Telling a psychiatrist what you think is the problem...

ParanormalChickenGeek · 28-04-2015, 01:43 PM

As some of you may know from reading my previous threads, I have an assessment with a consultant psychiatrist at the local CMHT this week. I've only ever seen one psychiatrist for an assessment before and that was at age 14. Other than that I've had one course of CBT at 16 and then thereon just treated with meds by my GP.

I have a good idea what is wrong with me but I don't know how to address that with him without him thinking I'm either a know-it-all or attention seeking in some way.

I've thought about the way I am regarding my looks, my obsessions about being ugly and needing to change my appearance. I think really, I fit the criteria for body dysmorphic disorder, which then leads to me having eating disordered behaviours, rather than me having an actual eating disorder.

I also think I have secondary PTSD (which is actually not a recognised diagnosis according to DSM-V), as my younger sister was sexually abused by her Dad, my Mum's partner at the time. This affected me so much and still does now. I lived with this man for ten years of my life... He never sexually abused me but he did emotionally abuse me and my Mum. I have nightmares about him frequently and almost nightly have nightmares about being raped. I feel very guilty that it's affecting me like this when my sister is the one who was abused and deserves the help and support.

I guess I'm really scared to tell the psychiatrist these things. There's a stigma that as I work in MH myself I should be able to help myself. And also that I shouldn't have such issues myself...
I'm scared the psychiatrist will think I am incapable of doing my job. I'm also scared that as I have symptoms of BDD, PTSD, anxiety, depression and ED, he'll just label it as BPD, which I don't feel I have, but I have seen psychiatrists just slap this label on anyone who has a large range of symptoms similar to mine.

I'm scared. I don't know where to go with this.

Margo · 28-04-2015, 02:10 PM

I've seen quite a few psychs over the years. I saw one yesterday. I always go wanting to tell them everything after reading everything and am pretty sure I know how to diagnose myself.

In all the years it's never quite worked like that. They usually ask a lot of questions to which you answer. I usually answer a lot of questions they never even asked cus I'm so nervous and they put me back on track.

I always take a list with me of issues I feel need mentioning. If something I feel major is missing I try and mention it as you are always given a chance to say anything at the end of the session.

If you've been referred there is a good chance that a lot of your issues will be known to the psych as the nurses will usually write up your case so you don't go in cold.

Remember psychs are people too. Some we get on with well and others we don't.

Just be honest and yourself.

This coming from a man who was convinced he was either going to be sectioned or laughed at and it all turned out well.

Take care xxx

sherlock holmes · 28-04-2015, 03:54 PM

Usually when I see my psychiatrist I talk about issues I want to raise (it really helps to write some things down) and I say what I think it might be and let her tell me her professional opinion. Sometimes I ask about trying certain meds or therapy and she'll consider it and will say if it's a good idea or not.

Definitely say what your issues are, maybe phrase it in a way like "I've been wondering if it might be something like body dysmorphic disorder because I struggle with these symptoms..." rather than outright telling the psych that's what you have researched and believe you have (some really do not like this).

Also just to say that just because you work in MH no-one expects you to be able to fix yourself. Even psychiatrists, psychologists and therapists cannot fix themselves, they have to go to others for help. So try not to worry about that.

LittleCloud · 28-04-2015, 05:02 PM

I hear you loud and clear having gone through a similar assessment a few weeks ago. I think the list of key points is a good idea. Try to go in with an open mind as well as your own ideas- you can always use your own ideas to ask questions.

ParanormalChickenGeek · 28-04-2015, 05:35 PM

Margo - quite often it has worked like that for me. I've had GP's ask me what I think is the problem and what medication I want. One GP even said "you know better than me so tell me which medication you need"!
Also the GP referred me due to low mood, I've never told a professional about anything else, especially not anything ED related- apart from when I went into a&e the other week after fainting due to dehydration from vomiting, and even then I was very vague with them.

Sherlock - thing is, as said above, many doctors have said I'm the "specialist" (which yes technically I am; I'm a clinical nurse specialist/therapist!), so they often just say "why don't you tell yourself what you tell your patients?". There is this expectation that I should know what to do. That a therapist shouldn't have big problems like this themselves.
Also I'm really scared to mention any ED behaviours as I actually work in eating disorders, ironically!! I'm scared the doctor will suggest I'm not fit for my job and suggest this to my employers... Which are the same trust!! Ahh it's all a mess. I don't know.

Alanna- yes I will think about going with a list! Thank you all for suggesting that, it's a good idea!

Margo · 28-04-2015, 06:29 PM

I think that is disgusting! Imagine going to an oncologist and them asking what meds you recommend just because you work on the ward. One of the things with mental health is that's it's so hard to quantify. We all experience things differently.

I'm sorry this has happened in the past. I think you have every right to complain. I sit on a board for MIND charity and if we heard of this practice in my own authority there would be an investigation and ramifications.

Hell, it's stressful enough without worrying about this.

I still stand by what I say but more importantly write things down. I think if you have built up a relationship with the same psych over time then you should be expected to contribute more. In the initial stages they should lead.

If you have the strength I'd mention what happened th last time.

Good luck xx

sherlock holmes · 28-04-2015, 08:52 PM

They really shouldn't be suggesting you treat yourself! Like Margo said it's different when you struggle with issues yourself. But you can absolutely have your own MH issues but be a great therapist. Honestly you shouldn't be expected to be making yourself better because you "know all of the answers". It doesn't work that way!

Have you heard of Kay Redfield Jamison? She's the professor of psychiatry at Johns Hopkins and yet she has severe bipolar disorder. She's been very unwell before, even sectioned, and yet nobody expected her to to treat herself out of it!

Try not to worry. If you don't want to be treated in the same trust you work in then protocols exist for this where you can see in a different trust for confidentiality.

ParanormalChickenGeek · 29-04-2015, 08:26 AM

Thank you both, you've said some very reassuring things. I'll try and be as honest as I can tomorrow.

Epicene · 29-04-2015, 05:01 PM

Good luck with this tomorrow. I just wanted to add that I have a background in psychology and worked in mental health, so have also experienced this dilemma. Generally I find its possible to reach a middle ground; sharing your thoughts about what's going on, but letting the psychiatrist put together the information and feed it back to you with their perspective. Some doctors hate being told what to do, so it can be sensible to feel them out first, but most acknowledge that the person with the problem has their own insight.

Snow White. · 30-04-2015, 08:42 AM

Wishing you all the best for tomorrow x

keep_it_together · 30-04-2015, 08:48 AM

When dealing with the CMHT I tend to just tell them my symptoms, how they're affecting my life and the difficulties therein. I leave conclusions up to them and talk through the recommended treatment.

Be honest and I know it's hard sometimes but try to tell them everything so they have all the information.

Good luck with the appointment

ParanormalChickenGeek · 30-04-2015, 12:00 PM

I was completely honest and just answered all of his questions. His opinion was that I have BDD which led to a mild ED and is keeping depression and anxiety going.
He said he will refer me to a psychologist but this may take up to a year.
He also started me on Lamotrogine and changed my Venlafaxine to XR.
I feel a bit hopeless as he was like 'BDD is very hard to treat'.

Snow White. · 30-04-2015, 12:16 PM

You're on the right path though at least for getting better. I can hear you're feeling hopeless but how do you feel about the diagnosis and being listened to? And the medication?
I'm really proud of you for being honest about what's going on for you.

Margo · 30-04-2015, 03:06 PM

Just because something is hard to treat doesn't mean it's untreatable. On paper my diagnoses is shared by millions and yet I seem to have one that likes to resist most meds and treatment, but even I am getting better (excuse the current slip).

I think if you can open up communication with him it would be good to express your professional feelings and express how difficult it makes you feel.

Well done for giving it your best.

*hands gold sticker for bravery*

ParanormalChickenGeek · 30-04-2015, 06:57 PM

Thank you so much guys, you've been so supportive and encouraging.

I really felt listened to, which I don't usually with professionals. Though I did forget a few important facts that he didn't ask about, ie; current SH. Maybe he just assumed I didn't do it anymore I don't know...

I feel positive that my meds are now XR as I wanted this initially but the GP said no and I think it's because XR is more expensive!! I'm happy to try the Lamotrogine but I guess he was right in saying the meds won't undo my deep self-hatred and obsessions about my looks. It won't stop me dieting or hurting myself.

It feels weird to have an actual diagnosis, a name for how I am. I've only ever been given a diagnosis of depression and anxiety when I was much younger.

I told him I've always been certain I'll die by my own hand and now I'm more certain than ever.

Epicene · 01-05-2015, 08:14 AM

Yay, I am so happy for you that it went well. Try not to worry too much about diagnosis, it will be an adjustment so expect it to take some time to get your head around. I hope you start to feel better soon now you've got new meds and support in place. Did he mention the possibility of therapy for the BDD symptoms?

Crazy Cat Lady · 01-05-2015, 04:26 PM

I am proud of you for going to the assessment, well done sweetie.

I'm so sorry I don't have many words at the moment but I will message you later.

K xx

ParanormalChickenGeek · 04-05-2015, 07:34 PM

Thanks guys <3

Epicene- yeah he's made a referral to a psychologist for therapy for the BDD but as I said it'll be a long wait for an appointment which is frustrating.

I just don't want to live like this anymore. I don't want to feel disgust and hatred every time I see my reflection.
I still need to pick up my new prescription so I'll do that tomorrow and hope the new meds have some sort of positive effect...