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Diagnosing anxiety (and a difficult doctor)

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Sanctuary

Although I've had issues with anxiety all my adult life I only recently consulted a doctor about it. This was triggered by being very stressed about problems at work but the problems run much deeper and relate to other things. Although I have tried to cope with anxiety I suppose I have become "tired of being troubled".

I found the doctor pretty unsupportive. I mentioned my problems, mostly involve constant worrying and "flashbacks" (if that isn't too strong a word) to incidents. However he seemed much more interested in physical or behavioural symptoms, e.g. panic attacks, being visibly distressed, insomnia, feeling unable to leave the house. Anxiety doesn't affect me in these sorts of ways - the problems are almost entirely mental. I have had for many years a "tension" in my stomach which might be related to stress but I forgot to mention this; in any event it may have nothing to do with anxiety and doesn't seem to change much when I am especially anxious. Overall he seemed reluctant to diagnose anxiety without physical symptoms.

Another issue he raised was whether my work problems were essentially connected to my current job or more broadly related to employment. I did say that I have had problems with past jobs but that I could be successful in the right kind of job. Again he seemed to be reluctant to diagnose anxiety unless my problems related to almost any type of work - I couldn't say is the case although for me most employment is stressful. I could see some point in his argument - in some cases anxiety only relates to us being pushed beyond our current abilities and it is the job or the situation that is the problem rather than our psychological state. If we find activities or situations more suited to us or if adjustments are made we can manage. By contrast there are some people who find even the most apparently mundane and straightforward activities difficult. He felt this was really a matter for me to resolve with work managers rather than a medical issue and while there is some truth in that it can create problems if managers are unwilling or unable to make changes.

Overall I had the impression he wanted to get the consultation over as quickly as possible. I didn't get the chance to outline the broader problems I have with constant worry,  OCD and irrational, bizarre fears. For example even writing this message I have a fear at the back of my mind - although I know  it's irrational - that the doctor will somehow come across this message even though it has no identifying information and that will lead to some unspecified negative consequence. A nonsensical fear but one which can inhibit what I do. Even if I'd mentioned these wider fears I suspect he would have been uninterested. Perhaps the problem is that GPs on a tight appointment schedule simply don't have the time to properly explore psychological conditions but it may also be that some are either unaware of how they really affect someone's life or are actively unsympathetic in their attitudes. 

Rounding things off is the doctor right that clinical anxiety has to have some physical symptoms - worry (no matter how persistent or distressing) is not enough? Does it have to be broader than relating to one job or activity we do?  

 

 

 

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Peridot

I guess he's right. I guess clinical anxiety results in a broader range of symptoms…so that's why you didn't get that particular diagnosis.

OCD is terrible, by the way. I had it so bad in the past that I couldn't function pretty much at all anymore. Such anguish.

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Sanctuary

I don't know the exact definitions doctors are working with and they may be different in different countries and interpreted differently by different doctors. I suspect many doctors are much more comfortable dealing with physical conditions. They try to apply similar parameters to mental illnesses and psychological conditions which may not be appropriate. Therefore they seek physical symptoms of mental illness but someone can be deeply tormented without showing physical symptoms. Governments may also push medical agencies in this direction as well, perhaps with the intention of limiting diagnoses of conditions such as anxiety.

The only other time I consulted a doctor about a mental health issue was many years ago when I was suffering from depression. I don't recall what I said but I was certainly suffering badly at the time and probably mentioned having suicidal thoughts and this may have ensured I got a diagnosis. As it happened the treatment I got was (in my view) ineffective and I recovered through support from other people but maybe at the time getting the pills gave me some hope and prevented me getting worse.

OCD differs from anxiety (for me anyway) in that it does have an effect on behaviour and isn't just a mental condition. For example because of my obsessive worries I do check locks and other things far more times than I need to as well as succumbing to various superstitious-type beliefs even though I know they make no sense. However whether my compulsive behaviours would pass a medical threshold I don't know, e.g while I will check locks multiple times (even when I haven't left the house) i'm not someone who checks them hundreds of times per day or returns home because of worries about not locking a door, 

 

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Dr-David-Banner

Doctors are not much use to you unless they refer to a psychologist. Like asking a bike mechanic to tune an aircraft engine. Try getting yourself relaxed and ask what specifically you feel. Then try and trace it to the source. For example, I was misdiagnosed with panic attacks but years later it became clear the problem was closer to alexithymia - inability to express emotions reciprocally. OCD seems ti be rooted in insecurity. I suffered from it badly in childhood. There is an element of superstition as you say. Try youtube resources in psychology and Eastern philosophy. I found much of it helps.

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Miss Chief

Is this a GP or a psychologist? If a GP request a referral to Psychology for formal diagnosis, GP's are like a jack of all trades but masters of none, this isn't meant to be insulting but they have to have just enough knowledge about everything to get you treated or direct you to where you need to go. One of my biggest mistakes was allowing my GP to treat all my mental health conditions for over a decade. Once I finally demanded a psychology appointment I was diagnosed correctly, properly and treatment was changed, what's more treatment was not just pills it was CBT/ACT and other therapies (as well as pills). 

I am not saying the doctor is wrong, so far as I know anxiety does usually result in physical effects like butterflies, diarrhoea, nausea, vomiting, headaches etc (not all of them of course but some). Flashbacks actually makes me think PTSD, which sounds a lot more like what your talking about, do you want to avoid things cause you fear they will trigger a reaction in you? Will that reaction be mostly mental and involve you reliving a memory or emotions linked to a traumatic event or memory you have?

What I would suggest you do is look into PTSD and see if it fits but also (and more importantly) request a referral to your local Psychology team for assessment, while you wait for that appointment write down what happens to you, what might trigger it, how you deal with that, what sort of things you dread or avoid, what things help, what is your safe zone, are there things you have done that you thought you couldn't but once you were there, what you feared never came to pass, did that change the way you felt about doing that activity again even if it was somewhere else, most important... be honest. The only person who needs to see this is you and your doctor, your doctor needs to know the truth in order to correctly diagnose and treat you. Once you get the appointment give them this report and let them read it then answer any questions they have, try to trust them to know their area of expertise, I know it can be hard to do that if you've had bad experiences in the past or been fobbed off, you can do some research into other mental health conditions to familiarise yourself with what you think you do or don't have but also remember you aren't a doctor and you don't necessarily know what all those terms mean or how much they have to have an impact before it is necessary to diagnose, sometimes it can be harmful to pigeonhole someone with a condition if they are coping ok without a diagnosis.

EDIT: Hit Post but accident...

Edited by Miss Chief
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Dr-David-Banner

I used to suffer from an extreme fear fixation of a teacher at uni. She was an assistant conversation language teacher. The phobia started after I witnessed her sort of reduce a student to jelly. This woman was serious and clinical and somehow I became fixated I'd be humiliated in the class. Somehow it built up and up to the point I got too scared to go to the language lesson. To other people it sounded ridiculous. One girl dragged me to the class and I'd be sweating. Back then I didn't know how to self analyse. Much later I learned to ask myself questions such as "What do you feel? Why is such and such so frightening?" What could it have been related to in the past?" I did see doctors back then and they tended to give me tranquilisers. Glad to say I outgrew phobia. I still feel not at ease in groups but certainly not panic stricken. I also outgrew ritualised OCD that involved touching door knobs repeatedly or squaring objects in line. 

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Sanctuary
15 hours ago, Miss Chief said:

Is this a GP or a psychologist? If a GP request a referral to Psychology for formal diagnosis, GP's are like a jack of all trades but masters of none, this isn't meant to be insulting but they have to have just enough knowledge about everything to get you treated or direct you to where you need to go. One of my biggest mistakes was allowing my GP to treat all my mental health conditions for over a decade. Once I finally demanded a psychology appointment I was diagnosed correctly, properly and treatment was changed, what's more treatment was not just pills it was CBT/ACT and other therapies (as well as pills). 

I am not saying the doctor is wrong, so far as I know anxiety does usually result in physical effects like butterflies, diarrhoea, nausea, vomiting, headaches etc (not all of them of course but some). Flashbacks actually makes me think PTSD, which sounds a lot more like what your talking about, do you want to avoid things cause you fear they will trigger a reaction in you? Will that reaction be mostly mental and involve you reliving a memory or emotions linked to a traumatic event or memory you have?

What I would suggest you do is look into PTSD and see if it fits but also (and more importantly) request a referral to your local Psychology team for assessment, while you wait for that appointment write down what happens to you, what might trigger it, how you deal with that, what sort of things you dread or avoid, what things help, what is your safe zone, are there things you have done that you thought you couldn't but once you were there, what you feared never came to pass, did that change the way you felt about doing that activity again even if it was somewhere else, most important... be honest. The only person who needs to see this is you and your doctor, your doctor needs to know the truth in order to correctly diagnose and treat you. Once you get the appointment give them this report and let them read it then answer any questions they have, try to trust them to know their area of expertise, I know it can be hard to do that if you've had bad experiences in the past or been fobbed off, you can do some research into other mental health conditions to familiarise yourself with what you think you do or don't have but also remember you aren't a doctor and you don't necessarily know what all those terms mean or how much they have to have an impact before it is necessary to diagnose, sometimes it can be harmful to pigeonhole someone with a condition if they are coping ok without a diagnosis.

EDIT: Hit Post but accident...

Thanks for your very through and helpful response. I consulted a GP. I very rarely go to see a doctor but I saw this same man a couple of years ago about a physical issue (not serious but uncomfortable all the same) and he wasn't interested and basically said it wasn't a problem. I was completely thrown by his dismissive response and didn't know how to reply. This time around I wanted a quick appointment and just accepted the first doctor available although I suspected it might be the same man. Perhaps with hindsight I should have asked for someone else and I would do if I sought another appointment. Of course it is possible another GP would say very similar things and might be even more unsympathetic but I suspect most would be more helpful even if their ultimate conclusions were similar. 

You are right that GPs are generalists and may have limited knowledge on certain issues. In such cases they should make a referral to more specialist advice - some will do so but others will not. Within the confines of narrow appointment slots GPs are unlikely be able to properly deal with mental health issues, except perhaps to help manage an existing and well-explored condition. 

It's very good advice to go to any consultation (with a GP or a specialist clinician) with notes about incidents, triggers and so on and I would certainly do that in future. The problems I have are troubling, tiresome but just about manageable but sometimes we want an improvement and not just to "manage".

I have tended to associate PTSD with being the victim of or a witness to serious violence or abuse. I haven't suffered those but incidents of mistreatment have had a big impact on me and regularly flash back into my mind without any obvious trigger and are very unpleasant. They are often accompanied by me imagining how I could have reacted differently although generally there was no alternative to how I acted at the time. Perhaps ironically some of the earlier incidents and flashbacks have faded in the light of the recent problems I've experienced and don't seem quite so bad - however it seems strange to argue that the way to ease bad memories is to replace them with newer examples of mistreatment. Maybe the most recent grievances will be replaced when fresh problems take over but obviously I don't want to be troubled by any of these things. 

 

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Sanctuary
14 hours ago, Dr-David-Banner said:

I used to suffer from an extreme fear fixation of a teacher at uni. She was an assistant conversation language teacher. The phobia started after I witnessed her sort of reduce a student to jelly. This woman was serious and clinical and somehow I became fixated I'd be humiliated in the class. Somehow it built up and up to the point I got too scared to go to the language lesson. To other people it sounded ridiculous. One girl dragged me to the class and I'd be sweating. 

The most troubling memories / flashbacks are almost entirely connected to people whom I feel have treated me badly. I can worry about activities I struggle with and have a "fear of future failure" but such events don't tend to trigger such troubling thoughts. Often the thoughts are about how to deal with future encounters with these difficult people. I try to maintain a neutral response if I do have future contact. It's tempting to be antagonistic but that too easily backfires and then our own conduct comes under the spotlight rather than theirs; it also allows them to portray themselves as the victim rather than the instigator / aggressor. "Letting bygones be bygones" can help build bridges but can also lead to different troubling feelings about being weak; on the whole though it's better to avoid putting fuel on the fire. Generally I just prefer to avoid that person so such decisions don't have to be made but that doesn't stop the constant ruminations about how to react.  

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Miss Chief

While PTSD is often caused by life and death situations, that is not always the case, really it is caused by your reaction to a scenario, not the scenario itself, so you can have PTSD in a situation that was traumatic for you but wasn't life and death, just like some people don't get PTSD when they are in traumatic life and death situations. 

One of the treatments for PTSD is to allow the flashbacks to come, not in a place where you are out of your comfort zone, but deliberately triggering them in therapy or at home so that you can go through the flashback and just it flow the more this happens in a safe and controlled way the less power it has. I am not suggesting you try doing this on your own at home but it might be worth looking into it and trying to get some therapy.

Avoidance is not a good coping mechanism it can lead to phobia's. I have some good course work and exercises (called StressPack) on managing stress, which explains this quite well if you're interested? You might also benefit from the course I am on at the moment called ACT (Acceptance & Commitment Therapy) which is designed for people who are struggling with stress and anxiety (and PTSD), things like unwanted negative thoughts, I will be scanning in the notes etc when I finish the course next week if you would also like a copy of those?

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Dr-David-Banner

Very early days yet but I am urged to read the very early work of Grunya Sukhareva. She claimed spectrum symptoms are connected to trauma. Especially in cases where children were treated more as adults in a regimented environment. Given I did have that background I aim to try and read Sukhareva's work which hugely predates Asperger. Probably though trauma may just act as a catalyst that mixes with the genetic factors. However the case may be self analysis I found very helpful. Latent sources for my anxieties were deep rooted fear of humiliation and ridicule. The idea of being forced to say and do the right thing to avoid rejection. Thus, phobias and repetitions develop. Personally I found acknowledgement of these fears and probable causes very helpful. I am not really phobic like I used to be. 

Edited by Dr-David-Banner

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Sanctuary
15 hours ago, Miss Chief said:

While PTSD is often caused by life and death situations, that is not always the case, really it is caused by your reaction to a scenario, not the scenario itself, so you can have PTSD in a situation that was traumatic for you but wasn't life and death, just like some people don't get PTSD when they are in traumatic life and death situations. 

One of the treatments for PTSD is to allow the flashbacks to come, not in a place where you are out of your comfort zone, but deliberately triggering them in therapy or at home so that you can go through the flashback and just it flow the more this happens in a safe and controlled way the less power it has. I am not suggesting you try doing this on your own at home but it might be worth looking into it and trying to get some therapy.

Avoidance is not a good coping mechanism it can lead to phobia's. I have some good course work and exercises (called StressPack) on managing stress, which explains this quite well if you're interested? You might also benefit from the course I am on at the moment called ACT (Acceptance & Commitment Therapy) which is designed for people who are struggling with stress and anxiety (and PTSD), things like unwanted negative thoughts, I will be scanning in the notes etc when I finish the course next week if you would also like a copy of those?

Those are interesting thoughts about the relative nature of PTSD. However this relative nature can itself cause problems for someone enduring difficulties. While I am certainly troubled by flashbacks / intrusive thoughts about certain events - and that is unpleasant in itself - the feelings are then amplified by ideas that I should be more resilient and shouldn't be troubled (or at least less troubled) by what has happened. The same applies more broadly to stress / depression - feelings of being stressed / depressed can be made worse by beliefs that we should be stronger and that our problems are not as bad as those faced by others. While it may be true that others may be more able to deal with difficult experiences we have to accept that we are different and - at least at this time - are not able to cope so well. It's also true we may overlook our strength in dealing with other problems that others struggle with. 

You are right about avoidance as a general strategy. Avoidance does tend to compound anxieties. However there are times when we are not ready / equipped to deal with certain problems at that point and it is safest to avoid them. However in the long-term we do need to develop strategies so we can face those difficulties.

Those resources will be useful - thank you for your good advice and support on these issues.

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Miss Chief
1 hour ago, Sanctuary said:

However this relative nature can itself cause problems for someone enduring difficulties. While I am certainly troubled by flashbacks / intrusive thoughts about certain events - and that is unpleasant in itself - the feelings are then amplified by ideas that I should be more resilient and shouldn't be troubled (or at least less troubled) by what has happened. The same applies more broadly to stress / depression - feelings of being stressed / depressed can be made worse by beliefs that we should be stronger and that our problems are not as bad as those faced by others. While it may be true that others may be more able to deal with difficult experiences we have to accept that we are different and - at least at this time - are not able to cope so well. It's also true we may overlook our strength in dealing with other problems that others struggle with. 

While I understand what you are saying and I imagine it is worse for men than women, (given societies expectations that men; protect, provide and generally be strong) the fact is struggling with mental illness does not mean you are weak, if anything it means you are stronger, you have all that extra crap to deal with and still you struggle on.

Also if you can learn to deal with it, find a coping strategy or a way of getting yourself out of the rut or even better recognising when you begin to spiral down and taking proactive action to stop the decline before it has too much of an impact then you are going to ultimately be stronger for it. You now have a better understanding of others who struggle with this but also you have the tools and the skill to overcome it. You might even be able to help others in similar situations.

I have to say exercise and a healthier diet can make a huge difference for me (I am not saying you don't already do that, perhaps you do but if you don't then it can help), I know when you are low or anxious it can be like getting blood out of a stone... just thinking about exercise can be exhausting, but if you can get a friend or family member to help, you can motivate each other, then the exercise pays off really quickly, it is kind of weird how expending energy results in you feeling like you have more of it but it really does work and it can give you a huge emotional boost, not to mention being confidence building. I am trying to get myself to go swimming at the moment, although it's really hard especially that first time.

1 hour ago, Sanctuary said:

You are right about avoidance as a general strategy. Avoidance does tend to compound anxieties. However there are times when we are not ready / equipped to deal with certain problems at that point and it is safest to avoid them. However in the long-term we do need to develop strategies so we can face those difficulties.

Well yes I think the issue is when you are actively avoiding something specific and you are avoiding it all the time. For example when I was in an abusive relationship I decided that it would be better if I stayed sober, that way I was less likely to allow the situation to escalate, but I didn't like being around drunk people when I was sober so my solution was to just not go out socially, this resulted in me getting exceedingly debilitating agoraphobia, where I would literally go without cigarettes for 10 hours because I just couldn't leave the house to go to the shop, if I had to leave the house I would get nausea, diarrhoea, vomiting. Worst part was the treatment was basically to go out and get over it. Which is why avoidance can be dangerous, it's fine if it's just now and then but don't let it take over :) 

1 hour ago, Sanctuary said:

thank you for your good advice and support on these issues.

You are welcome... that is what this place is all about, supporting and helping each other :) 

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Sanctuary

Another problem I've experienced related to anxiety or other personal troubles - and which others may have had as well - is a reluctance to tell others. I tend to keep problems to myself for fear that involving others will burden them in some way, e.g. that they may feel under pressure to help, that they may worry about my welfare. "Confessing" bigger problems is harder than smaller ones which seem less burdensome to others. Perhaps ironically outlining worries can be harder to do with friends or family members because of the existing emotional connection - they may feel more "obliged" to help than those who are less well-known. Sometimes I even worry that talking about certain fears will cause others to have them - planting anxieties they previously didn't have in their heads.

Guilt is often wrapped up in anxiety and there can be a feeling of guilt in drawing attention to our problems. However we have to overcome that reluctance to talk and not be afraid to seek help when we need it.

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