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Thread starter #1
Misdiagnosis is an unfortunate aspect of any diagnostic medicine, though there is a human element contained, and humanity is flawed and imperfect by design. If you take that a step further from medicine to mental health, then you remove further science based medical procedures and resort to humanities "best guess" principles based on a combination of education and experience to analyze human characteristics, with a fundamentalism on data collection and statistical modelling. You then have the diagnostic manuals which contribute to some degree, to over-lapping symptoms and lack of specificity and/or quality of criterion to be met.

Common Misdiagnosis

There are some common diagnostic labels associated with the misdiagnosis of Posttraumatic Stress Disorder (PTSD). These include, though not limited to:
  • Acute Stress Disorder (ASD)
  • Adjustment disorder
  • Attention Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD)
  • Bipolar
  • Brief psychotic disorder
  • Depression / depression based disorders
  • Malingering
  • Obsessive-Compulsive Disorder (OCD)
  • Panic disorder
PTSD can be confused for several reasons, being the lack of experience and knowledge in diagnostic medicine and also in some cases, the symptom overlap that occurs between many disorders that allow for easy confusion due to a requirement to only meet a limited range for the label to be applied, ie. whilst 5 criterion may exist, only two may have to be met.

Diagnostician Inexperience Mixed With Self Motivation

An accurate representation on how qualified physicians are currently applying the PTSD diagnosis is the same as giving a 5 year old a crayon and symptom checklist, ticking and flicking whether someone says they have something or not, with little further investigation, let alone understanding what a symptom actually is. Worst, because a person has a symptom, and they meet the criterion A, everything else is removed from the table and PTSD presented, first and foremost, with little thought.

What went wrong within the industry for PTSD to be diagnosed upon someone who endured a relationship breakup? Well, greed is as good as an incentive as any. You put a diagnosis in the hands of someone who wants to make money, and give them broad diagnostic wording, and you just created a capitalists dream diagnosis. That is where PTSD stands in 2011 within the United States, and has filtered into other countries by virtue of excuse: "They're doing it in the US, so we can do it too!"

You can look at diagnosis like this: the majority of Americans report exposure to situations that classify criterion A trauma. From that, fewer than 10% actually experience diagnosable PTSD. The problem with diagnostic inexperience is the lack of understanding of the fundamentals outside of the symptom clusters, such as symptom durations of 1 month for acute and 3 months for chronic PTSD. These variables do not mean that because you have experienced the trauma, and now have suffered symptoms for longer than a month, you should be diagnosed with PTSD. This is factually incorrect as the DSM IV-TR time frame actually already extends to 6 months after a traumatic event as being normal to experience symptoms, which often dissipate all by themselves, which means the person doesn't have PTSD, they just have Posttraumatic Stress. Physicians have become fixated on time frames.

If a physician treated a person without diagnosis or medication for a month or two, for a true evaluation, then many would find a far different result and no diagnosis required at all.

The biggest misinterpretation of the PTSD diagnosis is the symptom severity. Because you have a symptom does not mean you meet PTSD symptom severity for diagnosis. The symptom severity is everything that differentiates PTSD from other diagnosis, being a 1 - 10 scale, 7 should be the near constant symptom state for PTSD to be diagnosed.

Ultimate Example Of Misdiagnosis: 9/11

Besides the 9000+ accountable counselors suddenly turning up in New York city after the 9/11 attacks, due to seeing the potential financial gain from a large number of people possibly needing therapy, some mental health spokesmen projected 1 in 4 people within New York to have diagnosable PTSD from this one event.

Systematic studies showed that after four weeks from the occurrence of 9/11, the threshold was looking around 7.5% possibly having "caseness" for PTSD. This is nothing close to projections, of 25% from the onset, by those who stated to people they will have PTSD from nothing other than living in New York city during the 9/11 attacks. By the time 6 months had passed, the 7.5% had decreased to around 0.6% having diagnosable PTSD.

Putting this another way, of those who came close to being diagnosed with PTSD, 92% no longer had symptoms through nothing other than time combined with family support, friends, talking and grieving naturally while, as much as possible, returning to life as normal.

Moral of the story; because you endure a traumatic event fitting criterion A, does not mean you have PTSD even if you display some of its symptoms. You are just experiencing normal reactions to abnormal conditions, and most likely you will fully recover with no therapy required.

Military Controversy

There has been controversial issue surrounding the US military's diagnostic application with PTSD surrounding three aspects, being:
  1. The diagnosis of thousands of veterans upon return from deployment with personality based disorders,
  2. Confusion between Traumatic Brain Injury (TBI) and PTSD, as both overlap one another in majority symptoms, and
  3. The intentional misdiagnosis by treating physicians due to Department of Veterans Affairs (DVA).
Personality Disorder Basis

The reason the military gave a personality diagnosis to returning veterans, is because a personality disorder is considered pre-existing, therefor, would not require compensation or treatment from the military. Soldiers where given a dishonorable discharge and zero entitlements. The US military admitted to discharging approximately 1,000 soldiers per year from 2005 to 2007 with personality disorders, though have admitted that their diagnostic application was wrong, and attempted to seek further information from these discharged veterans.

To my knowledge from reading discussions within military forums, this has yet to be resolved and many veterans have seen no change towards assistance, nor really expect too.

TBI Diagnostic Complications

TBI and PTSD share extremely similar symptoms, therefore either could be easily misdiagnosed as a result. It has been argued that PTSD could not exist with TBI, however; more recent studies prove quite differently compared to previous academic assumptions and studies. TBI itself is from the suffering of concussion fragments from a blast, such as an Improvised Explosive Device (IED). Some forms are mild, some are severe.

The cross-over with TBI is fundamentally found that those with possible PTSD, have been diagnosed with TBI, and vice versa. Studies have found varying results for the PTSD diagnosis in veterans who suffer TBI, being depending on the type of scale used, and whether a clinician was involved directly in the process or not, asking the right questions and monitoring the physical reactions, depends highly on the overall results, with a cross-over from 3% to in excess of 50%. If the patient was given a questionnaire to complete, then it is assumed that the cognitive impairments that come with TBI affect their interpretation of completing that form, thus the higher scale for PTSD diagnosis, compared with those who had the assessment given by a clinician, which then showed what is believed to be a more accurate reflection, being the lower end of the PTSD diagnostic scale.

TBI also applies to Motor Vehicle Accidents (MVA's), assaults where the patient is knocked unconscious, etc. It is extremely unlikely a person with TBI will develop PTSD as they cannot recollect the trauma to meet the initial criterion.

Intentional Misdiagnosis by Treating Physicians

A soldier entered a therapy session with a recording device set on voice activation, what he didn't know was that the psychologist was going to tell him something that many long suspected, being:

"OK," McNinch told Sgt. X. "I will tell you something confidentially that I would have to deny if it were ever public. Not only myself, but all the clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder NOS instead." McNinch told him that Army medical boards were "kicking back" his diagnoses of PTSD, saying soldiers had not seen enough trauma to have "serious PTSD issues."

In this specific case, soldiers are being misdiagnosed with other disorders when they clearly present with PTSD, due to political assertions and pressures.

Mental Health Industry Responsibility

A study performed in 2004 in reference to General Practitioners (GP's) diagnostic application demonstrated they performed adequately in including PTSD as a possible diagnosis for their patient. Many failed in the area of treatment, and that included psychiatrists. Saying that, overall results still varied between 67% possibility for GP's, compared with 89% for psychiatrists, to include PTSD within their results for a differential diagnosis. There is a rather large gap at which misdiagnosis obviously occurs, though this has somewhat believed to have improved since this study.

The indication in a TBI vs. PTSD study has clearly demonstrated that through nothing other than the method of assessment given, the outcome can change between a 50% + diagnosis vs. clinician administered assessment of 3% with PTSD. A vastly large gap in misdiagnosis there in one instance. The worst case for mental health misdiagnosis is at the self-diagnosis level, and that of the general therapist, excluding psychologist or psychiatrist. Self diagnosis is straight forward, zero clinical knowledge, and then at the therapist level, the assessment is often given to the patient to fill-out. Those with PTSD are known to under-score themselves, and those often malingering to over-score themselves.
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Once you finally get a diag. Of PTSD, get ready!!Now your gonna need to call the VA, for a PTSD intake- counseling ect.Lets say it’s Mon. @ 0945 & you call,the Va says SURE, they have ONLY 1 opening on Friday & can get you in @1500hrs(just 4 days?!)& how’s that for you too?(great right!)So its set, you have an appt. @1500hrs for PTSD on Friday @ the VA. NOW!.the morning of Wed.(2nd day) the VA drafts a letter & sends it out AFTER c.o.b. This letter says your 1500hr appt on Friday @ VA, the day after tomorrow has been changed,from 1500hrs to 0830hrs. Any changes have to be 24hrs in advance of your appt. to reschedule you. So your now expected 15min be4 0830 on Friday.That letter was made Wed. Am,mailed Wed.PM(same as Thur. AM) The same Thur.AM your supposed to call & reschedule, letter is still in route. Guaranteeing the letter shows up on Fri. W/afternoon mail,so you now know,your a no call no show to your 0815appt.Fri. As its already 1300 Fri.& you just found out!?!!! Then the VA does a “NO CALL NO SHOW”courtesy call,about you no showing & to HELP YOU reschedule a date & time you won’t miss out on but are “willing” to attend. Unfortunately that Mfr is 6months out,maybe by then you’ll join the 22a day, or forget about it, Or not ccaught on,& call every morning for a week @ open,checking ur appt. didn’t change or vanish like a fart in brisk wind,& Even then, they’ll just call 30min be4 &.”unfortunately have to cancel your apt.today, but someone will call you within the next 24 hours to help you reschedule your appt.
Thread starter #3
Sorry to hear.

I really feel for veterans in the US, compared to Australia, you have a hard time getting the help you need. Our VA here, they have nothing to do with diagnosis, care, so forth. They manage the administrative side only, from the side lines, in essence. You get diagnosed by private psychiatrists (submit paperwork to VA), you get therapy from Government funded private therapists (paid for by the VA), in your location, otherwise you choose your therapist if outside a major city. Medications are managed by psychiatrist / GP and cost about $5 in total to fill a script.

All care is taken care off without issue, once recognised for PTSD from operational deployment, which can take up-to 6 months on average, but then fairly smooth sailing. Some don’t get approved, and they have obvious problems… but those with legitimate PTSD from operations, typically have little to nothing to worry about. Just be honest, jump through all the medical hoops, and you get approved and cared for with the best care available until you say STOP and go your own way again.
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