Diagnoses

In my very first post on this blog 9 years ago I listed different diagnoses I have been given. I was thinking it might be interesting to go through those now given that I have some expertise at this point in diagnosing where I can critically evaluate them. The diagnoses below are all ones I have been given in the past.

Dysthymic Disorder: This one is hard for me. I have a really hard time judging for myself whether I have this or not. I flip flop all the time about whether I think this diagnosis describes me well. It’s really hard for me to objectively take a step back and see if I meet that persistent depressed mood criterion. I can certainly tell when I’ve dipped down into an MDD episode but it’s hard for me to self evaluate if my baseline is really depressed. I certainly have chronically low energy and sleep a lot. But I also accomplish a ton of stuff and keep really busy. But my baseline is very self critical. Jury is out on this one.

Major Depression: There is zero question that I have had many major depressive episodes.

Bipolar type 2: I absolutely do not have Bipolar type 2. People who tried to give me this diagnosis looked at the apparent conflict between my depressive symptoms and my productivity and assumed that there must be a hypomanic component but I never have anything close to elevated mood for that could meet the duration and I sleep a ton all the time. I think there’s also an element of people mistaking my fast talking for hypomania when I just always talk really fast. There’s an anxious part to my rate of speaking but I’ve also tested at 99th percentile processing speed. I think there’s an aspect of me just being able to think very fast. Also I am very socially isolated. Sometimes when I have a chance to speak after not for a long time a lot of stuff comes out because I have not talked for awhile.

Bipolar type 3: An inpatient doc tried to give me this diagnosis once because I had a bad reaction to Ritalin. This diagnosis does not exist so I clearly don’t have it.

Social Anxiety: I have anxiety about a lot of things. Sometimes some of it is about social things but I don’t believe I have ever really had social anxiety. It’s more than some of my generalized anxiety bleeds into social domains. But the symptoms are better accounted for by my Generalized Anxiety Disorder.

Generalized Anxiety Disorder: Hell yes. This is my main underlying problem. Everything stems from my GAD. When I am depressed it’s usually because I ran myself into the ground from being super anxious. Sometimes I have a few good days where I think maybe I don’t have GAD anymore and then some speedbump happens and I realize I clearly still have GAD.

Panic Disorder: I have had panic attacks but I have never had panic disorder. Panic disorder requires fear about having panic attacks. For me it was always that I was anxious about something else and happened to have a panic attack.

OCD: I have a tendency to by obsessional but I think it is really stretching to say I’ve ever had OCD. That obsession compulsion loop does not describe me well generally and when it does it is better explained by other disorders.

Trichotillomania: I absolutely met for this in the past but no longer meet criteria for it. I still pull but the severity is so low that it’s not causing any problems for me. When i get stressed my pulling can increase but I’m not in the clinically significant category anymore.

Tourettes: Yes I meet criteria but I do feel like my symptom presentation is a bit odd since it developed more in adolescence than childhood. Ive had this tendency to get caught on repeating phrases though as a self soothing thing for my whole life so I think that I had an element of this going on as a kid but my parents perhaps didn’t realize that the verbal loops I was getting in were not under my control. I’d say things like “I like my cat” a bunch of times and my parents would respond “Yes we get it you like your cat”. But I wasn’t really trying to communicate things. It was more of a loop I was caught in. I still have tics and they get worse when I’m stressed. It’s only certain kinds of stress though. Social rumination is a major trigger for my tics. I feel nervous wearing headphones in public because I worry I will have verbal tics and not realize I am doing it.

ADHD (inattentive type): I have a pretty well documented pile of neuropsychological testing that says I have ADHD. I think perhaps though I actually have the combined type no the predominantly inattentive type. I’ve gone through all my records from childhood and they all talk about impulsivity symptoms. My most recent assessment found that I did terribly on measures of impulsivity on the Conners CPT.  Right now impulsivity symptoms are the most impairing part of my ADHD. For example I have an extraordinarily hard time inhibiting urged to blurt things out when a thought comes to mind which make some people REALLY mad when it means I interrupt them. I try so hard to manage that but I basically have two modes either fully suppressing any talking or talking where I’m likely to end up unintentionally interrupting.

Sensory integration Disorder: This is more an OT diagnosis and is not in the DSM so I don’t feel qualified to comment.

Auditory Processing Disorder: This is more an audiologist diagnosis so again don’t feel qualified.

Borderline Personality Disorder: Here’s the thing. I can see why people applied a borderline diagnosis to me. I still really don’t think I have ever 100% met criteria for it. I think you always had to stretch some of the criteria in strange ways to make me meet. As of right now I think it’s even clearer that at this  point in time I don’t meet criteria. Borderline PD is often conceptualized as being on this emotional rollercoaster. Certainly I was like that in the past. Now I’m more stably anxious. Under extreme stress I will start to look “borderline” ish because I become very emotionally reactive, am prone to impulsive self destruction, get very distrustful of others, etc. But the thing is I don’t look like that on a typical day or even in the typical week. In the past I had a lot more daily mood instability but I am less reactive now. Every now and then I get ambushed with periods of being on an emotional yoyo but it’s far from being my baseline. Even at my worst people were most likely to give me a borderline diagnosis when I was in acute distress. I don’t think that’s a good way to diagnose personality disorders. Do I have a personality disorder? Probably, but I think I’m more in the cluster A and C camps than B.

Mood Disorder NOS: This is not longer in the DSM but was basically a catchall for weird mood stuff that didn’t fit elsewhere. I actually think a lot of that weirdness can be explained by PMDD

PMDD: I fought this for a long time but I think I’ve come around to it.  The way I see it, PMDD is an amplifier of my existing symptoms. It explains a lot about why I often have short lived depressive episodes that are intense but don’t hit the 2 week criteria needed for MDD. It’s hard to really get across how giant of a mood shift I can have from this. Even when I know that PMDD is at fault because I can look at my period tracker it does little to help in the moment because the emotions feel like just as important signals as they do at other times. It is a source of endless frustration that there is so little research on treating PMDD.

2 thoughts on “Diagnoses

  1. Diagnoses are weird, they’re the sort of thing that I both want and need, and yet I really don’t want or need them. Like on the one hand, being diagnosed with something gives me something tangible to deal with; it’s no longer just some weird struggle that I’m having, professionals officially recognize that there’s something actually wrong, and that can be especially important if you were raised with certain “get over it” ideals like me and your knee jerk reaction is to bottle it up. And then there’s the other side of it; the chance that it’s at least partially wrong is scarily high, and that even if they get it right, some diagnoses can have really tangible effects on your life, and not always in a great way. It’s really hard to know if they do more harm than good.

    Reply

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