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Affect incongruent

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Edited by TOT

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Yes.  I have the same problem.  Lots of people do.  I've always referred to it as being high functioning.  How I feel inside has very little to do with the way I look or carry myself.  To know how I feel, you have to listen to my words.  If I say I feel like crap then that's how I feel.  If I'm sitting there dressed, clean, and going to work, that does not mean everything in my head is fine.  Looks can be deceiving.  

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The only time I ever shower get dressed and leave the house is when I have an appoitment. I figured its that way for alot of people. I knew pdocs looked at appearmces and body launguage but I never thought they would put that above what we say? Shouldnt they know we are all experts at acting like things are okay when theyre not? This has me worried. ive never looked at any of my records now im curious.

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Edited by TOT

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Edited by TOT

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Okay ill talk too her about it.

the thing about your pdoc thinking.your not looking at the positive..ive been there..I know there doctors and know whats best or are supposed too but ive had so many experiances where I just want shake them and say "why arent you listening too me?!?!" lol

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I wouldn't be thrown by it in your records. Noting that your affect is incongruent doesn't mean or imply you're lying. It's just an observation - one that psychiatrists are supposed to make. Sort of like how your GP is supposed to take and note your BP. It's a data point.There are all sorts of reasons your affect could be incongruent to what you say. Sometimes it can be a symptom.

 

But the fact that it's noted over and over by different people makes me think maybe it's not so subtle. Maybe it's more than just not crying. Maybe you seem upbeat or even cheerful? That would be a clearly "incongruent" affect if you're having suicidal thoughts. And it's important to note - because in some cases it could mean a mixed state or whatever. 

 

The last thing you want is for a doctor to ignore their observations and just go by what you say. You could get badly misdiagnosed. For the same reasons that self-diagnosis doesn't work that well. But, yeah, I could definitely see it being a barrier to treatment - and dangerous - if it means you're suicidal and not being taken seriously. Or just having your distress minimized.

 

I guess because I have chronic suicidal thoughts I'm not so shocked by your pdoc's and tdoc's reaction. Or lack thereof. I'm acutely aware that my providers have to use judgement to figure out when to worry about  safety, and when to not let it be a distraction.  Yes, there are people who just a hint of dark thoughts should trigger alarm. Then there are people like me at the other end of the spectrum. I'd think most people are somewhere in between.

 

But one thing I'm wondering kind of echoes your pdoc's insensitively-put question: how is she supposed to react? What I'm wondering about is: what is the help you need that you're not getting? Obviously, being taken seriously. But beyond that? I think if you articulated to your clinicians what help you think would help you - you'd be more likely to get what you need - regardless of what they make of your "affect."

 

 

 

 

 

 

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Edited by TOT

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I think the same thing happes to me.  I may be showered and neatly dressed at 9 am to see my pdoc, but that the only day I'm ever showered and dressed at that hour.  Heck, it might be the only day I've gotten showered and dressed all week.  Also, I was fairly upbeat at my last pdoc appointment.  I also told him I still thought I was depressed  And he didn't believe me.  Is it not possible that I was upbeat at that appointment, but had been fairly depressed for the rest of the month?  Did my behavior in his office negate the suicidal thoughts I had been having all week?  Aparently it did, because he totally blew me off. 

 

I feel like there's a certian way that I've been taught to act in front of doctors, and that behavior gets in the way of me getting effective treatment sometimes.  Get showered, dressed in nice clothes, wear clean (non-stained) underwear, exchange plesantries, don't talk about suicide.  Yes, I know I have to talk about the last one if I want to get help, but it's hard.  Should I also show up 20 minutes late in my pjamas and scream at the guy when he doesn't listen to me?  Because that's what I really feel like doing.  

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Keep in mind that there's a lot of things doctors look for when they study your affect. They look at your eye contact (something that is truly very hard for me when I am depressed or anxious), how quickly you answer their questions, your posture, etc. I am typically one of those who only really goes out for doctor's appointments, and who tries to dress nicely, put on some makeup, have clean and brushed (maybe even blow-dried!) hair, etc. But when I am really down, sometimes I'll skip the makeup, or my hair will just be back in a ponytail, or my outfit will be a t-shirt and jeans versus a blouse and pants or a dress with leggings. My pdoc notices those small changes. My thought patterns are almost always logical, but if I am really depressed it will take me a minute to answer questions he asks, or during the quiet moments my eyes will be wandering all over the room, looking at his diplomas and knick-knacks and really showing my inability to focus. 

 

I don't mean to say that you're doing it wrong (how can anyone do it wrong?), just that most pdocs, after you've seen them for a while, will be clued in to much much smaller details than just you looking nice or acting somewhat cheerful. They'll notice you wringing your hands or jiggling your legs or having slower than normal mental processes. That's just part of the benefit of seeing the same pdoc for a long period of time--assuming they're competent to begin with, of course.

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I tend to use humor to hide how bad I feel and this can confuse doc's. I laugh and joke but it is a mask I use to hide my true feelings. I usually state this upfront. I try and reduce things to concrete examples. "I am so depressed I have not changed my clothes or bathed is X days/weeks." "I can't watch sad things on TV as I will burst into tears if things get too unhappy." I have noticed that docs seem to better get things when the example is concrete and therefor less open to interpretation.

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I smile when I am anxious. For me this is most likely a survival strategy to protect myself from my parents, to make sure they were not aware of my anxiety because the consequences for me would have been so much worse if they knew.

 

I do wonder if this is one of the reasons I was accused of making everything up for so long when I tried to get help with my anxiety.

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I have the same problem. Mental illness is my favorite subject, and so when I get to talk about it, I become animated. The point, though, isn't to lob theories back and forth but to help me cope. I have some nice clothes and I generally try to be clean for the doctor's office. But a therapist recently told me that I "lead with my personality." I'd been cheerfully relating all the ins-and-outs of various methods to end my life, and he pointed out that I didn't seem bothered by the prospect. Maybe I'm trying to impress them. Actually, no, I am trying to impress them. This is my chance to be seen as intelligent and functional by someone who has no way to verify it. An employer expects me to do stuff, so they can see if I'm not capable. A mental worker just talks to me, and I'm a good talker so bully for me. 

 

I've considering going with unkempt hair and unwashed clothes, just to help get the point across.  But I have a crush on the receptionist, so I'd have to sacrifice some confident flirtation to pull off the depressed hobo look. 

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I don't allow myself to be sad most of the time so when I do cry, it's rare, doesn't last long and it's usually because of a sad movie or commercial. It might be something else that is making me sad but I won't express it so it sort of leaks out.

I know my pdoc has commented about me crying, he has never seen me even tear up.

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Edited by TOT

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Idk what to write, but wanted you to know I read what you wrote, and that I have been in similar situations as your (OP) situation/s, where I am not believed.  I used to want to "give my head to people to try on", like you said, too.  Now people believe me in terms of having MI no matter what I say/don't say.  The difference for me was finding the right pdoc.  After a multitude of pdocs, I finally found one who could "read" past the "happy, upbeat" me.  He just "got it," somehow.

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i had a tdoc show me a video of myself in session, so that she could point out to me that even though i was in major distress at the time, i was smiling and nodding.  apparently she understood the phenomena and wanted me to see it for myself.  i was surprised at how together i "looked"... while bleeding with pain on the inside.

 

so now i tell every new doc that i do this and to pay no attention to it, it's just a defensive thing i use with EVERYONE.  the more anxious i am, the more i do it.  and when i stop doing it, it's time to admit me NOW.

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My pdoc hasn't said anything but I get the feeling he thinks I am doing better than I am. He hasn't seen me at my worst. He gets upset when I can't remember when I re-filled prescriptions but I have trouble remembering things. He sees me every 4 months which is as far out as he goes.

 

I thought of changing pdocs at one time and the one I saw said I didn't strike him as having bp (my dx at the time).  I was happy to hear he didn't think I had a dx, but then it hit me later that he was just wrong.  I went back to the pdoc I was seeing and told him what happened and that I was having a good day and he agreed sometimes I come across as doing better than other times.

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Posted (edited)

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Edited by TOT

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The problem with me is masking. I am High Functioning though. The one thing I cannot mask is (hypo)mania

 

I can hide everything and then all of a sudden it will blow out.  Usually with my mum and the recieving end. That is probrably the results of communication problems.

Edited by helenllama

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