Answer:
Your questions raise several interesting points about diagnosis and assessment. First of all, let me say I am glad you are finally able to tell your psychiatrist more of your symptoms than you had been able to share previously. An accurate history and full symptom profile is essential for any clinician to make an accurate diagnosis. It is my opinion that psychological testing may be very useful to help confirm the diagnoses of PTSD and DID, when there is uncertainty about the accuracy of these diagnoses. By psychological testing, I am referring to a battery of tests that usually includes both questionnaire type tests and what are called “projective” tests, like the Rorshach (inkblot) and thematic apperception (TAT) tests. Such a combination of tests in the hands of an experienced psychologist can provide very useful information about diagnosis, thought contents, how a person perceives themselves and their relationships, and the kind of conflicts a person experiences. Because there are many tests for a psychologist to chose from, the psychologist can best be of assistance if asked specific referral questions.
Another type of testing, called neuropsychological testing, can be useful to determine if their is something “organically” wrong, which means that a person’s symptoms are based on some type of cerebral disorder, such as epilepsy, trauma, stroke, infection, vitamin deficiency, tumor, dementias (such as Alzheimer’s), etc. Neuropsychological tests assess different types of memory and attention functions, sensory and motor functions, planning, sequential task performance, and other brain functions. They are essentially very sophisticated neurological tests that probe the functioning of different areas of the brain. They provide information about whether any particular regions of the brain are not functioning correctly, and whether identified patterns of impaired function resemble types of brain disorders that have characteristic patterns of impairment, such as the “mini-strokes” that can be seen with hypertension. Most types of “organic” impairment do affect cognitive functioning, although cognitive functioning may also be affected by severe anxiety and depression. “The Man Who Mistook His Wife For A Hat: And Other Clinical Tales” by Oliver Sacks, M.D. is a very accessible book about some of the different forms of “organic” or neurologically based changes in mental functioning. Of particular relevance to patients who have dissociative disorders is that patients with certain forms of epilepsy can also have experiences of “lost time,” depersonalization, derealization, and of looking at themselves as if from a third person perspective. Yet patients with dissociation symptoms can also have “spells” that are difficult to distinguish from true epileptic seizures, but do not show altered brain electrical activity and are called non-epileptic seizures (also called pseudo-seizures). These overlaps in symptoms make teasing apart dissociative disorders and certain neurologic disorders quite difficult.
The best way to approach your psychiatrist about your concerns regarding the accuracy of your diagnoses, the possibility of having an “organic” disorder, and whether testing is appropriate, is to ask about what your diagnosis is based on, and compare that to your history and the symptoms you experience. This will require that you be able to discuss all of your symptoms with your psychiatrist. The need for additional tests would be based on the presence of symptoms not adequately accounted for by the diagnoses most consistent with your history and those symptoms already discussed.
In your question you twice mention a fear of being considered an hypochondriac. Hypochondriasis is best considered to be a form of obsessive compulsive disorder in which the focus of obsessional thinking is on bodily and health symptoms, and in which people misinterpret their sensations and experiences as evidence that they have very serious illnesses. I have never considered people with hypochondriasis to be “raving,” but they can suffer greatly with anxiety based on their continual fears of having various serious illnesses, and can become completely and totally convinced that they have these illnesses on minimal information. For example, I have one patient who becomes convinced he has Alzheimer’s disease if he forgets three phone numbers in a row, and he can become so depressed about this that he cannot function. This illustrates how serious hypochondriasis can be. Hypochondriasis is a treatable anxiety disorder and should not be excluded from consideration for people who are chronically and catastrophically worried about their health. I hope these comments are useful to you, and I wish you good luck in your treatment.
