When doctors get PTSD wrong, it could be because you did too

by
Chaplain Kathie

It is very easy for us to feel so overwhelmed when it comes to mental health that it is difficult to take active participation in the treatment of our own mental health or the treatment of someone we love. Understanding mental illness is often something we find impossible. This inadequacy gets in the way of proper treatment and above all, proper diagnosis.

There have been cases where someone is misdiagnosed because either someone did not know the right things to say or the doctor did not know the right questions to ask.

When average people are dealing with mental health professionals, we tend to not tell them everything they need to know. We just take their expert findings and settle for what they say. The problem with this is that if we do not really listen, take the time to read the information they give us, we could very well end up in a worse situation.

With Post Traumatic Stress Disorder the symptoms can be dismissed, disguised and denied for many years. PTSD follows a traumatic event. The term itself means "after trauma" but too often we do not connect a traumatic event with the changes. This is easy to happen especially when sometimes it takes years for PTSD to require medical intervention. How can this happen? Easy when PTSD is in a mild state. The VA has been seeing veterans as far away from the traumas of combat as World War II veterans presenting for the first time. Some of it is due to publicity focused on Iraq and Afghanistan veterans bringing understanding of this wound to them for the first time. Some of it is also due to age, life changes and another traumatic event in their lives. This is called a "secondary stressor" (Not to be confused with "secondary PTSD" which comes from living with someone with PTSD.)

Vietnam veterans are the same as older veterans, dealing with the same lack of connecting what is going on with their quality of life and relationships and what they went thru in combat. Many of them dismissed the changes in them, self-medicated or buried it all inside of them in a denial state believing they could hide what they were thinking. Changes witnessed by their families were misunderstood because of lack of knowledge and the veteran was blamed for the chaos they were perceived as causing instead of what was happening inside the veteran.

When years pass between the traumatic events and the admission there is a problem to be addressed by a doctor, we tend to withhold information from the doctor unknowingly because we do not connect something that happened so long ago with what we are seeing in now. This can cause a lot of problems with getting the right diagnosis and treatment.

The following is from the National Institute of Mental Health. It shows clearly how psychologist should be trained to look for what they specialize in, but if you are going to the wrong doctor because of lack of knowledge and do not tell them everything they need to know, you could end up with the wrong diagnosis.

How is bipolar disorder diagnosed?
The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person's close relatives or spouse and note how they describe the person's symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania.17 Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.



How is PTSD detected?
A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the person who has symptoms of PTSD.
To be diagnosed with PTSD, a person must have all of the following for at least 1 month:


At least one re-experiencing symptom
At least three avoidance symptoms
At least two hyperarousal symptoms
Symptoms that make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.

What are the symptoms of bipolar disorder?
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include: Symptoms of depression or a depressive episode include:
Mood Changes

A long period of feeling "high," or an overly happy or outgoing mood
This is not usually part of PTSD but the rest could be

Extremely irritable mood, agitation, feeling "jumpy" or "wired."
Behavioral Changes

Talking very fast, jumping from one idea to another, having racing thoughts
Being easily distracted
Increasing goal-directed activities, such as taking on new projects
Being restless
Sleeping little
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Mood Changes

A long period of feeling worried or empty
Loss of interest in activities once enjoyed, including sex.
Behavioral Changes

Feeling tired or "slowed down"
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide.
NIMH Bipolar

Borderline Personality Disorder
A brief overview that focuses on the symptoms, treatments, and research findings. (2001).

Raising questions, finding answers
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.5 These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
NIMH Personality Disorder

Looking at the symptoms of bipolar or even personality disorder and compare them to PTSD, they can be easily confused. If you do not listen to the doctor explain bipolar and hear

"A long period of feeling "high," or an overly happy or outgoing mood" which does not come with PTSD unless they are self-medicating, then you will not be able to tell them that is not the case with someone you love or yourself. There are mood-swings with PTSD, but the happy feeling does not last long. Depression lasts longer. If you simply tell the doctor about mood-swings and do not disclose the periods of being overly happy come with drinking or doing drugs, they will not know. Then you end up with the wrong diagnosis. If you do not know what PTSD and do not look for a truly traumatic event in the life, then you will not feel the need to share the information dismissing the event. They need to know! You have to not only know the right questions to ask, you need to know the right information to share with the doctor.

Take an active part by finding the information you need to know to share with the doctor. There is nothing wrong with telling a doctor "too much" because the more you share with them, the more they will understand someone you know a lot better than they do. Read what is part of the mental illnesses they have been trained to treat and if you know there is something else going on, you need to share it with them. If they were not trained to understand PTSD, they will not be looking for it.