suggest beginning the evaluation with the frank discussion of how hard this is for you to talk about and how you need a lot of yes/no questions (all of which, in my opinion, points toward the PTSD diagnosis to begin with).

 

[Lisa]

Hey She Cat and Kers

Thanks for your replies. After reading this, I spent 5 hours typing a 2 page letter to the Psychiatrist to take with me. So thank you. I couldn't write details about the first trauma, but was able to briefly list the extent of the second abuse. I explained how difficult it is, and gave him a list of problems, and previous problems (ie. self harm, drink and drug abuse, overdoses etc).

It took me so long, because that's how bloody long it takes me to think about it!! But... something is written. Also, kers... thank you for your suggestion re: therapist. That's actually already being done, I forgot about that. I need a 'referral letter' from somebody so I asked my therapist. He can't do referrals for some reason, the service won't allow that, BUT he did say he would write a summary of what we've been working on for me. He said he'd email it to me but he hasn't and is off work now til tuesday so I hope he hasn't forgotton.

That, with my letter, should ensure that if nothing else, I can give the psych 3 bits of paper about me. I hope if I end up giving it to him, he will take the time to read it. Maybe I'll giv him the choice to read it, or me read it to him? I hate reading out loud, but if that's what it takes at least I'll be able to focus on words and letters and not what they mean. And then he can take it from there. Hopefully, I'll be able to walk in with a little confidence thatr i have back up should I clam up and go silent. Still worried about him asking more specific questions though... but I've described what happens when remember and that this is why I can't openly talk about it.

 

[Luthien]

First of all, that first woman you met with is an idiot. You do not have to have your life ACTUALLY threatened to have PTSD. If you perceived that type of danger it is enough. Living under abuse that is ongoing, and always feeling the danger of the abuse, and "what will happen next?" is enough. Even people who have just witnessed a trauma can have PTSD, though they weren't the one hurt. That woman obviously didn't know what she was talking about.

You shouldn't have to go into details, in order to be properly diagnosed, but I think you do need to share the details at some point. That is just vital.

I know the trigger, the flashbacks, and all the physical ways that doing so can manifest are HORRIBLE. You'll feel like you can't take it. But you can. Trust me, you can. You didn't die when it was happening, and you won't die now talking about it. I know it feel like you will, but you're stronger than you realise.

If you feel writing it out is the only way you can do it, then by all means do so. But breaking down in front of the doctor, wouldn't be so bad, in fact, it might be beneficial. For all your telling them how you react, and how much it affects you, it will not sink in for them unless they witness it.

And if they see your reaction first hand, it may cause them to react more strongly, and do more to see that you get the help you need.

I hope that this new appointment goes well, and that you get what you need.

If you'd ever like to talk to me, about anything, feel free to PM me.

Take care.