Advice - psychiatrist appointment - DID diagnosis?

We are currently off on a medical leave. It's due to depression and anxiety - we can't handle the COVID matter in our work environment (front line worker, ZERO protections). We've been off for months now.

We are actually doing better right now than any time prior in our life. Being home, away from triggers (mostly), not having to work and deal with a way too stressful job even under normal circumstances - this time has been very healing, actually.

But it took two months before we even started to feel okay. We are better, yes, but not feeling up to returning to work yet. Our current hellish boss is being replaced with our former boss that we know is excellent in September - we'd like to return then.

Our union is covering our medical leave. The coverage stops this month UNLESS the doctor thinks we need more. We actually have gotten an appointment with a psychiatrist for the first time ever.

So...here's our question:

We only see the psychiatrist once, for 45 minutes. She will determine if we stay off. Do we just talk about work/life stress and focus on the depression/anxiety, or should we be talking about DID?

Are there risks to having an official diagnosis? We're terrified of it. Of it being on a record. We already struggle with getting medical care as we're stressed about our scars as we have self-harming alters. Some have been good to us, but we've had some bad reactions too. We already feel we're not taken seriously most of the time, even when they don't know about the SI. How would we be treated with DID written on file?

Besides that, can she even diagnosis that in 45 minutes (and this isn't even in person, BTW - we forget, but we think it's via the phone - we can't recall - appointment was made over a month ago as this was the soonest opening)? Do we allow ourselves to say, "we" during session? Do we try to get a switch to happen (our understanding is that is needed for a diagnosis anyway)? We don't even know if we can - it's the rarest of times we've been able to "call" someone to front (usually one of our two numb alters).

We have no doubt the DID is not helping with our stress and breaking down and being on leave, but we left that out.

Thoughts? Advice?

Hope that made sense. We are up very early and we're dissociated (odd dream...though not a nightmare or anything, but still seems to be triggering us) writing this, but it is something we needed to ask anyway...

honestly, we would stick to depression and anxiety and make sure we use only singular. 45min is not enough time to get a proper diagnose, even if you managed to find someone who knows enough to make one. which is probably not the case.
what is it you want to achieve? the work situation. then focus on what is needed for that.
you can go get a formal diagnosis later if that would be helpful or needed to get access to therapy or disability. then you find someone specalized who is able to do it properly and in the time that is needed. showy switching is not recommended in any situation. it is widely considered a sign of faking.

We'll never be able to live on disability - it's not enough to live off of where we are. Our country is TERRIBLE for providing enough for people to live in, especially as cost of living was out of control here before the current inflation.

We also found out where we are you have to require someone to help you in order to qualify, which is so stupid. Just because you can't work, doesn't mean you need a babysitter.

We are not 100% sure on work, we just know that right now we're doing better than ever before. This is the first time in the longest time, like decades, that we haven't had constant thoughts of SU. Being safe from most triggers has done wonders for us.

We know we have to go back as we can't live on disability, even if we could get it. We are not sure how long our union will cover us - it's a complicated matter and depends on the doctors and their opinions among other things. We are pretty sure we could be covered until Sept though, which we think would be best. The reason being our HORRIBLE boss, who has been an unending source of stress and anxiety since we started at this new location not only is leaving, but our old boss, who rocks, will be taking over. It doesn't fix all the problems, but huge difference working under a good leader vs working under a Karen.

It took me six appointments of 1h to complete the diagnosis tool my T is using, and we were pretty fast as I'm a psych student who knows well how that kind of tools works, and I've been seeing her for two years.

So nope, no way it could be done in 45min with a psych that doesn't know you well, and I'm not sure a psych would accept to do that on the phone. Diagnosis tools' questions can be highly disturbing, it's better if you are at the office, where the psych can directly help you if a question become a trigger.

Do we try to get a switch to happen (our understanding is that is needed for a diagnosis anyway)

It's not needed. The "psych seeing a switch" criteria have been abandoned long ago. Diagnosis tools now have questions that address identity disturbance, so it can be identified without a switch from the patient. Any psych that requires seeing a switch to diagnose you isn't up-to-date or trained enough.

I can't talk precisely about the risks. Where I live, we don't have general records for mental health (except for psychotic disorders), so it's up to the patient to tell professionals about their diagnosis.

Depending on what's needed, I say nothing, mention PTSD only or mention "dissociative disorder". People don't know enough anyway to ask me which DD I have, so it allows me to just talk about effects of traumas, DP/DR, amnesia, etc. without mentioning the alters. In my experience, with people who don't know well what DID is, it's better to stick to what they already know if mentioning DID isn't heavily needed, or otherwise you'll end up with people focusing so much on the alters/voices they'll not notice the other symptoms.

As you don't know if the psychiatrist is qualified to diagnose DID, and if it could help you to have a diagnosis related to trauma, maybe you can consider talking about PTSD ?

Thank you, that's all VERY helpful!

We don't have any official diagnosis as we've only ever seen one T and she's not a medical person. She said we have PTSD and DID. The DID is pretty obvious to us now (well, it always was, but our fronter at the time was VERY good at making excuses for those of us she couldn't deny were there), but very good point on only dealing with someone who knows their stuff on that front. That seems...unlikely to find, but that's fine - we've never cared about anything being official, we've never seen a benefit at this time to have a label others put on us when it's not their business anyway.

Yes, our PTSD is VERY much why we can't handle the dangerous COVID situation. Being forced into an unsafe environment, ESPECIALLY with how our current boss works, has been a CONSTANT trigger the entire time we're at work. Our flight/fight is triggered ALL DAY and we've come close to hitting unmasked people who get too close, and this was when there was a mask mandate. We're not going to get into all the details of how our boss made it all worse, but her being gone will be HUGE to us being able to go back, even without protections (we have our three shots and proper N95s - our family member who knows such things says we're pretty protected that way to avoid getting it), but with our new boss, we know we'll be supported if we add social distancing, as the distance is the big trigger for us mentally.

That and we just KNOW we need MORE TIME. We know a few more months isn't going to "fix" us or anything, but we're hoping it helps us have a stronger foundation to return on, vs a rickety bridge that will crumble under the first load.

We really appreciate your advice. We'll focus on dissociation, PTSD, and the anxiety. Thank you.

i agree with just sticking to the reasons why you are struggling, the anxiety and depression. if you were going to them long term, then it would be worth it to have that conversation. not everyone needs to know about it unless it's specifically the reason you are seeing them or will affect your interaction with them and you want to explain.

i don't know that i have it on paper as a diagnosis, but i'm not sure. it wouldn't affect me though because it's not anything i would have to disclose to anyone, employer or otherwise. it's not their business. a therapist or other mental health or medical professional also wouldn't know about the diagnosis unless they got copies of my records which i'd have to give permission for.

What if she asks us a question that would lead to talking about DID? Like asking about others?

We don't know why we're so nervous and worked up about this, but we are.

I have never met anyone asking about parts or alters or others, without me bringing it up first. And even then, it's remained non-intrusive so far.

Of course it's not an experience of each and every therapist there is in the world. I just hope my personal sample of T is big enough and representative enough so that it can help you feel more at ease.

ConcealDontFeel wrote:Yes, our PTSD is VERY much why we can't handle the dangerous COVID situation. Being forced into an unsafe environment, ESPECIALLY with how our current boss works, has been a CONSTANT trigger the entire time we're at work. Our flight/fight is triggered ALL DAY and we've come close to hitting unmasked people who get too close, and this was when there was a mask mandate. We're not going to get into all the details of how our boss made it all worse, but her being gone will be HUGE to us being able to go back, even without protections (we have our three shots and proper N95s - our family member who knows such things says we're pretty protected that way to avoid getting it), but with our new boss, we know we'll be supported if we add social distancing, as the distance is the big trigger for us mentally.

If this is the main part of why you're struggling with work, I'd be inclined to run with that. The depression and anxiety I'm guessing also tie into that, so they're quite easily explainable.

I had an occasion where I've thought "if I can go in there and explain to this psychiatrist my dissociation..." when I was applying for disability. In the end, most of what I planned to explain about I was blocked from speaking about, and she totally misjudged how dissociation affects me, it was written in the report as a really minor issue.

Where I live mask mandates have been dropped (I disagree with that) and I'm triple vaccinated. I choose to keep wearing one, because of immune issues. But I have had people ask rather rudely why I do still. I was quite ok with the social distancing thing- I'd prefer it stay.

ConcealDontFeel wrote:Are there risks to having an official diagnosis? We're terrified of it. Of it being on a record. We already struggle with getting medical care as we're stressed about our scars as we have self-harming alters. Some have been good to us, but we've had some bad reactions too. We already feel we're not taken seriously most of the time, even when they don't know about the SI.

My diagnosis is shared between medical professionals and allied health workers I see/have been referred to. I've found the advantages outweigh the disadvantages for me. All are bound by confidentiality- they share information with referring GP when/as necessary, but otherwise, that's it- it's extra knowledge that gives them insight to why they're seeing me as a patient/why my symptoms are there. eg. I see a physiotherapist regularly for stress related hip/back issues, and he can tell better than anyone when I'm not doing well by how jammed up or jumpy my body is. Except specific symptoms that professional is treating, those things are written on my referral as diagnosis names only. Outside of that, no-one else has reason to know, unless I choose to share it with them. I have scars on my arms, which have now faded a lot, I've had both negative and very kind reactions to them- honestly, one particularly kind one from a nurse sticks with me most. Oddly- you'd think it would be the negative ones.

Before your appointment, I highly recommend writing out some notes for yourself- write out the items of your history that you are willing to share with them and put it in some kind of order that makes sense to you. It's easier than trying to recite it off the top of your head. I've always missed stuff otherwise. I put them in short dot points and have done that with the past few psychiatrists I've seen, it's a lot easier- some in person appointments, I've handed it to them. Write down any questions you want to ask them, I've never been otherwise able to remember what I wanted to know when I've got to the end of the session.

Is it worth contacting the psychiatrist's office ahead of time to confirm what type of appointment it is? Just so you can feel a bit more prepared for what you're going into?

I hope that you can get what you need to get through that period until the new boss arrives.