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TL;DR: I think some flavor of ADD might be really the core of my problem, but every therapist and psychiatrist I see chalks up all my symptoms to either a mood or personality disorder and almost immediately dismisses ADD or treats it as ancillary. I desperately need treatment for ADD, but even without treatment, I more desperately need acknowledgement that it could potentially be the source of my dysfunction.

 

Nobody really takes it seriously. Sometimes it's "ADD is a very popular diagnosis right now" -- as if having more people diagnosed with an illness is somehow evidence that it doesn't exist (?!?)"Well, do you have school records illustrating trouble in school when you were a child?" No, I don't have my records from elementary school. I'm also pretty smart, so I can muddle through most things just by listening in class and reading the book if it's something that interests me (which fortunately it often is). But every teacher said I didn't work up to my potential, I always turned in papers late, I dropped out of college because I couldn't handle the work, etc. "But do you have the paperwork from school?" No! I'm forty fucking years old; I don't have my records from elementary school! 

 

Today it was, "You're describing the symptoms of depression... I think you're trying to outthink your symptoms." But here's the thing: I think I *do* have bipolar / depression, and I've been enough of an unreasonable asshole that I think I *do* have a personality disorder -- or at least enough of a fundamental coping mechanism that needs to be addressed. So I am totally 100% completely through-and-through willing to acknowledge that and work on it. But I also see some stark differences between myself and other people with similar diagnoses; the main one being is that I'm not interested in very much for very long and doing basic, boring tasks is very difficult, and doing novel, short-term things is extremely easy (until they are no longer novel, at which point they become boring). The bipolar / depressed people I talk to all have interests they pursue before and after episodes. The personaltiy disordered folks also have keen interests, even as they are yelling at their boyfriends and rage quitting their jobs and wondering why their children hate them. I know about these differences because every time I come to a place like this, people come out and tell me what they do that works for them, that helps them feel better. That's great. But I just can't do those things. I'm not motivated. I start, then lose interest.

 

And because I can't maintain an interest, I can't maintain a job. And being broke and unemployed is depressing. I also can't maintain social relationships unless they're based on debating politics, so that's also depressing. I also can't maintain my OWN interests, so my life has almost no real meaning. I can't do chores around the house as much as I need to, and that makes my girlfriend threaten to leave me just about once a week. How that make me feel? Scared and ashamed. I start things I think I'm going to enjoy and then I stop enjoying them for no apparent reason. It's like living in a barren cage with a concrete floor and every once in a while the keepers through me a toy then take it away the next day. You know how that makes me feel? Hopeless! And then there is the fact that I am smart, and everyone acknowledges it, and encourages me to do wonderful things but I always fall flat on my face to the puzzlement of everyone that's not me. How does that make me feel? Really sad! Ashamed! Angry! Like a personality disorder almost. And nobody wants to treat the motivation / attention part of it. And that also makes me sad / ashamed / angry / depressed, so, voila: Patient has a raging personality disorder, refuses to accept help, thinks he knows everything, and it's no surprise he doesn't want to get better because he's not open to doing the work.
 

Anyway, dear readers, I don't know what to do anymore. I'm very sad because I think therapy would be so helpful in helping me cope, but at the same time I just can't work with someone who thinks my most important symptoms are somehow under my conscious (or subconscious or whatever) control. It's so frustrating because the person I was seeing started off talkiing about personality styles and I was all, "yes! awesome! i have a personality style (in a bad way)! this is going to be helpful!" and then I went on to describe my problems with motivation and she brought it right back to personality style. Really? I have absolutely no hobbies and do random things as they occur to me and leave projects half done and start and end careers and instruments, sports, and hobbies because I have a personality style? Is there a personality style that limits someone to now more than 12 hours of any activity before it becomes unbearably dreary? Is there one that makes it impossible to mow the lawn even when you're in a good mood? That makes video game your only consisten friend in life? Because I don't think there is.

Very, very frustrated.

 

My options for treatment are very limitted. I went from a community health center to the local big hospital. The hospital was worse about blaming me for my problems and on top of it, over medicated me for close to a year (2012 will be known as my year in bed), and then I couldn't even get in to see the psychiatrist for frequent med adjustments so I was making zero progress. I'm back at the community health center now; I just had my intake with a therapist that I would have loved a few years ago and would be super helpful if she were willing to accept a neurological component, but she is clearly not, and when you have someone who is a professional that thinks she knows what she's talking about, that doesn't have a neurological orientation, that thinks people like me are responsible for their own symptoms, experience has taught me that there is no convincing them. And the more you try, the more they think you're "resistant to treatment," confirming they were right all along.

 

I cant' afford to see someone privately and nobody takes medicare outside of the institutions.

 

That leaves the psych nurse I'm meeting in a month. I've already met with him. I don't like him. I think he's a nice idiot. But my only hope at this point is that I can talk him into treating me for ADD in a serious way and keeping chipping away at it with different meds. You don't have to be smart to work your way down a list of ADD drugs, and being smart probably doesn't help you move down it any faster. I *have* been treated for ADD with Ritalin and Adderal, neither of which really did much. My last psychiatrists wouldn't give me anything else, thinking that the lack of effect was more of an indication that I didn't have ADD. But any psychiatrist won't seriously treat me for ADD unless he thinks it's a big part of my problem, which, if he is like everyone else ever, he won't.

 

Argh.

 

 

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Addendum: One of my favorite things about NOT being in therapy is that I don't spend time thinking of ways to convince people that I have a real problem. I've been out of therapy for a while, and it's been a huge relief not planning out arguments with my therapist. I really miss the days when I thought my problem was under my control and could enjoy my therapy time. Now that I'm 40 and haven't functionally improved after years of therapy, Now I have short temper with therapist who peddle the same theories and ignore my own. And it's just so unecessary. Just, please, please, please, believe me and I can work with you.

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What kind of treatment for ADD are you looking for? Med treatment? If trials of Ritalin and Adderall have failed, I guess that leaves Strattera or guanfacine.

 

Is it possible to find another therapist? Because appropriate therapy can teach you skills to deal with ADD symptoms.

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Is there any kind of treatment for ADD that isn't medical? I don't think I can train my brain to be motivated, especially if I'm not motivated to do it. :)

 

I would like therapy for coping, but, as I said, nobody really takes it seriously as a root cause and I am so done with depression / life adjustment / insight therapy. I can't get help with coping with something when the therapist thinks I shouldn't be coping, but directly addressing an issue. For instance, hey, I'm not motivated to do thing that's important in my life. Coping, for me, is that maybe I'll never be able to do that thing. Coping is asking how can I structure things so that thing isn't so important. The depression / insight therapy focus would make my lack of motivation the entire issue. Am I depressed? Did my father beat me? Am I a perfectionist? No, I just have an executive functioning problem. Can you see why I'm so frustrated?

 

Do you have an "appropriate" therapist? What do you guys do together?

Edited by ovOidampUle
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Actually, I am not in therapy at present. But if I could afford it, I certainly would do it. I do know that there are therapies to help with ADD. However, Ritalin works for me so I am not having the problems that you are.

 

I don't know why doctors are not taking you seriously. Perhaps they think you are drug seeking? I'm certainly not saying that you are, but many doctors see people who say they are ADD just to get controlled substances (stimulants) so they are very reluctant to treat for ADHD in adults without a prior history.

 

One thing I would like to add is this: have you considered that these professionals might be right? That your self-diagnosis is wrong? I would play their game while keeping an open mind. If you get the other conditions under control, then you will be able to say to them that you still have the ADD symptoms and require treatment.

 

I don't mean to invalidate your feeling that you have ADD. Just keep in mind that it is impossible for any of us to know whether you have ADD or not. We can't diagnose you.

 

On that note, there are comprehensive tests which can help diagnose ADD. Perhaps you can find a doctor who does this testing?

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Is there any way for you to see a psychologist that specializes in learning disabilities? I was able to see two psychologists for free at my university, and get a battery of tests done to determine if I had ADHD and mathematics disorder (turns out, I do! And I tested positive for crazy to boot!). Universities with clinical psychology programs sometimes have clinics where the students practice, which is why it is free. There is often long wait lists, but hey, it's worth a shot. Of the two psychologists I saw, one was a specialist in learning disabilities and the other was a student. 

 

So, I recommend looking around some campuses for resources. And if a university doesn't have a clinic, they may be able to point you in the direction of free/low cost services. 

 

Edit: Sorry to not answer all your questions. I guess I want to say, I understand your frustration. Hopefully you can find someone who may be able to trial you on a different ADHD med, to see if maybe that makes a difference. But I recommend some kind of therapy or book to help you control your symptoms. I have a good book. It's broken up into small chunks so you can focus on each section and then take a break. I forget what it's called now, but I'll post if I can find it. I don't take medication for my ADHD, cause they can cause psychosis, and I have a psychotic disorder. So, that's out. All I rely on is learning as much as I can about ADHD and how to manage it. It's tough sometimes. I nearly failed a class cause of my ADHD. 

 

Edited to add again: My ADHD is certainly not severe. I do quite well, despite it. That leads me to believe that I either compensate very well or it's of moderate severity. 

Edited by Parapluie
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jt07 - Of course! I've spent most of my life thinking I was depressed and being treated for depression, bipolar, and being a dick. I think I have all of those things; but I see ADD as really the biggest problem. I've only made on request of every therapist: help me be productive in any aspect of my life, even if it's stacking pennies to look like famous civil war generals. I've never even been close to anything like that. Not even cardboard picture frames colored orange and decorated with macaroni.

I finally talked to one psychiatrist as a consultation who only sees the "tough cases," and he said that my never feeling "normal" in between bouts of depression points to something else -- he thought ADD.

 

And I do try playing their game. It's tricky because I think inattentive ADD looks like dysthymia in a lot of ways, and I already have a mood disorder which I freely cop to. So how do I play their game? I say, hey, I've taking your drugs and I'm really feeling better -- but I'm still not productive. Their response: well, if you're not being productive, then you're probably still depressed. Catch-22. If they're not willing to consider an executive functioning component, nothing I say or do will convince them.

 

Cactus Grenade Girl - I like the idea of getting a learning disorder workup from a university. They are really expensive otherwise, and usually only done for children. I don't really know how to get a "definitive" diagnosis. Psychiatry diagnosing is a slippery piece of shit, and individual treaters will come up with their own diagnoses as suits their outlook. As an adult, I don't know that there's some definitive test short of a complete learning disability work up. Thank you. I will start researching that.

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CGG- Just got off the phone with the local university psychology clinic. They do assessments and on a sliding scale, so maybe I will have a definitive "fuck you" diagnosis. Or maybe I don't have inattentive add at all. I'm cool with that, too. Maybe I'm just looking for a new problem because I can't fix the old ones. But it's nice to have an actual assessment by people who know and don't have a bias for or against.

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CGG- Just got off the phone with the local university psychology clinic. They do assessments and on a sliding scale, so maybe I will have a definitive "fuck you" diagnosis. Or maybe I don't have inattentive add at all. I'm cool with that, too. Maybe I'm just looking for a new problem because I can't fix the old ones. But it's nice to have an actual assessment by people who know and don't have a bias for or against.

 

Excellent! :) I'm glad you were able to get somewhere. In regards to what tests they do, I had a bunch of specific tests for for ADHD. I also took the WAIS (an intelligence test) and the MMPI (a 567 question personality test). I also took specific questionnaires to look for ADHD symptoms. And I did some tests to test for mathematics disorder, which was pretty much just a math test, though math is part of the WAIS. I imagine you'll do some similar tests. 

 

PS: It's cute that you call me Cactus Grenade Girl, my username is Parapluie. ;) Haha. Most people call me Para.

Edited by Parapluie
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CGG- Just got off the phone with the local university psychology clinic. They do assessments and on a sliding scale, so maybe I will have a definitive "fuck you" diagnosis. Or maybe I don't have inattentive add at all. I'm cool with that, too. Maybe I'm just looking for a new problem because I can't fix the old ones. But it's nice to have an actual assessment by people who know and don't have a bias for or against.

Glad to hear this.

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That's odd, French for Umbrella, because everyone calls me "ovoidampule," but my real name is member.

 

I'm a little uncomfortable taking the tests, because I'm worried I may do too well. But then I remember how poorly I do on standardized test and am confident I can fail with flying colors.

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That's odd, French for Umbrella, because everyone calls me "ovoidampule," but my real name is member.

 

I'm a little uncomfortable taking the tests, because I'm worried I may do too well. But then I remember how poorly I do on standardized test and am confident I can fail with flying colors.

 

It's not really about failing the tests, so much as it is about getting a picture of your functioning.

 

For example, there is a rather well known computer test for ADHD where you click the mouse every time you see a letter EXCEPT for "X."  The letters flash on the screen at varying speeds. This is called the Conners' Continuous Performance Test II. I actually did quite "well" on the test. I had no indications of major attention problems. However, they noticed that every time I clicked the mouse at the wrong time, it was because the speed had changed. No matter if it was going slower or faster, every time the speed changed I would mess up. They said this was indicative of an inability to adapt to changing task requirements, commonly known as "task-switching," which is something people with ADHD tend to struggle with.

 

So, as you can see, you don't necessarily have to "fail" the tests to be diagnosed with ADHD. I would argue that you can't fail something like the WAIS because it's just a measure of your intelligence. They will probably give you a lot of questionnaires which ask you to report which symptoms you struggle with most and then compare that to the DSM 5 diagnostic criteria for ADHD. Be honest throughout the testing process too, if you are having trouble paying attention. It was torture for me to sit through those tests. My mind was wandering and I struggled to bring my attention back to tasks at hand. I told the interviewer this, and she made note of it. It helped support my diagnosis. 

 

So, be honest. I hope you find some answers. :) As well, it's kinda fun to take the MMPI, hopefully they give that to you. Maybe I'm just a dork. The MMPI can tease out a lot of stuff about you. My test indicated that I go through periods of anxiety, depression and psychosis, but was currently not reflective of major psychopathology. So, it actually ended up confirming my psychiatric diagnoses too. Cool stuff!

Edited by Parapluie
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  • 2 weeks later...
  • 2 weeks later...
  • 3 weeks later...

I can relate to much of what you say. I have the inattentive form of ADHD. I always got decent grades in school, and didn't have any of the behavioral problems many people associate with ADHD in then-children.

I also have depression from some kind of bi-polarity (maybe type 2, maybe type whatever). I also have anxiety, mostly in the form of social phobia.

It's tough when people who don't have what you have, and never will, tell you that you don't have it.

The National Institute of Mental Health (NIMH) has studied Bipolarity and has found that ADHD, and--in my case--social phobia are common co-morbidities. Here's a direct quote from their website:

"Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted."

So, yeah, no less than The National Institutes of Health [the NIMH being one of the Institutes] say that, yep, you can have them both, or all 3 or 4, and it's common. You can read about Bipolarity on their site: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml . In fact, you could take a printout to your healthcare provider with the pertinent bits underlined. Be nice, charming, and on your best behavior if you do that, and don't "tell" them that this is what you have, but ask earnestly if they think this might be your issue, because you can relate to the symptoms so well (if indeed you do, only you'd know that). I get better treatment responses when I approach things that way.

Edited by KeepGoing
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  • 1 month later...

Update: The local university I called does give evaluations, but students do the evaluating (under supervision). Because it's training, insurance doesn't cover it; because I live in the worst country in the industrialized world, I still pay ridiculous amounts of money. Or since I can't afford it, I don't get it.

 

The good news is that I just was approved for a program that pays my premium (!) and my medicare co-pay, so I think when I get that letter, I will start looking for a new psychiatrist and someone to do evaluations.

 

In other news, my new psych nurse is a huge dissapointment. He gave me an rx that made me nuts and wouldn't even return my calls to tell me to taper off. I had to do that myself. Then for the next visit, he gave me an ADHD medication I tried before, gave it to me at the lowest dose (which I knew had been ineffective) and told me to see him in six weeks for a follow up. Six weeks is a bit long, don't you think? Most ADD meds work instantly; you have to monitor blood pressure, etc., but you don't need to wait six weeks for that. But it turned out that the medication he prescribed was not on my drug plan formulary, so I couldn't afford it. He wouldn't return my calls *or* my emails. I've given up. I'll see him next week and try not to be obviously angry and therefore, obviously, malingering in a borderline manner. Fuck.

 

But that's just ranting. I have a *little* more freedom, so I'll start looking for a new treatment team when my new insurance kicks in. 

 

 

 

 

I have bipolar 2 as well, but I don't have social anxiety. All the doctors ask me if I have it, like it would so match my profile. My social problems stem from finding social interactions boring because of my ADD or alienating because people have actual interests in things that I don't even understand as a concept.

 

I have tried the educational not-sure-what-it-is tack with medical providers before. It has limited results. It's obvious I'm advocating for a diagnosis that most of them wouldn't come to on their own or don't know about. Bipolar 2 is relatively new -- it took 15 years to get a dx -- and inattentive ADD (motivational deficit disorder) is not only new, but my manifestation is even challenged as a real thing. So far, my best results have been to stress my personal experience and to just repeat over and over again that I've never from childhood been able to entertain myself, sustain attention towards a goal, find any form of reward to be motivating, been completely surprised by the ability of other people to work even normal hours at familiar tasks; not to mention the usual stuff like hold down a job or graduate school. I'm reading a book on Chronic Illness and it makes a point that health care providers like diseases that are clearly defined and treatable. Depression is treatable with anti depressants and goes away. My doctors want my problem to be like that. But inattentive ADD doesn't respond wonderfully to medications and it is absolutely chronic. Without the meds it's right back. Doctors hate that and they don't want to spend time with ammelioration and maintenance. It's much less emotionally rewarding.

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I have a lot of ADHD problems in my life, but don't demonstrate problems when given standard ADHD tests.  My pdoc says that isn't uncommon, and that it's important to see a pdoc and/or therapist who specializes in adult ADHD, because adult ADHD can look different from what you see in kids and adolescents.

Edited by tamagotchi
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Yes, I imagine it is important to see a specialist in adult ADHD -- I've even tried to find 'em, but they've been few and expensive. Though I don't think my adhd manifests any differently as an adult than it did as an adolescent. The only difference is my environment and expectations are different. I did well in school when classes were broken into 55 minute segments, homework assignments lasted half-an-hour per subject at most, and you saw the same five teachers everyday who cared about you and how you were doing in your work. Contrast that to college where none of those things are true. Or contrast that to work, where you have to do the same damn thing every damn day for months or years without learning anything new or having anyone that really encourages and motivates you to anywhere near the pathological degree that you need. I'd really say I have the same attention profile I've always had.

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