Hey everyone,

I saw my new therapist on Wednesday and really like him so far - he spent almost 2 hours with me and took more notes than any of my other therapists combined. He delved into other health issues that I had no idea could be in relation to my PTSD. Anyway, he said as a snapshot diagnosis, he is diagnosing me right now as having Complex PTSD, Dysthymia, and Panic Disorder with Agoraphobia.

My question is this - everything that I have read about Agoraphobia states that you can not diagnose a case of agoraphobia if the person also suffers from PTSD.

So, I'm confused?? Can anyone help me understand?

Best,
Rachel

Well I'm not a physician so I won't attempt to suggest whether your therapist is right or wrong...is your therapist a psychiatrist?

But Panic Disorder and PTSD seem a little like two of the same thing to me. What I mean by that is that panic is often a huge part of PTSD anyway... though obviously those with panic disorder do not necessarily have PTSD. But off the top of my head I don't know what the DSM criteria is for Panic Disorder so I'm not actually sure what I'm talking about...just my thoughts, as I know a lot of people first diagnosed with panic disorder are often misdiagnosed and later rediagnosed as PTSD. Again, I wouldn't want to attempt to state anything on this, as I'm not a doctor...

I'm not sure why agoraphobia would not be diagnosable alongside PTSD though... agoraphobia is a specific phobia. Not everyone with PTSD is agoraphobic... I'd be interested to know why the sources you have read state that?

I think there is a thread in the anxiety section that would be of help to you. If I wasn't so computer illiterate I could link it for you...God I hate being so dumb when it come to linking, and quoting on the forum.......

I kind of got it a little skewed - here is the actual criteria from the DSM:

D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

Still, mine are "better accounted for" by my PTSD, so doesn't the diagnosis of panic with agoraphobia not seem right? I don't know....

Best,
Rachel

Lisa,

He is a psychologist who specializes in Trauma. Funny, I never really questioned the panic diagnosis along with the PTSD...hmmmm....

Also, my last psychologist diagnosed me as having MDD, however, this doctor is diagnosing me as having dysthymia. I questioned that and he said that I probably DID have MDD at that particular time. So that leads me to another question - when a person develops a particular disorder that falls beneath another disorder - as MDD can develop as a byproduct of my dysthymia- does a person's diagnosis just constantly fluctuate??

Rachel,

We recently got into a few debates over the DSM and the accuracy/validity of its diagnostic methods. If you haven't read them yet it is quite interesting, especially Lisa's lengthy posts.

Diagnostic and Statisical Manual of Mental Disorders
"Game Playing" With PTSD?

Correct me if I'm wrong, but isn't Dysthymia mild chronic depression while MDD is major depression? Perhaps this is a sign that something in your life is improving?

Also there was a thread on Agoraphobia and PTSD:
How Many Of Us Have Agoraphobia?

Food for thought... hope it helps...

Hmm...while I've never been oficially diagnosed with agraphobia, it is clear that I do have it and it is due to the same trama that my PTSD is associated with. (I have trouble going out at night, esp. on dates.) Just from experience I would say that like panic and PTSD, agraphobia is also closely linked.

Thanks for the clarification linasmom! Additional question: would you say your Panic and agoraphobia is a result of or directly linked to your PTSD and trauma?

You know, psychiatrists are not always right and neither are psychologists always right either... I don't think it would hurt for you to bring up your thoughts on your diagnoses... perhaps you could be re-diagnosed by a psychiatrist if you're thinking is right (as only a psychiatrist can officially diagnose, though psychologists often work with psychiatrists in aiding them in diagnosis with the information they both collate with the patient). I believe that you have expertise on yourself, and they have expertise on their area of knowledge into disorders... so it's a partnership. If you think you have something to say that they don't know about - tell them, they are there to help you...

In terms of can we 'fluctuate'... well in a word, yes. Diagnostically, it depends on the disorder though... for example, if you're diagnosed with a personality disorder, you're diagnosed with that for life. Depression is not like this though... one in four get depression at some point, and within 6 months a lot of people get better on their own. A lot of people don't, and a lot of people get better, then 'relapse'. Some suffer a "clinical" depression, whereby there appears to be no cause, and it is persistently extreme. Many, many, people suffer depressive episodes because, frankly, life is shit. Additionally, there is loads of research on the fact that people often relapse with depression... so it is known that depression fluctuates. Makes sense... mood fluctuates. I am not lucky enough to say that I have periods whereby PTSD seems to minimally affect my life, but some may... but there are times when I am being hit over the head with a big giant mallet constantly with several aspects of PTSD, and days where more or less of these aspects of PTSD may be affecting my life.

There is a pyramidial issue here... for example a person will have the big disorder such as PTSD, schizoprhenia, etc. Underneath that, a lot of psychiatrists and psychologists will say it is a given that somebody would also be diagnosed with a depressive illness... because they're depressed from the impact of the big illness at the top. There also may be sub-anxiety disorders such as panic, phobias etc. also... in terms of the DSM and PTSD, PTSD is under the anxiety category of disorders... so some could say it is again, a given that one would also have several offshoots of anxiety problems in the form of other diagnoses.

I think it's important that diagnosis is right, obviously. And i think it's important for people to have a good understanding of their diagnosis/es, and the diagnostic system... but in terms of overcoming PTSD, the diagnosis itself serves no purpose.... dealing with root causes is what will change things. Often, people are 'treated' on the surface for one disorder or another, only to find themselves being re-diagnosed as some other disorder... that's because sometimes the disorders people end up with are actually disordered coping mechanisms... and disordered coping mechanisms are often due to trauma in the case of PTSD... so dealing with the trauma is what will lead to the lack of needing to 'cope' in any extreme or disordered way...

Having the same diagnosis, it has always been my understanding that my agoraphobia is a spin off and result of my anxiety/panic disorder.

I would go somewhere, have an attack and then be to scared to return to that place. So over time my world got smaller and smaller untill I am to scared to go any place. My therapist would always issue me a challenge upon leaving his office. "Try an add a new place to your comfort zone this week" he would say.

Hope this helps