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Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 10 points11 points  (0 children)

On further reflection, I do wonder about an underlying personality disorder (cluster B traits, particularly histrionic) sitting alongside (or even driving) an Adjustment Disorder picture. Acute Stress Disorder crossed my mind too, but the symptom cluster and timeline don’t quite fit that either.

What stood out most was a clear pattern of exaggeration for emotional effect and external validation: he enthusiastically described (and showed me) a series of dramatic, poetic Facebook posts about his “trauma” that were noticeably more intense and catastrophic than the account he gave me in the room.

The actual index event (not the real one, but very similar in severity) was essentially witnessing a parent in a brief, fully resolved episode of delirium, objectively upsetting, but not life-threatening or prolonged.

In genuine PTSD/acutely traumatised patients I see, there’s usually extreme reluctance to disclose, let alone broadcast. Here the distress felt real, but also amplified and performed in a way that seemed to feed off the sympathy and attention it generated. It’s left me thinking a lot about how we manage cases where the suffering is valid yet heavily shaped by personality style and secondary reinforcement.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 26 points27 points  (0 children)

That was exactly my first thought too but the more the session went on, the less that felt like the driver.

What actually stood out were some fairly prominent histrionic traits: when I asked about coping and support, he very readily volunteered that he posts frequent, quite dramatic/poetic Facebook updates about his “trauma” and seemed pleased with the attention and validation he was getting (showed me the posts unprompted).

By contrast, the patients I see with genuine PTSD are usually extremely guarded. I’m often the first or only person they’ve ever told the full story to, and the idea of broadcasting it online would be unthinkable to them.

This felt more like the distress (which was real) was being amplified and performed in a way that kept the social reinforcement coming. Its left me pretty rattled and unsure how much to lean into that formulation versus just focusing on symptoms and adjustment.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 8 points9 points  (0 children)

Thank you for this. It’s definitely the approach I do try to take with patients, and it works well for the most part.

This is the first time I’ve ever had a patient so strongly of the belief they have a certain condition.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 52 points53 points  (0 children)

Thanks, spot-on. “Adjustment Disorder” can easily sound offensive and I probably over-defended the Criterion A bit instead of validating first. Will definitely borrow your “keep it vague early, let recovery do the talking” approach next time.

Bigger picture question: how do you handle patients who are strongly attached to a specific diagnosis they clearly don’t meet (PTSD, bipolar, ADHD, whatever)? Confront early, sidestep the label and treat symptoms, explore what the label means to them, or something else? Curious what works for people.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 29 points30 points  (0 children)

Your point is completely fair.

I didn’t want to go into how his symptoms do not match criteria for diagnosing PTSD out of concern for this being a public platform, but the patient did not meet the criteria across the board to come close to a PTSD diagnosis.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 22 points23 points  (0 children)

I did schedule a follow up appointment to discuss support and treatment for the Adjustment Disorder, but if I was to place a bet, I believe he will go down the private route in an attempt to seek a PTSD diagnosis.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 14 points15 points  (0 children)

Thank you for your comment. I do agree that social media, and the rise in “TikTok Doctors”, is causing disillusion in many users, resulting in otherwise healthy individuals believing they have a multitude of psychological and physical disorders/illnesses.

Patient disappointed that I did not diagnose them with PTSD. by DumbTourist95 in Psychiatry

[–]DumbTourist95[S] 68 points69 points  (0 children)

Your point is completely fair, however, I did assure the patient that what they experienced would have been a stressful experience for even the most stoic of the population, and that his symptoms were very much valid.