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Scared to reveal anxiety to pdoc


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Hi, I've been diagnosed with Major Depression/Inattentive ADD and OCD. I've just started seeing a new psychiatrist for my issues but am having a great deal of difficulty with assertiveness. I realize this is probably something I should speak to my therapist about, but a) I have already to some degree, though not in great detail, and b) I was more interested in hearing some advice from people who might've actually been in similar situations.

Generally, I find that no matter how much I psych (no pun intended) myself up prior to an appointment/phone call, it's like this basic survival instinct will suddenly kick in upon encountering him, and I'll find myself acting really apologetic and obsequious. Part of it is his presence - he's older (in his 60s), highly intelligent, and quite dominating in stature, though he's also friendly, good-humored and compassionate. Still, I find that that instinct will basically override any moment-to-moment impression of him.

The biggest problem is the fact that it was nigh impossible to find a psychiatrist who would treat ADD where I live and I'm scared that if I reveal the extent of my anxiety, he might bail on me, because as it stands, my life is almost literally in his hands (which leaves me with no sense of agency). He's already claimed (albeit in a trusting sense) that he's going solely on my word, as there was zero evidence of an attention problem in my report cards, but I *know* that I have an attentional issue and nearly broke my back trying to (unconsciously) find workable coping strategies in high school and college. There's also a strong ADD presence amongst my siblings, mom, and (deceased) grandfather, though none have been officially dx'd.

He knows that I have OCD, though I think I've held back on revealing just how much of a problem it's been, especially w/r/t the nasty depersonalization/dissociative symptoms it causes from time to time. When I try and explain that I'm having certain reactions to meds (i.e. more agitated/anxious on Dexedrine.. and now paradoxically sleepy/insomnia-riddled on Strattera), he sometimes acts perplexed, so I'll kind of just try and cover up because I feel scared I might be denied treatment. Anyway, he did say that if my anxiety doesn't resolve with a stimulant, he'll prescribe an AD and then add a stimulant back in, though since the ADD came first (OCD only appeared at 19), he was hoping the comorbidities might disappear with a stimulant.

So, I suppose there isn't much general advice people can give me and I kind of just wanted to vent, but I'm just not sure how to conduct myself in session, i.e. is it best to just come clean and tell him that I'm scared of him and am holding back, or should I 'man it up' and try to act more bold and stand my ground with my med reactions, etc.? Given how hard it is to break patterns of unassertiveness, I really feel like the latter just isn't going to happen (at least not anytime soon).

Also, I suppose I was wondering how common dissociative/depersonalisation symptoms are in anxiety disorders? The last time I tried to discuss these with a psychologist, it resulted in a schizophrenia diagnosis. My new psychologist (an OCD specialist) poo poo'd that dx within twenty minutes of meeting me, and was completely unfazed when I mentioned the dissociative issues. But I've never discussed them with a psychiatrist before and thought they might resolve once my anxiety was treated anyway ... so I wasn't sure if going into more detail might just sabotage me.

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Tell your doctor everything. That's the only way he'll be able to treat you appropriately.

Take in this post or something else that you write that describes your symptoms and difficulties in an explicit, organized manner. That helps a lot if your tendency is to clam up when you get in session. If nothing else, stop worrying about how he's going to see you or think about you. Your best bet is to be you and be candid.

Depersonalization and derealization are common symptoms of anxiety disorders. I'm not sure how that can be confused with schizophrenia. You need to discuss that with your doctor.

Thanks for the advice. I actually took in four pages of notes related to ADHD during the first session, but he was very much into directing the questioning himself, so I haven't really tried to do the same thing since. That wasn't explicitly a bad thing, since I find - and have found - that he is very careful in tailoring his approach to meet the situation (there are times where he will actually pause for like 10-15 seconds at a time and reflect on what I've told him, before speaking again).

The schizophrenia dx. was basically a desperate catch-all for my symptoms - executive functioning/motivation difficulties related to ADD/depression became 'negative symptoms', fatigue and leaden paralysis became catatonia, my body dysmorphia (obsessed with signs I'm aging) was termed delusional, and the DP/DR was the icing on the cake. I became very attached to the psychologist in question and then found out that she had passed information on to the psych she referred me to, who was trying to treat me for schizophrenia without my knowledge (the Abilify was supposedly for my anxiety?). I finally had some neuropsych testing done, which suggested ADD, but it was too late - I'd completely lost trust in the psychologist and have been struggling with similar trust issues since.

I know you said I need to "tell him everything", but should that include the fact that I'm scared to tell him everything?

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I agree with the others. You must tell him everything. I'm sure he's heard everything, and you need to get treatment for ALL your symptoms.

Yes, you should write something down because when you are nervous you get hesitant or forget to mention things. I know from experience. And you don't have to take 4 pages of notes to explain it to him. Just take in a 1 page outline explaining your symptoms so that he can glance at it on the spot and ask you about your symptoms to get more detail.

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