Getting An Accurate Assessment

1. I want to go to the top medical professional/facility wherever that is to get an accurate assessment of if I have a diagnosis and what it is. It has been very frustrating to see different professionals, get different diagnoses or an opinion that I do not meet criteria for any diagnosis. Who is the primary authority on how to accurately diagnose?

2. I want a plan and a professional to help me carry it out...whatever is best for me. This BS approach of talk therapy got me nowhere and I kept quitting. I’ve heard others here mention they had treatment plans with their professionals. What does that look like?

If you have a teaching hospital within reasonable access, call their psych department and tell them you feel you need a comprehensive diagnostic evaluation. That might include talking to a psychiatrist and therapist as well as taking psychological tests and maybe having medical tests done. It'll all depend on what kind of information you can bring them and how your initial diagnostic exam goes. The more information you can provide them (medical records, inpatient records, clinical records of other types) the more complete your diagnosis will be.

I was sent for psychological testing by both of my psychiatrists as second opinions to verify if their own diagnosis of me was accurate. They both were of the mind that having that other, more objective, set of eyes on my diagnosis was helpful to them in being sure they were treating me correctly. My psychological evaluations were done by psychologists who specialized in assessment. The trick is finding one on your insurance (if you are going to use insurance) because they are rarely categorized that way. It took a jillion phone calls (mostly leaving messages because so many don't have secretaries -- pet peeve of mine) and playing phone tag, but eventually I found one.

I found it helpful to have the assessment done by a psychologist who really didn't know me because they had no prior opinion about me and could simply base their evaluation on the testing protocols and results.

The testing was done in two sessions if I remember right. Some of the testing is kind of long and feels really redundant, but there is a reason for the repetition. In the end, they wrote a report with the diagnoses, etc. that was helpful in confirming how I had been previously diagnosed.

I don't usually post here, but I agree with ArtleyWilkins... You probably want psychological testing -- specifically, a "comprehensive psychological evaluation" administered by a licensed psychologist or neuropsychologist. (Use those words when requesting testing, if you decide to go that route.)

In a typical comprehensive evaluation, you'll be given some personality testing, IQ testing (to see if you have any deficits in concentration, attention, math, reading, etc.), screening for anxiety disorders, screening for mood disorders, screening for PTSD, and screening for psychosis. The psychologist who administers the test may look at more things, but generally, those are the basic things that psychologists look at. They don't really go out of their way to test for things like autism because there technically aren't any standardized ways of testing for it in adults and you'd need some kind of autism specialist to accurately diagnose you with autism if you have it.

If the psychologist who administers the test is good, he or she will pay attention to your behaviors and actions during your testing to look for things like flat affect, flat vocal tone, facial expression, eye contact, rate of speech, motor impairments, etc.. Also, a good psychologist will provide you with recommendations for treatment at the end of the report they write up for you. Such recommendations range from books that you should consider reading to specific types of therapy you would likely benefit from (e.g., EMDR, DBT, CBT, etc.). They may even say basic things like, "patient could benefit from learning progressive muscle relaxation in this manner [blah blah blah]" or "patient may want to consider light therapy for her depression."

Anyway, I did comprehensive psychological testing in 2015 and then "follow up" testing in August 2018 when my psychosis started getting stronger/frequent. Both came up w/ a bipolar 1 diagnosis, but the second one added the "w/ psychotic features" specifier. Both tests were helpful to me because the "mini" one I did in school only said I had depression, ADHD, OCD, and anxiety... but well, you don't treat bipolar in the same way you treat depression. (It was a disaster.)

feel free to ask me questions if you have anything specific in mind.

If you want a truly honest assessment, i would present my case(s) to the reddit thread, am i the bad guy. Or whatever its called.

I’ve been presenting my case here. So, am I the bad guy? Lol. I know you are kidding.

Went back to the therapist that I saw months ago. He said they don’t like to diagnose and avoid labels. He referred me to trauma therapy.

Im serious. You have a vested interest in us, as we do with you - we dont want to hurt your feelings, we dont want to push too hard, we want to maintain the relationship.

Maintaining the relationship usually comes at a cost of nobody being right (or wrong).

My family are right-fighters too. That is, being right is important to a lot of them, which means if you dont agree with them, you (meaning me) are wrong and therefore bad. But "being right" is not one of my important values. I would be more judgmental about a person being interesting or boring, rather than right or wrong, say to talk to. KWIM? Unless of course they were always handing you the wrong screwdriver or something.

So im just saying - i dont think theres anything psychologically wrong with you or your family, more than any other "normal" american family. But needing to be right? Having to say, aha, i knew i was right! That is exactly what kept me away from my mother the last ten or so years of her life. I knew that that was ALL she wanted with me, was the last word, that she was right. I know I'M right. She had played it out with me SO many times, where she led me on and then tricked me at the end, that i wasnt going to be tricked ever again.

Thats my story. I think yours with your mom is a little different. I was hoping reddit could help you find a better solution to your other cases. Seriously!

I finally learned it’s so much easier to tell my mom she is right. As she got older she’s gotten confused and insists she is right about things she so obviously is not. I get a little chuckle now saying she is right.

I’ll have to check out reddit. As for being the bad guy, sometimes it is me, sometimes it isn’t. I’ll always admit it and apologize.

I just wish I hadn’t been obsessively neurotic trying to figure out how much is me and how much is them. I need to relax and let trauma heal, avoid more, stop retraumatizing.

You also make a good point how we may not really tell each other we think they were the bad guy because we want to be supportive and we want to be liked.

I agree with your therapist.

I'd never consider one of those comprehensive tests except for things like suspected learning disability. I don't see how it would change anything if you have a trauma history, or what use it would be.

With the variability among therapists' school of thought, lack of diagnostic specificity, shoddy training, etc., people can read the DSM and psychology books themselves and come up with a more accurate conclusion. People will say to not self-diagnose, but this is only my opinion.

What is your goal? Are you having cognitive difficulties, sleep, emotional, medication effectiveness? Depression or anxiety?

Also agree Reddit can be a good source.

So he may not have given you a DSM diagnosis about it but it sounds like he thought you had unresolved trauma issues? What do you think about that? Did the referral to trauma therapy sound like a red herring or lost cause to you? Not worth looking into?

Also, I would be glad to tell you you were the bad guy if/when I thought you were and if you had specifically said that you wanted that kind of input. If you decided not to respond to me, or some other kind of not keeping a relationship with me after that, then so be it. I like you, but it's only the internet, for heaven's sake! We can try things a little differently here, if we want to, I would think.

But, seriously, to your point -- do you think the top experts are really going to be able to pinpoint your troubles and issues with an expert diagnosis and give you a definitive plan for how to overcome those? Do I have that correct, that that is what you think/hope such a diagnosis/treatment plan would provide?

However, I thanked you for the OP because, even though I don't think that is possible any more, at least for me, I think it would be nice if it were, and if you find a place and get it done, I think it would be very interesting to see a post about your experience and the results!

^^^I agree with this. If you are thinking if they have a definitive diagnosis they'll have a clear plan and if you follow that plan, you'll get better, that's really not realistic.

Even with a definitive diagnosis, the road to recovery and healing is pretty much fully dependent on the ability to work through or get beyond whatever issues continue to interfere in your day-to-day functioning in the present, and most often those present-day problems are tied to history, in your case an apparent trauma history, that for many people requires many years of processing to get beyond. There is no easy fix.

That said, how diagnostic testing served in my case was simply as a confirmation that the psychiatrist and therapist were on the right track. Honestly, not much in my treatment changed because the diagnoses (and there were several) were not the kind of thing that had any one answer for treatment; even the diagnosis where medications are standard only narrowed down the treatment options but "narrowed down" is a VERY relative term.

If you think you therapist/psychiatrist are completely off-track with their diagnoses, then perhaps evaluation will either confirm that they are on the right track and perhaps you have some coming to terms with your own diagnosis to adjust to (that's very normal), or evaluation will help point them in a different direction. What probably won't happen is a simple plan of action that will be a direct route toward healing.

The 2nd question you asked about treatment plans hasn't really been addressed. The only time I had any sort of formal treatment plan was when I was hospitalized and the insurance company required the psychiatrist to complete a treatment plan on paper to continue my hospitalization. It really wasn't worth the paper it was written on (and my psychiatrist told me as much as we wrote it -- we knew we were writing it to jump through insurance hoops). Beyond that, I wouldn't say either my therapist or psychiatrist had a "treatment" plan that was set and followed from start to finish. The closest thing we had was a few goals (very loosely and informally developed over time) which were flexible and prone to adjustment because . . . life.

The best treatment plan I had for myself was a determination to do what it took in my therapy to deal with my past so that it stopped running the show. We had no idea what that would entail when we got started; I only knew I wanted to function again without depression and anxiety and severe PTSD symptoms. Pretty vague, right? I knew I had a good therapist and a good pdoc, so my end was to actively show up for every appointment, actively engage in my therapy, and work to transfer my insights and skills from the safety of the therapy room out into my real world.

What will work for each individual is variable to that person's history, temperament, complicating diagnoses and current life circumstances, and many, many other factors.

It’s not that I’m hung up on the diagnosis. It’s that I’m trying to figure out if it’s complicated or simple. Bad relationships with incompatible people or emotional issues within me causing the problems.

Mental health isn’t the same as broken leg. It’s much harder to accurately diagnose.

Some disorders are diagnosed only when everything else is ruled out. Some people have several illnesses and diagnoses but having them all official makes no sense.

Sometimes it’s good enough to just work on symptoms. But I do see value of clear diagnosis. My husband was diagnosed with one thing at 20 and then other mid 20s. Finally had clarity and understanding of how and why life was so hard .

It’s not curable, but right meds certainly take edge off but mainly therapy, meditation and using various strategies learned in therapy do wonders making his life much easier.

You can do full evaluation and insist on diagnosis. But usually unless you put an effort into one or more strategies like maybe combination of things like meds and therapy and your own effort, there is no 100% cure or treatment that is going to get you all fixed.

If anyone wants to do a treatment plan on your own, there are many sample plans and instructions available for free online:

Treatment Plan
How to Write a Mental Health Treatment Plan: 13 Steps
https://dss.mo.gov/mhd/cs/psych/pdf/...ate_sample.pdf

There are templates at this link:
Guide to Creating Mental Health Treatment Plans | ICANotes

Good questions, and it certainly seems worth looking into, given where you are coming from. I hope they call back.

Please keep us posted. I'd really like to know.

No call back today. Not a good sign. So much for that idea.

I think it's important to feel confident in the treatment you're receiving, but diagnosis, especially in mental health, is not very cut and dry and in some ways largely irrelevant, more for insurance purposes than anything clinical.

Plus, a lot of factors go into diagnosis, including the person's years of experience, their level and amount of training, their gender, ethnicity, etc. The list goes on. You as a person also add numerous variables from gender, ethnicity, experience in receiving mental health services, etc.

If you live in the United States or another country, that can play a huge factor in the help you receive. Even within the United States, not all states receive the same amount and quality of services.

But, at the end of the day, if you think you'll benefit from help, I think important part is that you start the process and try to take everything with a grain of salt. Try not to let things frustrate you too much, at least not to the point that it gets in the way of you getting help.

That's my 2 cents anyway.

That's definitely important to note — that without testing and professional expertise and depending on what's going on at the time, some people ultimately get diagnosed with certain illnesses, e.g. bipolar disorder, after things get worse, not better.

For example, sometimes people get treatment initially when they're young because they're away from family and in college, they're stressed, using substances, etc. and they express symptoms of anxiety or depression, get put on an SSRI at the school clinic or primary care, and become manic and/or psychotic.

A lot of university health services and primary care offices for that matter don't have the experience, time, or formal training to dig deeper and ask questions, refer out to specialists, or run even basic psychological testing batteries.

I know that was my experience, starting at sixteen or seventeen in my primary care office and getting prescribed Serzone and Trazodone. Then, another SSRI at the university health service by an Family Medicine NP still in training. She also did a very basic computerized Beck Depression Inventory. Nothing to do with diagnostics, but to get a baseline to compare against future Beck Inventory's after starting the SSRI.

I didn't know any better. I was young, didn't have my parents or anyone else in my corner to ask questions or provide guidance. Also didn't know at the time I wanted to go into mental health as a career, didn't have even a basic bachelor's degree in psych and biochemistry, or the ten years of experience I do now from working in acute inpatient mental health.

Not to say that it's wrong per se. They provide a service and they're doing the best they can. Plus, ultimately, I think at least some of the responsibility lies on the person — 50%, let's say — as the consumer. But looking back on it, if I were you and could go to some professional, get testing, and potentially avoid some of that initial pain and suffering, I'd definitely consider it.

I understand what you're getting at, but it's not like if you had a diagnosis, that would disprove the other hypothesis of bad relationships with incompatible people. Even if you have interpersonal issues that can cause problems, be careful about making blanket assumptions that your problems must be the cause of problems in every relationship. In fact, one rather common issue many people have is that they choose relationships with people who aren't going to treat them well. So then that becomes a situation where the person finds themself in the relationship due to their own emotional issues, but the problems in the relationship cannot be ascribed solely to that person.

For example, many women find themselves repeatedly in relationships with men who are abusive. I wouldn't then say the relationship issues are caused by the woman - she does not cause her partner to physically strike her, devalue and belittle her, or impose himself on her sexually. Those actions are caused by something with her partner, not by her. Yet there is no denying that a history of abuse makes people more likely to be abused again, and in the case of the types of abusive relationships I've described, it is quite possible that the woman does have some issues that made her vulnerable to choosing an abusive partner. However, they are issues more related to recognizing who is safe/unsafe, self worth, and being able to recognize abuse for what it is and not normalizing it - rather than issues that can be conceptualized as "causing the problem" in a relationship.

The DV scenario was just an example - the same dynamic where people repeatedly choose relationships (of any kind) with people who are incompatible with them can happen in many different circumstances. If you're looking to figure out what's going wrong in your relationships, you're going to have to spend time talking about them and trying to find some sort of pattern. I don't think a diagnostic assessment would be necessary or even helpful for this goal.