PTSD Can Look Like Other Disorders
I was working with George the other day and he brought up an issue he has been working through. Since George is pushing 80 years old and struggles with anger issues, it was suggested by his family he get help for his anger. George claims to have a horrible temper, and it is backed up by his wife. George’s aggression appears to be consistent and long lasting. The VA had diagnosed George with Bi-polar disorder 20 years ago. Since George was diagnosed some 20 years ago with bi-polar I started to look at the diagnosis, asked some questions and found George does not have bi-polar disorder, he has PTSD.
Since I specialize in PTSD I look for certain telltale signs. After talking to George, I noticed the PTSD right away. I wondered how any clinician, especially one at the VA could miss the PTSD signs, they were glaring. George has most PTSD symptoms, not liking crowds, hypervilligance, anger, nightmares, flashbacks, history of drug use, and multiple other PTSD signs. George was wounded in combat, and lost friends. He has had several brushes with death throughout the years, usually caused by his PTSD thrill seeking and drug use, but now he is too old to go out seeking danger to get his adrenaline up, he is 10 years clean from drug use and finally has a decent relationship. Georges thrill seeking now involves getting in arguments with others, displaying aggression, even with his family, to get his adrenaline up. I thought to myself, how could a clinician miss this. The answer was in the PTSD itself.
What George failed to mention to his previous therapist is his drug use. George started using drugs to self-medicate to handle his PTSD while in Vietnam. The drugs would send George into what looked like a state of mania to the clinician. Once the mania was gone George would slip into a depression, the therapist was seeing the two major signs of bi-polar, mania and depression. The cycle continued for years, solidifying their diagnosis. When given this information it is easy to see how a therapist could mistake PTSD for bi-polar.
Clinicians often get criticized for mis-diagnosing clients. George did not give his VA clinician all the facts. The shame and guilt of using illicit drugs prevented him from getting a proper diagnosis. Since the therapist was at the VA George also feared losing his benefits because he was a drug addict. This train of thought is common amongst veterans, and even the public.
People who have drug problems are looked down on, even if they are self-medicating for their PTSD. George did not realize what he was doing, he was in survival mode trying to manage his PTSD by using drugs, making things worse.
When seeing a therapist, it is imperative that you tell them everything that is going on. The therapist should not judge you for your actions, if they do you need to find a new therapist. Therapist are trained not to judge and must maintain confidentiality, even if you broke the law and used illicit drugs. George did not give his clinician all the pieces of the puzzle 20 years ago.
If he had he might not be trying to get VA compensation for his PTSD at 78 years old. He might have had his disability pension 20 years ago.
For questions or comments, I can be reached at bo@afterdutyvets.com or visit our website at afterdutyvets.com.