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Why your mental health may be misdiagnosed

I get frequent reminders that most doctors and nurse practitioners have little or no training in substance abuse and addictions.

Consequently, there are two conversations I have on nearly a daily basis:

  1. No, chances are, you don’t live with Bi Polar Disorder (BPD)

  2. It’s a grossly over diagnosed condition because it shares symptoms with a LOT of other mental health disorders

  3. BPD is literally the presence of Depression and Mania/Hypo-Mania. Lots of folks live with depression and anxiety. Depression & anxiety together looks a lot like Depression & Mania

  4. If we don’t ask the right questions (especially about trauma) we tend to get the wrong diagnoses.

  5. Active addiction looks a hell of a lot like BPD. (Be honest with your prescribers, folks)

  6. If your mood swings, paranoia, grandiosity, irritability, or sleep disturbances are caused by using drugs/alcohol, that muddies the waters diagnostically.

  7. BPD is 4-5 times more common in men than in women

  8. No, chances are you don’t live with Attention Deficit Disorder (ADD)

  9. In layperson terms, nearly all symptoms of ADD are also symptoms of PTSD

  10. Lots of mental health conditions and substances lead to inattentiveness

  11. Lot of physiological conditions and anxiety manifest nervous energy and behavior that looks an awful lot like hyperactivity but is actually psycho-motor agitation

  12. Nearly all medications for ADD are stimulants. They work by what it referred to as the “paradoxical affect” – stimulants actually slow folks with ADD down. If you take Adderall, Ritalin, Concerta, or Vyvance and find yourself hyper and jittery, chances are, you’ve been misdiagnosed.

Here is the main problem with both ADD and BPD – they’re very appealing. They’re both present at birth and come out later in life. Diagnoses like these are usually referred to as “organic illnesses.” That means they’re not caused by poor parenting or making bad decisions as an adult. The go to treatment for both conditions is medications. It’s very tempting to believe that one simply has an imbalance of chemicals in ones brain and that all you need to do to fix it is take the right med.

The go to meds for BPD are called, “mood stabilizers.” These meds often act more as self-fulling prophecies than to effectively treat mental health. A mood stabilizer will typically improve ongoing depression. The person who experiences this is likely to believe they were accurately diagnosed because the meds for BPD improved their mood. Yet, any anti-depressant might have achieved the same results.

Long before we consider the presence of organic illnesses, we need to look at a person’s:

  1. Physiological health (especially thyroid levels, possibility of diabetes or high blood pressure)

  2. Misuse of substances

  3. Their physical environment

  4. The people in their lives – especially family and friends

  5. The experiences of domestic violence, sexual assault, or any other form of abuse

  6. Major life stressors like poverty, food insecurity, oppression, other experiences that result in chronically high levels of stress

Thorough assessment doesn’t fit well into the time managed care allots to prescribing clinicians. A responsible mental health therapist will take 2-4 hours to come up with a preliminary diagnosis. If your doctor came up with a label in under 15 minutes, please don’t consider it gospel truth.

My suggestions:

  1. It takes a minimum of six months of sobriety to get an accurate mental health diagnoses

  2. A year of sobriety is much better

  3. Nearly all diagnoses hinge on honest and accurate self-reporting

  4. Family histories of physiological diseases should be screened out before mental health is likely to be accurately assessed.

  5. When in doubt – get a second opinion.

  6. Research any condition you are diagnosed with. Wikipedia is actually pretty helpful with this.

  7. Major life events/major shifts/changes in one’s life can easily manifest in episodic feelings of depression or anxiety. Please consider the impact of recent shifts or losses before determining that you need meds.

  8. I am in no way anti-medication. I do challenge folks that whether they feel they need meds or not that they can also learn strategies to better cope and improve their quality of life.

For more insight on these topics, I highly recommend

Dawn is our kind of people and being in recovery herself, she is an expert on the relationships between mental health and addiction. I highly recommend her book Edge of the Cliff 

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