Psychiatrist’s Misdiagnosis or Just a Changed Diagnosis?

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Reader’s Question

In 2007, I was diagnosed with Bipolar I and PTSD from years of physical, emotional and sexual abuse in childhood and early adulthood. Today I saw a new psychiatrist and she added adult ADD/ADHD and dissociative disorder to my diagnoses. Is it possible or common for psychiatrists to miss or combine some diagnoses/symptoms in patients?

Psychologist’s Reply

Yes, it is possible. Different doctors often make different diagnoses than preceding doctors.There can be a number of reasons for this; your diagnosis is complex and different symptoms express at different times, causing a new doctor to make a diagnosis based on your current presentation. Doctors also have differences of opinion, that may or may not be significant in terms of your treatment. Or, a doctor may add a diagnosis to facilitate medical treatment of those presenting symptoms.

In your case, it’s important I think to realize that PTSD and dissociative episodes are both constellations of anxiety disorders. If both doctors are treating your anxiety, then it doesn’t make a huge difference to your treatment. Your prescription won’t likely change that much. However, ADHD is a diagnosis that is often treated with an entirely different category of medication. Bipolar Disorder is also treated with a different class of meds. Therefore, your doctor will need to watch you to see how you respond to a combination of different meds. Your new doctor may be thinking about certain drug interactions and how different meds combine for a positive, synergistic effect.

One other reason why psychiatrists may not agree on a diagnosis is this: they don’t have a lot of time to spend with you and observe you. In my own state of California, for example, psychiatrists usually make a one-hour initial appointment with 15-minute follow-up appointments. That doesn’t give much time to do a proper assessment. For this reason, it’s often a good idea to meet with a therapist or physician’s assistant, who can prepare a summary report for the doctor. Every time I’ve seen a psychiatrist and therapist collaborate in treatment, it has been to the benefit of the patient.

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Finally, I’d like to encourage you to ask your new psychiatrist what he’s thinking about you. It is not impolite to tell him that your diagnosis has changed, or to ask what that means for you. Having this conversation is an important building block in your relationship with him. It will let you know if your doctor listens to you and responds to you. It can be the basis of trust, which is absolutely necessary in any relationship, especially one so important as your relationship with your doctor.

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