Trauma alters an individual's course in many different ways. Often, the journey leads to the need for support to include mental health treatment. In doing so, individuals with a history of trauma are often misdiagnosed and at times, given treatment that doesn't quite fit their experience. SymptomLog.pdf Other Articles by Dr. Panos: Anniversary Reactions: A Survivor's Guide on How to Cope
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The Misdiagnosis of Trauma
By Amy Menna, Ph.D., LPC.
This article will address the misdiagnosis of trauma. It is meant to inform those struggling with trauma-based symptoms with some of the issues related to diagnosis. It is by no means a substitute for a comprehensive assessment with a licensed professional. In addition, it is not meant to override any existing diagnosis. It is simply a means to educate trauma survivors on common misconceptions and issues related to the misdiagnosis of trauma.
Trauma Related Diagnosis
There is a reference book for mental health professionals known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM-V has a list of all the different mental disorders with which one can be diagnosed (i.e. major depressive disorder, bipolar disorder, post traumatic stress disorder, etc.). There is a category of trauma related disorders, one of which is Post Traumatic Stress Disorder (PTSD). This is the most common diagnosis directly related to trauma survivors.
There are specific criteria one must meet to be diagnosed with PTSD. At times, an individual with a history of trauma may present with one or more of the symptoms but may not meet the entire standard for the diagnosis. As such, an individual may be experiencing trauma related symptoms but not quite meet the full diagnosis of PTSD.
As a clinician, an overwhelming amount of trauma survivors I work with have one common theme. They don't feel safe. This can manifest itself in various ways. When one does not feel safe, it leads to a state of hypervigilance. This is when an individual feels "on guard" against life.
When you are safe, there is no need to be hyperaware of your surroundings. When one is unsafe, it is imperative that she (or he) is vigilant to what is going on around them. This leads the body to go into a heightened sense of awareness resulting in an increase in adrenaline, the heart rate going up, and the body getting prepared in case there is an emergency. These physical sensations often result in feelings of anxiety.
Misdiagnosis of Trauma
Misdiagnosis of trauma is often a factor in the trajectory of trauma. Thinking about the example above, one may present to a mental health professional about being "anxious." If the mental health professional does not connect the anxiety to not feeling safe or is unaware of the history of trauma, it may be easy to diagnosis the client with an anxiety disorder. The client may receive treatment or medication for the anxiety disorder alone and the trauma may never get resolved.
This can be seen in other diagnoses. A common diagnosis for women with a history of trauma is the borderline personality disorder. It is common for individuals with this diagnosis to have a history of relational trauma. Symptoms of this diagnosis typically have to do with unstable relationships. It would make sense that an individual with a history of childhood physical, emotional, or sexual abuse would not feel safe with intimate partners. This would naturally lead to unstable relationships. The characteristics such as anger and instability in moods could be explained through the history of trauma instead of pervasive personality characteristics.
Individuals with a history of trauma act differently when they feel unsafe. This may look like anxiety, anger, withdrawal, or even obsessive behavior. An individual who grew up in household where the only thing she had control over was cleaning may grow up to "obsess" over cleaning when she becomes anxious. As a result, she may seek help and be diagnosed with obsessive compulsive disorder (OCD). This behavior comes from the need to create safety through control rather than the typical origins of OCD.
Thus is true for avoidance. Misdiagnosis doesn't just lend itself to formal mental health diagnosis. Misunderstanding behavior or symptoms is also a part of this phenomenon. Avoidance is a characteristic of PTSD. When one feels unsafe, it is natural to avoid a particular feeling or situation. To illustrate, take a man who grew up in an abusive household. This may lead him to naturally avoid conflict at all costs. When conflict arises, it may appear that he becomes withdrawn and avoidant. A complaint from his partner may be that he doesn't take care of things directly and avoids taking responsibility. It may be seen as a character weakness instead of a trauma related symptom.
There are also times that individuals have another diagnosis in addition to trauma related symptoms. Often, a diagnosis such as bipolar or major depressive disorder will overshadow what has happened in the past. The symptoms may be more visible and therefore treatment may be more readily available. An additional diagnosis may also be unstable and need more immediate attention.
It is important to address both issues when there is another problem present. An individual may never know the answer as to whether one diagnosis is related to the other. For instance, so many diagnoses are brain based in nature, an individual may not know if the depression he or she is experiencing is related to a chemical imbalance or the trauma experienced in the past. It is important to put that question aside and seek treatment for both difficulties.
When it comes to resolving an issue, it is important to get to the root of the issue. A comprehensive assessment with a trained professional is one of the first steps. At times, professionals are not adept at assessing trauma related symptoms and therefore may not identify the proper origin of the difficulty. It is important that, if one has a history of trauma, an individual does some research into the professional doing the assessment. Asking specific questions with respect to training in trauma is beneficial.
In addition to having a trained professional, it is important to provide as much information as possible. An individual does not have to divulge more information than he or she is comfortable. It is, however, important to let the professional know that there has been a traumatic event in the past. Knowing about past experiences will assist the professional in tying in the present day symptoms.
Getting a second opinion
Trusting your gut is important. If an individual feels as if they do not have an accurate diagnosis, it may help to talk to their present professional about the concerns. It may even be helpful to seek a consultation from another provider.
Getting ready for the appointment starts with educating oneself on the effects of trauma. It is important to know the symptoms in order to recognize what is going on in one's own life. Some individuals find it helpful to write out a list of symptoms or a timeline of events prior to going into an appointment. It is beneficial to be open and provide as much as information as possible in order to get an accurate picture of what is going on. Here is a symptom's log that you might find useful.
The path of symptoms related to a traumatic event can be vast. As with any journey, it is important to know the landscape and map out the course. The word "diagnosis" may sound like there is something wrong with someone. Think of it as a marker on the course indicating a starting point or a direction in which to go. The aftermath of trauma often includes misdiagnosis and misunderstanding. Remember that we can never change the past but we can always create a new, more informed, starting point.
Dr. Amy Menna is a member of Gift From Within's Professional Advisory Board.
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Trauma alters an individual's course in many different ways. Often, the journey leads to the need for support to include mental health treatment. In doing so, individuals with a history of trauma are often misdiagnosed and at times, given treatment that doesn't quite fit their experience.
Other Articles by Dr. Panos:
Anniversary Reactions: A Survivor's Guide on How to Cope
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