unexpected diagnosis
Long talk with psychiatrist, told her many things I’d told other psychiatrists, got dx PDD-NOS, said she gave that instead of Asperger’s because I didn’t have as broad a range of symptoms. Am relieved and surprised.
I was expecting to spend $700-1100 for a formal assessment that might or might tell me something useful and I am glad that I have this because I think it will make it easier to get an effective specialized therapist.
Psychiatrist said that’s probably why therapy hasn’t been very helpful for me, and that therapy here (rural area) would probably not be helpful and she recommended waiting until I moved to CA in early December. It was incredibly good to hear that. The tension between my experiences with therapy and the experiences I’m supposed to have with therapy messes me up when I think about it.
I’m using some DIY cognitive therapy for some of my thought patterns. This is the only time I’ve ever found cognitive therapy useful but it actually is.
1. List your feelings and rate their intensity:
* Safe (I wasn’t expecting this but it was the first thing that came to mind), 80% of max
* Guilty, 40% of max
* Confused, 20% of max
* Relieved, 80% of max
2. list automatic thoughts:
a) “I don’t deserve this” (i.e. don’t have adequately severe problems to deserve a label that will facilitate my getting help”
b) “It will look like I sought it out” (even though I didn’t ask for an assessment and only told her in response to her asking about what stressors I was having, but I still worry that I might have reframed what I said to “fit” a diagnosis)
c) “It’s a conciliatory diagnosis, like when you go to the doctor and they give you antibiotics you don’t need”
d) “It’s like not having real problems, like Asperger’s lite”
3. My responses to those thoughts:
a) feeling like I don’t deserve it: regardless of diagnosis, I damn well deserve respectful therapy
b) answer to “I sought it out” is “hell yeah I did, I’ve been trying to get help for seventeen years. I’ve rephrased how I talked about things during those seventeen years, but my most recent way of rephrasing was based on analysis of personal experience, talking with my mother and my former babysitter, and reading the experiences of people with similar diagnoses. It is a sign of me being healthy that I kept looking for a way to explain what was happening that would help me get the right kind of therapy.”
c) answer to “conciliatory diagnosis”: “If it didn’t fit, she wouldn’t have diagnosed me.”
d) “It’s like Asperger’s lite”: the DSM-IV states that PDD-NOS (pervasive developmental disorder not otherwise specified) “should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes “atypical autism’ – presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.”
In practice, it seems to get used both for children who are so severely impaired you can’t tell whether they have autism, and for people who don’t meet enough criteria for autism or Asperger’s. It probably does get used as “Asperger’s lite” sometimes, in the same way that Asperger’s diagnoses are sometimes misused to mean “Autism lite”, when the only difference between the two is presence or lack of language delay.
It looks like the DSM-V will fix that in 2010, by adjusting diagnostic criteria to better fit how people are actually diagnosed. And to better represent the fact that it’s a spectrum.
Anyway. Regardless of all that. I think I’m more comfortable with a PDD-NOS diagnosis than an Asperger’s diagnosis because a lot of representations of Asperger’s don’t seem to me much like me.
