Please help me not freak out about my first ever psych visit
August 11, 2013 2:00 PM Subscribe
I've asked for a long, long-overdue assessment for ADHD and anxiety, which will be this week. I've never ever talked to a psychiatrist before and I'm getting really anxious about it. Help me know what to expect and how to prepare for it?
This is way too long and I apologize. Feel free to head straight to the questions, skipping the backstory - it's really just there if you want the details of why I'm going in for the assessment (not really necessary), and extra-long since this is anon and I'm trying to anticipate possible questions.
Backstory:
-The ADHD is my major concern - the anxiety's just tacked on since I may as well go for broke if I'm seeing a shrink anyway.
-female, late 20s, in grad school program (medical research) that I enjoy and find interesting
-family history of ADHD (diagnosed in one immediate family member, suspected in several more), anxiety (diagnosed in 1, maybe 2 family members), depression (diagnosed in both parents and one sibling).
-I get mostly-enough sleep (avg 7.5h) and a decent amount of exercise (2-3h running + 4-5h light exercise). My diet could be better but isn't awful. Overall I'm healthier than average, with a normal BMI and no health problems.
-my insurance covers psychiatrist visit, some counselling (8 sessions/year I think), and 80% drugs, so no major issues there
ADHD comments:
1) Habits - I was raised in a very chaotic, disorganized home environment. One parent is a hoarder, the other is easily overwhelmed/scattered (probable ADHD, went in for assessment but never followed up after). My parents never taught habit-forming for hygiene, cleaning, homework, etc. I moved out from my parents 6 years ago. I've gotten better at forming habits for hygiene and cleaning than I used to be (i.e. never) but it's still very, very difficult for me to form new habits. After years of smelling bad (I am active and sweat a lot), I was finally able to form the habit of showering daily about 2 years ago. About 4 years ago, I finally formed the habit of brushing my teeth once daily and 1 year ago I managed to up that to twice daily, after an extremely painful dentist visit. Those are the only daily habits I've managed to stick with, due to their obvious importance. Others I've tried and succeeded at briefly but then failed - daily cleaning/tidying of any kind, cleaning the litterbox daily, anything related to schoolwork (including pomodoro and just about every other system).
2) Deadlines - I have always been extremely (purely, actually) motivated by deadlines. If there isn't a deadline, it won't get done. If there is a deadline, it will get started at exactly the last minute possible. Examples: I have an upcoming minor presentation at work, known about for weeks in advance. 1 week before, I open powerpoint, play with slide designs for 3 hours, and slack off the rest of the day on the internet while pretending to work on my ppt. Do this a few more times throughout the week, usually not getting any further than opening the file before it gets so utterly boring or I'm distracted by something (a thought or a person or anything). Day before: I open the presentation, slack off on the internet all day, clicking back to stare at the ppt every hour or two, if I'm really luck managing to work on a slide or two for a few minutes before I get bored. Night before: Around 10 pm, think "oh yeah my presentation tomorrow, I almost forgot!". Open ppt. Switch to internet timewasting. Around midnight, think "oh crap, I need to get up in 8 hours!" Switch back. Crank out all the slides in about 1-2 hours of stressful, magically-acquired focus (knowing all along that it would be that short). Beat myself up for losing sleep pointlessly. Get 4-6 hours of sleep, which is my very minimum needed to function at ALL the next day. Present an OK presentation, stumble a bit because it wasn't practiced at all and I probably forgot to finish one slide. Never learn from mistakes and do the exact same thing next time. I realize everyone procrastinates, but on every project, to the point of losing sleep, for no reason? Even when I try to start earlier? Even when the work is genuinely interesting?
3) Forgetfulness - I'm practically an old lady. If I walk from one room to another, I'd better have something in my hand to remind me what I'm doing, or be repeating in my head "do X do X do X" and not get interrupted by anyone on my way there, or I will NOT remember what I was doing. At least 5-10 times a day I will arrive in a room, have no idea what I was doing, and return to the original room. Sometimes this will make me remember what I wanted (usually with a visual trigger), sometimes it's gone forever. I am actually fairly good at not losing things now, although I used to be absolutely awful at this as a kid. Now everything has a place or a very limited list of places it belongs, and I try very hard to put things in those places only. If they aren't in those places, I'm totally lost - I don't remember where I put things because I put them down absent-mindedly. I've left non-fridge things in the fridge and vice-versa, if I get distracted. I once flooded my work because I was filling up a big jug of water at the end of the day (takes 15-20 min) and wandered off and totally forgot about it, going home on a Friday. The next day the whole building was 2 inches deep in water. Many times, I've taken home the common key needed by everyone to open something in the lab because I put it in my pocket and forgot about it. Countless times (more days than not), I've gone home at the end of the day, forgetting to do something important that needed to be done (sometimes after putting it off all day, sometimes after not thinking about it at all all day). I check my google calendar every few hours because if I check it in the morning, I'll have forgotten in a few hours anything that was there. If I remember to write things in there, I'm ok - if not, I will not usually remember it on my own.
4) Distraction - I'm very sensitive to noise and visual distractions, and also extremely easily bored. This means that during lectures and conversation, I zone off after 5-10 seconds usually. I'll either start thinking about something unrelated, look idly around the room, or just get really anxious and think about how trapped I am and fidget/doodle, trying to endure the painful boredom. That sounds very dramatic, but it's almost literally unbearable to sit through lectures sometimes. Even if the topic is interesting, but much more quickly if it's not. Conversations are painful too sometimes - people get upset with me because I zone off halfway through their sentence, respond with an unrelated thing I just thought of, or lose track of what I'm saying halfway through my own sentence. I often feel like I'm "in my own world" rather than directly interacting with the person I'm talking to, and I'm not sure how to fix that. The trigger that brought me to finally make the appointment was drifting through a red light on my bike because I wasn't paying attention to the road and was just following the guy ahead of me (who ran the light). This was a bit scary on a bike but also illustrates perfectly why I've been too nervous to get my drivers licence so far - I could all-too-easily imagine myself doing something similar in a car and killing someone, and I can't deal with that possibility. I just don't understand how anyone can drive and pay attention to all the things that are going on without paying too much attention to one of them and not enough attention to the road or the kid running in front of you.
5) School - I actually did OK during university because most professors had ppt slides to focus on, and that is far more attractive for my attention (although it only extends it from 5-10 seconds to 5-10 minutes or so). I also took extensive notes, which at least I could study later, even though I didn't remember the actual class. For most classes I ended up being lost all year, reading the textbook in a panic the day before the exam, and suddenly getting it and doing OK on the exam (A- to A+ for most classes). I was never able to motivate myself to read the textbook any earlier than the last possible minute, but once I was anxious enough about the exam, I could sit down and study for 6+ hours without getting up, and then it all came together in my mind. Because of this I got good grades in classes that were heavily exam-based (most of them, in university) but not very good at assignment-based classes (I'd either not do them, do them late, or do them poorly since I underestimated the time needed). In elementary school I never ever did assignments, but tested well. In high school I did homework exclusively during the lunch hour before the afternoon classes, and generally not at all for the morning classes. Again, I tested well and did well in-class so I got fairly decent grades.
6) Endlessly procrastinating when there's no deadline - I went 5 years between dentist appointments once, because I rarely thought about making an appointment, and when I did, I was nervous about talking on the phone so I'd put it off until "later". Ditto, vet appointments (going on 7 years now. Yes, I am a bad person). Ditto "yearly" physical - went in Jan for my first physical in 6 years and first STI test ever (>8 years of being sexually active). Have not done my taxes in 5-6 years, although the government owes me hundreds, perhaps thousands. No financial reasons for any of these, just a seemingly endless capacity to procrastinate mildly unpleasant things. It gets worse the longer I wait, too, because I'm afraid they'll judge me for taking so long. Yes, I realize this will not go away by procrastinating further.
In addition, I relate to probably 95-99% of the "this is what it's like to have ADHD-PI" comments on here and elsewhere. I realize self-diagnosis is evil and "everyone's like that sometimes" but I seem to be kindof a textbook case, all the time, to a severe enough degree to cause me a lot of stress and impair my productivity. And yes, every one of these has been a problem for my entire life. I'm somewhat better now as I have developed some coping skills, but I still have a lot of problems with time management, prioritizing, remembering things, and just generally getting things done.
Anxiety comments:
-mostly just social anxiety and general anxiety, feeling overwhelmed all the time.
-difficult to untangle from my shyness and introversion, but it seems worse than that because I avoid social situations and conversations out of fear
-I have some strong skin-picking tendencies - no scabs left unturned, minor irritations picked until they become scabs, fingernails and skin around fingers chewed until bleeding, any loose skin anywhere has to come off
-I used to self-injure when I was going through an especially rough time in high school (a decade ago), and it seemed more anxiety/stress-induced than depression
-I'm kinda obsessive about having control over my environment and get anxious when this isn't possible
-I endlessly turn things over in my head, worrying and beating myself up for what I should have done
-I do not want drugs for anxiety. I don't actually know what I do want. I wish I hadn't mentioned it at all. Everyone gets stressed out.
-I don't really want to talk about any of this and am really regretting asking for the referral at all, although I've thought about it for literally my entire adult life. I'm really terrified about talking to anyone about any of this, let alone some random stranger. I don't want to admit weakness but even more, I'm afraid of being told "get over it, everyone has problems, there's nothing wrong with you, you're just whining".
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Specific concerns/questions (answers to any or all are very much appreciated!):
1) I'm worried they'll think I'm drug-seeking (either personal or to sell), because it's a university-run clinic. How can I avoid giving this impression while also conveying that I would actually like to try medication, assuming I am actually diagnosed? How do they decide what drugs to give you or if you need drugs at all? I'd kinda like to avoid the more scary ones like adderall if I can, both because they seem like a pain to acquire and because I'm afraid of getting addicted or changing my personality. Is there such a thing as a "mild" drug for ADD?
2) I'm really anxious about the possibility that they'll tell me I have nothing wrong with me and just need to work harder and be more disciplined. I realize I shouldn't and can't self-diagnose, and that drugs won't work if I'm not really ADHD anyway. I'm just not sure how to deal with this outcome if it occurs. I really feel like I've been trying my best for so long and it's so exhausting already, the idea of being told to just man up and work harder is so depressing. Is there a way I can prepare myself for this possibility so it's not so nerve-wracking?
3) I have a really hard time accessing vague memories like "tell me a time when you were forgetful" but can answer yes/no things like "do you tend to forget your keys a lot?" far more easily. If the questions they ask are of the first variety, I'm worried that I won't be able to remember specific examples, even though they literally occur dozens of times a day. It's just something that doesn't stand out in my memory. I tend to panic and blank and become incoherent when I'm put on the spot. When the referring GP asked me why I wanted an adhd referral, I was all "ummm...I'm really spaced out all the time...I dunno how to explain?!" but thankfully she asked me some more specific questions which I was able to answer. How can I convey my history accurately if the psych just wants me to spew out specific examples out of nowhere? I can do it in writing if I'm not on the spot (see above!) but not when I'm the centre of attention and panicking internally about why I can't remember already. I thought about bringing a written list of examples in but I am paranoid that this will give the impression that I'm way too organized to have ADHD or that I'm lying to get drugs? I am far, far more coherent in writing than speaking in person.
4) I've always gotten good grades and am most of the way through a doctoral program. I'm worried that this rules me out for an ADHD diagnosis even though it causes me extreme amounts of stress, interferes with my social life, and I'm certain that I could be far more successful if I didn't have these issues (as in, I have always been an A- to A student without good work habits - if I could manage to work properly I could easily be an A+ student). I'm doing well in my doctoral program and my supervisor is happy with me, but I'm also 4 years in and haven't published anything, mainly due to poor work habits. I (usually) achieve everything within the deadline but I do it by working 10+ hours in a row overnight hours before the deadline, which is highly stressful and lowers the quality of my work. It also keeps me at the level of "meets minimum requirements" rather than "excels". I'm a solidly average doctoral student, not a terrible or great one. All my life I've been told that I'm "not meeting my potential". I would like to do a better job of achieving this potential, even if compared to a lot of people I'm "successful" already just because I'm in grad school. How can I convey this to the psych? Again, would it be better to write this down? I don't know if I'll remember to mention it at all, let alone remember a detailed explanation, and I know I'll be incoherent and terrified in-person.
Also I have read every single ADD-tagged question here over the years, including this recent one which was very helpful, but if you want to point out some especially relevant ones for me to re-read, feel free.
This is way too long and I apologize. Feel free to head straight to the questions, skipping the backstory - it's really just there if you want the details of why I'm going in for the assessment (not really necessary), and extra-long since this is anon and I'm trying to anticipate possible questions.
Backstory:
-The ADHD is my major concern - the anxiety's just tacked on since I may as well go for broke if I'm seeing a shrink anyway.
-female, late 20s, in grad school program (medical research) that I enjoy and find interesting
-family history of ADHD (diagnosed in one immediate family member, suspected in several more), anxiety (diagnosed in 1, maybe 2 family members), depression (diagnosed in both parents and one sibling).
-I get mostly-enough sleep (avg 7.5h) and a decent amount of exercise (2-3h running + 4-5h light exercise). My diet could be better but isn't awful. Overall I'm healthier than average, with a normal BMI and no health problems.
-my insurance covers psychiatrist visit, some counselling (8 sessions/year I think), and 80% drugs, so no major issues there
ADHD comments:
1) Habits - I was raised in a very chaotic, disorganized home environment. One parent is a hoarder, the other is easily overwhelmed/scattered (probable ADHD, went in for assessment but never followed up after). My parents never taught habit-forming for hygiene, cleaning, homework, etc. I moved out from my parents 6 years ago. I've gotten better at forming habits for hygiene and cleaning than I used to be (i.e. never) but it's still very, very difficult for me to form new habits. After years of smelling bad (I am active and sweat a lot), I was finally able to form the habit of showering daily about 2 years ago. About 4 years ago, I finally formed the habit of brushing my teeth once daily and 1 year ago I managed to up that to twice daily, after an extremely painful dentist visit. Those are the only daily habits I've managed to stick with, due to their obvious importance. Others I've tried and succeeded at briefly but then failed - daily cleaning/tidying of any kind, cleaning the litterbox daily, anything related to schoolwork (including pomodoro and just about every other system).
2) Deadlines - I have always been extremely (purely, actually) motivated by deadlines. If there isn't a deadline, it won't get done. If there is a deadline, it will get started at exactly the last minute possible. Examples: I have an upcoming minor presentation at work, known about for weeks in advance. 1 week before, I open powerpoint, play with slide designs for 3 hours, and slack off the rest of the day on the internet while pretending to work on my ppt. Do this a few more times throughout the week, usually not getting any further than opening the file before it gets so utterly boring or I'm distracted by something (a thought or a person or anything). Day before: I open the presentation, slack off on the internet all day, clicking back to stare at the ppt every hour or two, if I'm really luck managing to work on a slide or two for a few minutes before I get bored. Night before: Around 10 pm, think "oh yeah my presentation tomorrow, I almost forgot!". Open ppt. Switch to internet timewasting. Around midnight, think "oh crap, I need to get up in 8 hours!" Switch back. Crank out all the slides in about 1-2 hours of stressful, magically-acquired focus (knowing all along that it would be that short). Beat myself up for losing sleep pointlessly. Get 4-6 hours of sleep, which is my very minimum needed to function at ALL the next day. Present an OK presentation, stumble a bit because it wasn't practiced at all and I probably forgot to finish one slide. Never learn from mistakes and do the exact same thing next time. I realize everyone procrastinates, but on every project, to the point of losing sleep, for no reason? Even when I try to start earlier? Even when the work is genuinely interesting?
3) Forgetfulness - I'm practically an old lady. If I walk from one room to another, I'd better have something in my hand to remind me what I'm doing, or be repeating in my head "do X do X do X" and not get interrupted by anyone on my way there, or I will NOT remember what I was doing. At least 5-10 times a day I will arrive in a room, have no idea what I was doing, and return to the original room. Sometimes this will make me remember what I wanted (usually with a visual trigger), sometimes it's gone forever. I am actually fairly good at not losing things now, although I used to be absolutely awful at this as a kid. Now everything has a place or a very limited list of places it belongs, and I try very hard to put things in those places only. If they aren't in those places, I'm totally lost - I don't remember where I put things because I put them down absent-mindedly. I've left non-fridge things in the fridge and vice-versa, if I get distracted. I once flooded my work because I was filling up a big jug of water at the end of the day (takes 15-20 min) and wandered off and totally forgot about it, going home on a Friday. The next day the whole building was 2 inches deep in water. Many times, I've taken home the common key needed by everyone to open something in the lab because I put it in my pocket and forgot about it. Countless times (more days than not), I've gone home at the end of the day, forgetting to do something important that needed to be done (sometimes after putting it off all day, sometimes after not thinking about it at all all day). I check my google calendar every few hours because if I check it in the morning, I'll have forgotten in a few hours anything that was there. If I remember to write things in there, I'm ok - if not, I will not usually remember it on my own.
4) Distraction - I'm very sensitive to noise and visual distractions, and also extremely easily bored. This means that during lectures and conversation, I zone off after 5-10 seconds usually. I'll either start thinking about something unrelated, look idly around the room, or just get really anxious and think about how trapped I am and fidget/doodle, trying to endure the painful boredom. That sounds very dramatic, but it's almost literally unbearable to sit through lectures sometimes. Even if the topic is interesting, but much more quickly if it's not. Conversations are painful too sometimes - people get upset with me because I zone off halfway through their sentence, respond with an unrelated thing I just thought of, or lose track of what I'm saying halfway through my own sentence. I often feel like I'm "in my own world" rather than directly interacting with the person I'm talking to, and I'm not sure how to fix that. The trigger that brought me to finally make the appointment was drifting through a red light on my bike because I wasn't paying attention to the road and was just following the guy ahead of me (who ran the light). This was a bit scary on a bike but also illustrates perfectly why I've been too nervous to get my drivers licence so far - I could all-too-easily imagine myself doing something similar in a car and killing someone, and I can't deal with that possibility. I just don't understand how anyone can drive and pay attention to all the things that are going on without paying too much attention to one of them and not enough attention to the road or the kid running in front of you.
5) School - I actually did OK during university because most professors had ppt slides to focus on, and that is far more attractive for my attention (although it only extends it from 5-10 seconds to 5-10 minutes or so). I also took extensive notes, which at least I could study later, even though I didn't remember the actual class. For most classes I ended up being lost all year, reading the textbook in a panic the day before the exam, and suddenly getting it and doing OK on the exam (A- to A+ for most classes). I was never able to motivate myself to read the textbook any earlier than the last possible minute, but once I was anxious enough about the exam, I could sit down and study for 6+ hours without getting up, and then it all came together in my mind. Because of this I got good grades in classes that were heavily exam-based (most of them, in university) but not very good at assignment-based classes (I'd either not do them, do them late, or do them poorly since I underestimated the time needed). In elementary school I never ever did assignments, but tested well. In high school I did homework exclusively during the lunch hour before the afternoon classes, and generally not at all for the morning classes. Again, I tested well and did well in-class so I got fairly decent grades.
6) Endlessly procrastinating when there's no deadline - I went 5 years between dentist appointments once, because I rarely thought about making an appointment, and when I did, I was nervous about talking on the phone so I'd put it off until "later". Ditto, vet appointments (going on 7 years now. Yes, I am a bad person). Ditto "yearly" physical - went in Jan for my first physical in 6 years and first STI test ever (>8 years of being sexually active). Have not done my taxes in 5-6 years, although the government owes me hundreds, perhaps thousands. No financial reasons for any of these, just a seemingly endless capacity to procrastinate mildly unpleasant things. It gets worse the longer I wait, too, because I'm afraid they'll judge me for taking so long. Yes, I realize this will not go away by procrastinating further.
In addition, I relate to probably 95-99% of the "this is what it's like to have ADHD-PI" comments on here and elsewhere. I realize self-diagnosis is evil and "everyone's like that sometimes" but I seem to be kindof a textbook case, all the time, to a severe enough degree to cause me a lot of stress and impair my productivity. And yes, every one of these has been a problem for my entire life. I'm somewhat better now as I have developed some coping skills, but I still have a lot of problems with time management, prioritizing, remembering things, and just generally getting things done.
Anxiety comments:
-mostly just social anxiety and general anxiety, feeling overwhelmed all the time.
-difficult to untangle from my shyness and introversion, but it seems worse than that because I avoid social situations and conversations out of fear
-I have some strong skin-picking tendencies - no scabs left unturned, minor irritations picked until they become scabs, fingernails and skin around fingers chewed until bleeding, any loose skin anywhere has to come off
-I used to self-injure when I was going through an especially rough time in high school (a decade ago), and it seemed more anxiety/stress-induced than depression
-I'm kinda obsessive about having control over my environment and get anxious when this isn't possible
-I endlessly turn things over in my head, worrying and beating myself up for what I should have done
-I do not want drugs for anxiety. I don't actually know what I do want. I wish I hadn't mentioned it at all. Everyone gets stressed out.
-I don't really want to talk about any of this and am really regretting asking for the referral at all, although I've thought about it for literally my entire adult life. I'm really terrified about talking to anyone about any of this, let alone some random stranger. I don't want to admit weakness but even more, I'm afraid of being told "get over it, everyone has problems, there's nothing wrong with you, you're just whining".
-------------------------------------------------------------
Specific concerns/questions (answers to any or all are very much appreciated!):
1) I'm worried they'll think I'm drug-seeking (either personal or to sell), because it's a university-run clinic. How can I avoid giving this impression while also conveying that I would actually like to try medication, assuming I am actually diagnosed? How do they decide what drugs to give you or if you need drugs at all? I'd kinda like to avoid the more scary ones like adderall if I can, both because they seem like a pain to acquire and because I'm afraid of getting addicted or changing my personality. Is there such a thing as a "mild" drug for ADD?
2) I'm really anxious about the possibility that they'll tell me I have nothing wrong with me and just need to work harder and be more disciplined. I realize I shouldn't and can't self-diagnose, and that drugs won't work if I'm not really ADHD anyway. I'm just not sure how to deal with this outcome if it occurs. I really feel like I've been trying my best for so long and it's so exhausting already, the idea of being told to just man up and work harder is so depressing. Is there a way I can prepare myself for this possibility so it's not so nerve-wracking?
3) I have a really hard time accessing vague memories like "tell me a time when you were forgetful" but can answer yes/no things like "do you tend to forget your keys a lot?" far more easily. If the questions they ask are of the first variety, I'm worried that I won't be able to remember specific examples, even though they literally occur dozens of times a day. It's just something that doesn't stand out in my memory. I tend to panic and blank and become incoherent when I'm put on the spot. When the referring GP asked me why I wanted an adhd referral, I was all "ummm...I'm really spaced out all the time...I dunno how to explain?!" but thankfully she asked me some more specific questions which I was able to answer. How can I convey my history accurately if the psych just wants me to spew out specific examples out of nowhere? I can do it in writing if I'm not on the spot (see above!) but not when I'm the centre of attention and panicking internally about why I can't remember already. I thought about bringing a written list of examples in but I am paranoid that this will give the impression that I'm way too organized to have ADHD or that I'm lying to get drugs? I am far, far more coherent in writing than speaking in person.
4) I've always gotten good grades and am most of the way through a doctoral program. I'm worried that this rules me out for an ADHD diagnosis even though it causes me extreme amounts of stress, interferes with my social life, and I'm certain that I could be far more successful if I didn't have these issues (as in, I have always been an A- to A student without good work habits - if I could manage to work properly I could easily be an A+ student). I'm doing well in my doctoral program and my supervisor is happy with me, but I'm also 4 years in and haven't published anything, mainly due to poor work habits. I (usually) achieve everything within the deadline but I do it by working 10+ hours in a row overnight hours before the deadline, which is highly stressful and lowers the quality of my work. It also keeps me at the level of "meets minimum requirements" rather than "excels". I'm a solidly average doctoral student, not a terrible or great one. All my life I've been told that I'm "not meeting my potential". I would like to do a better job of achieving this potential, even if compared to a lot of people I'm "successful" already just because I'm in grad school. How can I convey this to the psych? Again, would it be better to write this down? I don't know if I'll remember to mention it at all, let alone remember a detailed explanation, and I know I'll be incoherent and terrified in-person.
Also I have read every single ADD-tagged question here over the years, including this recent one which was very helpful, but if you want to point out some especially relevant ones for me to re-read, feel free.
So, bringing in a written list of things will not give the impression that you're "too organized" to have ADHD or that you're lying to get drugs. I guarantee you that, as someone who (a) has ADHD and (b) has brought in written stuff to psych appointments multiple times because I knew I'd forget stuff otherwise.
I actually would recommend that you literally just print out this post and bring it with you to the appointment. Actually, bring two copies -- one for yourself and one for the doctor. When the doctor asks you "What brings you here today? What are your concerns?" (which is a very standard opening question), you can literally say "I often forget things or don't explain myself well on the spot, and I do better in writing, so I wrote down my concerns ahead of time." Then hand them the paper. They should be able to take it from there -- go through it with you and ask whatever questions they need to ask.
It is totally normal to have these concerns and anxieties about seeking treatment, and your doctor won't be surprised or taken aback by any of this. They'll know how to work with you on this. For real.
posted by snowmentality at 3:02 PM on August 11, 2013
I actually would recommend that you literally just print out this post and bring it with you to the appointment. Actually, bring two copies -- one for yourself and one for the doctor. When the doctor asks you "What brings you here today? What are your concerns?" (which is a very standard opening question), you can literally say "I often forget things or don't explain myself well on the spot, and I do better in writing, so I wrote down my concerns ahead of time." Then hand them the paper. They should be able to take it from there -- go through it with you and ask whatever questions they need to ask.
It is totally normal to have these concerns and anxieties about seeking treatment, and your doctor won't be surprised or taken aback by any of this. They'll know how to work with you on this. For real.
posted by snowmentality at 3:02 PM on August 11, 2013
About being anxious about the visit: You're supposed to be anxious, given that you generally have plenty of anxiety! The moment you sit down, feel free to say, "I feel very anxious about being here." Also, whatever neuroses you have in real life will be with you when you're with the doctor or therapist; it's just normal for everyone.
I can completely empathize with your apprehension, because I've experienced it in spades. It's so uncomfortable, and gets worse as you wait. For me, it lessens when I start to interact with the new therapist. I guess that's partly because it's actually happening, instead of being an abstract thing that I'm imagining could go badly in hundreds of ways. But it's also because the professional usually turns out to be very accepting.
About the meds... just say that you're willing to try medication. Some people are opposed to using drugs, so just let them know you're open to it. Describing your problems with memory, concentration, and planning with be enough to show them that meds are called for.
You can edit what you wrote above and bring it to your appointment. Whoever you're seeing can probably read faster than you can talk... and then ask you more questions as appropriate. If you want, you can come up with examples of forgetting and confusion ahead of time, since it's so tough to recall them when you're on the spot.
posted by wryly at 3:08 PM on August 11, 2013
I can completely empathize with your apprehension, because I've experienced it in spades. It's so uncomfortable, and gets worse as you wait. For me, it lessens when I start to interact with the new therapist. I guess that's partly because it's actually happening, instead of being an abstract thing that I'm imagining could go badly in hundreds of ways. But it's also because the professional usually turns out to be very accepting.
About the meds... just say that you're willing to try medication. Some people are opposed to using drugs, so just let them know you're open to it. Describing your problems with memory, concentration, and planning with be enough to show them that meds are called for.
You can edit what you wrote above and bring it to your appointment. Whoever you're seeing can probably read faster than you can talk... and then ask you more questions as appropriate. If you want, you can come up with examples of forgetting and confusion ahead of time, since it's so tough to recall them when you're on the spot.
posted by wryly at 3:08 PM on August 11, 2013
I hope the doc you're seeing has a firm grasp of ADHD and how it can present in women. I have the inattentive type and did extremely well academically, have been able to hold down jobs, etc. And yet, reading about ADHD, and with an uncle diagnosed with it (and a mother who probably has it but dislikes psychologists/psychiatrists enough that she will never be diagnosed), I was fairly certain that this applied to me. It was like, wait a minute--everyone doesn't space out constantly in conversations? Everyone doesn't go to start something only to find that two hours later they're engaged in something completely different and haven't accomplished anything?
To get back to my original point, I saw two different psychologists before I found one who would give me an ADHD assessment. One of the docs I saw initially was of the "oh, you did too well in school, there's no way you have ADHD" type. It makes me really angry now when I think of how she dismissed my concerns. Finally, I found a doctor who listed ADHD as one of his specialties. He administered the Brown ADHD Assessment and found that I do have ADHD.
I guess that's probably not the most encouraging story to be sharing, but I did want to let you know that there are doctors who are competent in diagnosing this condition, and there are tools (although they are somewhat blunt) such as the assessment I linked above. IIRC, the questionnaire went through a list of common areas in life that ADHDers struggle with, and I filled out a version and my boyfriend filled it out one too, to serve as an outside perspective.
From the sounds of things, you're going in specifically for an ADHD assessment, so hopefully whoever is seeing you knows that not everyone with ADHD is a hyperactive, unruly ten-year-old boy. It's frustrating that this condition is treated with medication that is fun for others to abuse, but you don't sound like you'll come across as an rapacious drug-seeker. Based on what you've written it sounds like you have genuine struggles that will most likely come through on the assessment. I agree with wryly above that printing out what you wrote above might be a good way to get all of your concerns across to the psych without worrying that you'll forget anything or misrepresent yourself. And if you've learned through the years to present well and compensate for all the struggles ADHD causes, it might help your doc to know what's going on in your head, even if you present a calm or pulled-together demeanor to the outside world.
Oh, and none of this should be construed as an internet diagnosis. :)
posted by whistle pig at 3:42 PM on August 11, 2013 [1 favorite]
To get back to my original point, I saw two different psychologists before I found one who would give me an ADHD assessment. One of the docs I saw initially was of the "oh, you did too well in school, there's no way you have ADHD" type. It makes me really angry now when I think of how she dismissed my concerns. Finally, I found a doctor who listed ADHD as one of his specialties. He administered the Brown ADHD Assessment and found that I do have ADHD.
I guess that's probably not the most encouraging story to be sharing, but I did want to let you know that there are doctors who are competent in diagnosing this condition, and there are tools (although they are somewhat blunt) such as the assessment I linked above. IIRC, the questionnaire went through a list of common areas in life that ADHDers struggle with, and I filled out a version and my boyfriend filled it out one too, to serve as an outside perspective.
From the sounds of things, you're going in specifically for an ADHD assessment, so hopefully whoever is seeing you knows that not everyone with ADHD is a hyperactive, unruly ten-year-old boy. It's frustrating that this condition is treated with medication that is fun for others to abuse, but you don't sound like you'll come across as an rapacious drug-seeker. Based on what you've written it sounds like you have genuine struggles that will most likely come through on the assessment. I agree with wryly above that printing out what you wrote above might be a good way to get all of your concerns across to the psych without worrying that you'll forget anything or misrepresent yourself. And if you've learned through the years to present well and compensate for all the struggles ADHD causes, it might help your doc to know what's going on in your head, even if you present a calm or pulled-together demeanor to the outside world.
Oh, and none of this should be construed as an internet diagnosis. :)
posted by whistle pig at 3:42 PM on August 11, 2013 [1 favorite]
How do they decide what drugs to give you or if you need drugs at all?
Different meds have different effects on different people, and it can be a bit of a process to find one that works for you. Typically the way it starts is that the psychiatrist suggests a drug that similar past patients have had success with. You can voice any concerns you may have, and they'll either recommend something else, or they'll say that they still would advise starting with that first one. They won't write you a prescription you don't want though. Anyway, assuming you can agree on something, they give you a prescription, and schedule a follow-up appointment for not-too-long, and you try it, and come back and discuss if it helped with your ADHD, and if you had any side effects. They may change the dosage or try something else, or if everything went well, they'll just write you a refill.
I'd kinda like to avoid the more scary ones like adderall if I can, both because they seem like a pain to acquire and because I'm afraid of getting addicted or changing my personality. Is there such a thing as a "mild" drug for ADD?
The vast majority of ADHD drugs are stimulants. The one that is not is Strattera, which is a selective norepinepherine reuptake inhibitor. I experienced pretty bad side effects with Strattera (among other things, nausea), which apparently is pretty common. My doctor didn't really think it was very likely to be successful but for similar reasons to yours I wanted to give it a shot anyway.
In terms of changing your personality, I did find that on Adderall, it was a lot more important for me to "win" arguments. A friend of mine had a similar experience with Strattera. But these kinds of things aren't permanent changes, and both of us stopped having that effect when we switched to other things.
I thought about bringing a written list of examples in but I am paranoid that this will give the impression that I'm way too organized to have ADHD or that I'm lying to get drugs?
It's totally okay to go to a doctor with a list of things to ask or tell them about. It doesn't show that you don't have ADHD, in fact, I think it shows you're taking steps to counteract some of the symptoms of that disorder.
posted by aubilenon at 3:52 PM on August 11, 2013
Different meds have different effects on different people, and it can be a bit of a process to find one that works for you. Typically the way it starts is that the psychiatrist suggests a drug that similar past patients have had success with. You can voice any concerns you may have, and they'll either recommend something else, or they'll say that they still would advise starting with that first one. They won't write you a prescription you don't want though. Anyway, assuming you can agree on something, they give you a prescription, and schedule a follow-up appointment for not-too-long, and you try it, and come back and discuss if it helped with your ADHD, and if you had any side effects. They may change the dosage or try something else, or if everything went well, they'll just write you a refill.
I'd kinda like to avoid the more scary ones like adderall if I can, both because they seem like a pain to acquire and because I'm afraid of getting addicted or changing my personality. Is there such a thing as a "mild" drug for ADD?
The vast majority of ADHD drugs are stimulants. The one that is not is Strattera, which is a selective norepinepherine reuptake inhibitor. I experienced pretty bad side effects with Strattera (among other things, nausea), which apparently is pretty common. My doctor didn't really think it was very likely to be successful but for similar reasons to yours I wanted to give it a shot anyway.
In terms of changing your personality, I did find that on Adderall, it was a lot more important for me to "win" arguments. A friend of mine had a similar experience with Strattera. But these kinds of things aren't permanent changes, and both of us stopped having that effect when we switched to other things.
I thought about bringing a written list of examples in but I am paranoid that this will give the impression that I'm way too organized to have ADHD or that I'm lying to get drugs?
It's totally okay to go to a doctor with a list of things to ask or tell them about. It doesn't show that you don't have ADHD, in fact, I think it shows you're taking steps to counteract some of the symptoms of that disorder.
posted by aubilenon at 3:52 PM on August 11, 2013
Drug-seekers for recreational sale don't actually work all that hard to get what they're looking for, they just go to doctors known to be accommodating. Significantly easier to pay an extra "office fee" than to put on an act.
It's fine. Not a single one of your fears is unusual, and given that a lot of psychiatrists use questionnaire-type initial assessments, you'll probably find that most of your anxieties are on the assessments.
You're not going to shock anyone. You're not going to get thrown out for not being sick enough or sick in the right way. The feelings you're having are actually part of the disorder.
If the doctor who has been to medical school and has a lot of patients wants you to take Adderall, you should probably try it and then if it doesn't work you can try something else.
posted by Lyn Never at 4:13 PM on August 11, 2013 [1 favorite]
It's fine. Not a single one of your fears is unusual, and given that a lot of psychiatrists use questionnaire-type initial assessments, you'll probably find that most of your anxieties are on the assessments.
You're not going to shock anyone. You're not going to get thrown out for not being sick enough or sick in the right way. The feelings you're having are actually part of the disorder.
If the doctor who has been to medical school and has a lot of patients wants you to take Adderall, you should probably try it and then if it doesn't work you can try something else.
posted by Lyn Never at 4:13 PM on August 11, 2013 [1 favorite]
This interview (here's the cached version because the site seems to be down) on Psych Central Professional is geared, as indicated by the name, toward psychiatrists rather than patients, but the doctor talks through his diagnosis and treatment-planning process for ADHD, so you might find it helpful.
Practical points that popped out at me:
* For a diagnosis of ADHD, symptoms must have been present before age 12 (it used to be age 6, and that criterion only recently changed). So if you have or can get anecdotes or proof of your symptoms as a child (this doctor mentions report cards, comments from parents or teachers, written recollections from parents or siblings), that would be helpful.
* Given you said you tend to blank out when asked open-ended questions, you might want to think out (and write down) any memories of symptoms you experienced as a child. You've got a lot of detail in this question about your schoolwork during university, for example, but not grade school. You might want to think back further now, so you're not caught off guard when the doctor asks about your childhood symptoms. The doctor's going to have to know about them in order to give you an accurate diagnosis.
* Many medications for ADHD can make anxiety worse, so your psychiatrist is going to want to find treatment that doesn't do that, and that will likely be a big guiding factor in which medication the doctor chooses to try first. If the first medication doesn't work, you can always go back and try another.
posted by jaguar at 5:24 PM on August 11, 2013
Practical points that popped out at me:
* For a diagnosis of ADHD, symptoms must have been present before age 12 (it used to be age 6, and that criterion only recently changed). So if you have or can get anecdotes or proof of your symptoms as a child (this doctor mentions report cards, comments from parents or teachers, written recollections from parents or siblings), that would be helpful.
* Given you said you tend to blank out when asked open-ended questions, you might want to think out (and write down) any memories of symptoms you experienced as a child. You've got a lot of detail in this question about your schoolwork during university, for example, but not grade school. You might want to think back further now, so you're not caught off guard when the doctor asks about your childhood symptoms. The doctor's going to have to know about them in order to give you an accurate diagnosis.
* Many medications for ADHD can make anxiety worse, so your psychiatrist is going to want to find treatment that doesn't do that, and that will likely be a big guiding factor in which medication the doctor chooses to try first. If the first medication doesn't work, you can always go back and try another.
posted by jaguar at 5:24 PM on August 11, 2013
1) If you say you want to avoid scary things like adderall, you certainly aren't going to be characterized as drug seeking. There are other types of drugs, and those types are not what people who are drug seeking seek.
3) Say "It's hard for me to think through broad examples, can you be more specific?" Ask anything that might help narrow down the question "Do you mean at school, at home, or at work?", as though you were playing twenty questions.
4) Is something really important, explaining why you have come for help and how it is a major issue in your life.
As close to the beginning of the appointment as you get a chance to, mention that you were able to work around your problems at lower levels, but now that you are doing grad-school level work you feel that your organization and attention issues are really holding you back from reaching your full potential. On the grades you might just go with "my grades are OK but I can't seem to manage longer term projects like thesis and publication no matter how hard I try, and that could affect my career/degree, so I decided to seek help." I'd also mention how "I've even caused a flood at work and almost gotten into bicycle accidents due to inattentiveness" somewhere in there. (don't worry about the details of those, they will ask if they need them, you are simply conveying that you've had difficulties in a number of areas)
Writing out a short paragraph on the above would be a good idea, you could say you wrote out why you are there and read it aloud. Make this note all on one sheet of paper with most of the paper as white space, and have it where they can see that this will be just a quick preliminary.
Conversations are painful too sometimes - people get upset with me because I zone off halfway through their sentence
This seems to tie in with 3), and if you find yourself doing this at the appointment, you shouldn't feel to worried about it -- part of the in-person appointment with the specialist is so they can use their professional judgement to evaluate you, not to "judge you", and that is part of the diagnosis.
If you are asked very specific questions as part of an assessment, you might want to explain your answer or elaborate on related things you've had difficulty with.
For example: "Do you ever misplace your keys?" -- this question is meant to be a proxy for whether you have trouble with misplacing day to day items. Well, I never loose my keys, because I have very specific things I do with them like it is my religion (almost never anyhow, the key god sometimes frowns on me if I do not follow the tenants properly). I think they ended up marking down "frequently" for that question.
You might write some things down and read them over several times before the meeting. This should be helpful for recalling these things to discuss. You can expect some questions about elementary school days, these are most likely to be very general, but you just say something about how teachers complained you didn't pay attention, they probably won't expect too much detail.
[I confess to skipping around in your question a lot because I was distracted. Sorry.]
posted by yohko at 4:13 PM on August 12, 2013 [1 favorite]
3) Say "It's hard for me to think through broad examples, can you be more specific?" Ask anything that might help narrow down the question "Do you mean at school, at home, or at work?", as though you were playing twenty questions.
4) Is something really important, explaining why you have come for help and how it is a major issue in your life.
As close to the beginning of the appointment as you get a chance to, mention that you were able to work around your problems at lower levels, but now that you are doing grad-school level work you feel that your organization and attention issues are really holding you back from reaching your full potential. On the grades you might just go with "my grades are OK but I can't seem to manage longer term projects like thesis and publication no matter how hard I try, and that could affect my career/degree, so I decided to seek help." I'd also mention how "I've even caused a flood at work and almost gotten into bicycle accidents due to inattentiveness" somewhere in there. (don't worry about the details of those, they will ask if they need them, you are simply conveying that you've had difficulties in a number of areas)
Writing out a short paragraph on the above would be a good idea, you could say you wrote out why you are there and read it aloud. Make this note all on one sheet of paper with most of the paper as white space, and have it where they can see that this will be just a quick preliminary.
Conversations are painful too sometimes - people get upset with me because I zone off halfway through their sentence
This seems to tie in with 3), and if you find yourself doing this at the appointment, you shouldn't feel to worried about it -- part of the in-person appointment with the specialist is so they can use their professional judgement to evaluate you, not to "judge you", and that is part of the diagnosis.
If you are asked very specific questions as part of an assessment, you might want to explain your answer or elaborate on related things you've had difficulty with.
For example: "Do you ever misplace your keys?" -- this question is meant to be a proxy for whether you have trouble with misplacing day to day items. Well, I never loose my keys, because I have very specific things I do with them like it is my religion (almost never anyhow, the key god sometimes frowns on me if I do not follow the tenants properly). I think they ended up marking down "frequently" for that question.
You might write some things down and read them over several times before the meeting. This should be helpful for recalling these things to discuss. You can expect some questions about elementary school days, these are most likely to be very general, but you just say something about how teachers complained you didn't pay attention, they probably won't expect too much detail.
[I confess to skipping around in your question a lot because I was distracted. Sorry.]
posted by yohko at 4:13 PM on August 12, 2013 [1 favorite]
Mod note: From the OP:
Just wanted to give an update since I made it to the psych. The most terrifying thing I've done in a long time but pretty damn anticlimactic - I was expecting either "yeah you might have add, let's discuss meds" or "yeah you don't have add, just improve your study habits and organization". I got....nothing, basically.posted by jessamyn (staff) at 2:47 PM on August 15, 2013
He started off with "so you have add and anxiety?" which really caught me off guard and I said I was hoping he could tell me that. He didn't seem very professional. He actually didn't ask about my concerns at all...he asked a couple questions, most of which were family history and questions about my grad program, which he asked the name of FIVE TIMES (wtf why does it even matter, and how does a psychiatrist not know the word "molecular"?!). He asked me to dig up my grade school report cards even though I said I'm 95% sure my mom doesn't have them. I brought in a giant list of concerns I had but didn't get a chance to talk about them at all because he seemed very rushed (I was sitting in the waiting room SO PAINFULLY for 30 minutes because the receptionist forgot to buzz him or something, and he had another appointment after me, so our whole appointment was about 20 minutes). I stared at the list of a million disasters in my life and had no idea how to cut it down to the most important ones so I just talked about how I can't work without deadlines and crushing stress forcing me into it, so I'm not really doing any of the work I need to be doing.
He gave me a dumb ADD survey and told me to bring it back next week with my report cards. He didn't really say anything the whole time besides asking a few obvious questions (do you pay attention in class, do you forget stuff) and waiting for me to stammer out some kind of semi-coherent, rambling answer. He didn't tell me what will happen next week, if he'll do a real assessment then or what. He gave me an alarmingly significant look when I answered that I got good grades in undergrad but I talked a bit about how those were mostly exam-based and I test well but do badly at managing big projects, so hopefully it got through that I'm not just a perfectionist or something.
So....yeah. Not super impressed with the whole process so far. I was really hoping to get, if not meds, SOME kind of helpful suggestions from him today, not just "take more time off work to see me next week".
ANYway, I'll stick with it until I get some kind of conclusion, hopefully soon. I better not have to take time off from work to see him every week because that is ridiculous.
Thank you all so much for your help, every answer really helped me feel more prepared for my appointment, even if it turned out I didn't really need to be since nothing happened. I really appreciate it.
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2) If you have any problems handling your life at all, and it sounds like you have, I 100% guarantee you that the counselor will not tell you “Just go home and be a better person.” That's something you can stop worrying about right now. But don't feel bad for thinking it in the first place - I think a lot of us have those moments!
3) “When the referring GP asked me why I wanted an adhd referral, I was all "ummm...I'm really spaced out all the time...I dunno how to explain?!" but thankfully she asked me some more specific questions which I was able to answer.” The counselor will most likely be able to do the same thing. I know that awkward silences while you’re trying to think of what to say are incredibly painful (been there), but they really are OK in this context. You can come right out and tell the conunselor, “I’m having trouble putting my thoughts together,” or “I’m having trouble putting my thoughts into words,” and if they’re competent at their job they’ll try to help you do that.
4) Brains are complicated. A single brain can do some things very well and others not so great. Again, if your counselor knows what they’re doing, they should understand this.
This is a huge thing for you, and however it turns out and whatever you decide to do, I'm really proud you made the step to try it.
No matter how stressed or awkward you get, or how hard a time you have expressing your needs and symptoms during the session, I guarantee you the counselor has seen worse. If they, or you, feel that you haven't covered enough in the first session to figure out what you need, ask about scheduling a second one ASAP.
posted by The Underpants Monster at 2:24 PM on August 11, 2013