"I realize that I seem fine, doctor, but..."
December 14, 2016 12:53 AM Subscribe
I've been extremely irritable and short-tempered lately. I think it's time to do something about this. The trouble is, I'm very, very good at "superficial professional interactions" (it's like a reflex I can't stop), and I'm afraid my doctor is just going to pat me on the head and shoo me off home. What can I do to make sure I'm taken seriously?
Some examples of what's going on:
* I snapped at my boss today (oops!).
* I get mad at the dog if she wants to cuddle too much. I frequently can't stand her being in my space even though I love her.
* I have zero tolerance for interruptions (e.g., dog & boss). (Not, "I find them annoying", more "rising tide of internal rage".)
* Everything feels like a chore, and trying to do anything "fun" tends to end in aggravation.
* I'm not sleeping well (trouble falling asleep + waking up in the middle of the night).
* I don't feel sad, just irritated to the point of losing my temper.
* I recently had a week off of work, and was grumpy the whole time then too.
Some examples of what's going on:
* I snapped at my boss today (oops!).
* I get mad at the dog if she wants to cuddle too much. I frequently can't stand her being in my space even though I love her.
* I have zero tolerance for interruptions (e.g., dog & boss). (Not, "I find them annoying", more "rising tide of internal rage".)
* Everything feels like a chore, and trying to do anything "fun" tends to end in aggravation.
* I'm not sleeping well (trouble falling asleep + waking up in the middle of the night).
* I don't feel sad, just irritated to the point of losing my temper.
* I recently had a week off of work, and was grumpy the whole time then too.
I have a similar thing (strong tendency to perform/compensate in stressful formal settings even when it's against my best interests to do so). It took me more than a decade from first symptoms to get an accurate mental health diagnosis and this was at least part of why.
I think the thing to do is remember that this is a habit that can be super helpful in some scenarios and super unhelpful in others, and that this is a super unhelpful place for that behaviour to manifest. Which doesn't mean you won't do it, but you can acknowledge it directly during the consultation - "I have a habit of underplaying how serious things are for me, which is exacerbated by the stress of being in a medical setting, but I want you to know that this is having a significant impact on my quality of life" and then list the examples you gave above.
Another tactic is to talk specifically about stuff that's not going well that could have a big impact on your life situation, e.g. the examples with your boss. "This is impacting my performance at work and I'm concerned that it could have significant consequences if it carries on unchecked." A doctor might not be getting the see/feel part of what's going on from how you're presenting but this kind of framing tends to get their attention even if you look okay.
For me, the performance aspect is part of a big mental game, and I find it helpful to remind myself that I can actively choose to circumvent the framework of the game. Even if my brain is screaming "no we've got to pretend we're okay don't you dare acknowledge anything", I can still choose to say "I have this unhelpful problem where I underplay my symptoms but I want you to know that this is seriously affecting me" to the doctor, and that is usually a helpful thing for them to know.
posted by terretu at 1:12 AM on December 14, 2016 [6 favorites]
I think the thing to do is remember that this is a habit that can be super helpful in some scenarios and super unhelpful in others, and that this is a super unhelpful place for that behaviour to manifest. Which doesn't mean you won't do it, but you can acknowledge it directly during the consultation - "I have a habit of underplaying how serious things are for me, which is exacerbated by the stress of being in a medical setting, but I want you to know that this is having a significant impact on my quality of life" and then list the examples you gave above.
Another tactic is to talk specifically about stuff that's not going well that could have a big impact on your life situation, e.g. the examples with your boss. "This is impacting my performance at work and I'm concerned that it could have significant consequences if it carries on unchecked." A doctor might not be getting the see/feel part of what's going on from how you're presenting but this kind of framing tends to get their attention even if you look okay.
For me, the performance aspect is part of a big mental game, and I find it helpful to remind myself that I can actively choose to circumvent the framework of the game. Even if my brain is screaming "no we've got to pretend we're okay don't you dare acknowledge anything", I can still choose to say "I have this unhelpful problem where I underplay my symptoms but I want you to know that this is seriously affecting me" to the doctor, and that is usually a helpful thing for them to know.
posted by terretu at 1:12 AM on December 14, 2016 [6 favorites]
Hey, me too! One of the things I did was start crying during the appointment, which probably helped, but I also wrote out a bunch of symptoms much like you have above and had that to hand - and I told the doctor that I had a huge tendency to downplay my feelings. She gave me a couple of questionnaires, one on depression and one for anxiety, and I was surprised to learn that a lot of my symptoms (which overlapped with yours) pointed to anxiety, which had never crossed my mind. I left that appointment with a prescription for Prozac. So, I'd say you're at a good start with a clear list of things that are causing problems for you. I would try and add any timelines, like have you been feeling this way for a few weeks? All year? For as long as you can remember?
posted by the agents of KAOS at 1:14 AM on December 14, 2016 [4 favorites]
posted by the agents of KAOS at 1:14 AM on December 14, 2016 [4 favorites]
-Write everything down before you go in.
-Ask/tell directly that you're looking for a solution, that this is affecting your "quality of life", relationships, sleep, and job.
-It's helpful to acknowledge the mental health aspect of health, especially when it comes to mood. However if they dismiss this as "just anxiety or depression go work on it" without concrete solutions like "try seeing a therapist, here are some I like, and we'll run some bloodwork" or similar, then get a new doctor. Dismissing physical causes that aren't mental health as mental health is extremely frustrating and dismissing mental health issues as something to "Deal with" on your own is also very bad doctor-ing.
For example if they mention that it may be depression or anxiety or something, ASK again, "What should I do for that? What do you suggest? What do we do if X/Y/Z doesn't work? Could there be a physical aspect?"
(My health issues have anxiety as a symptom and are often misdiagnosed as an anxiety disorder, when it's a nervous system disorder. So I had to awknowledge that it was physical and that my therapist agreed it was not "just anxiety" and that it was something I was aware of, but it did not account for all of my physical symptoms. This goes the same for if your doctor isn't willing to offer medication if you've been working on therapy, etc, as a first step or if it's worthy of trying medication first.)
- This may sound crazy. But dress down. (Especially if you're a woman or female-presenting.) When I would dress down (t shirt, jeans, barely any makeup) I was taken more seriously than if I even wore something as simple as a button down shirt. (Because I guess you're not sick enough if you can button a shirt?)
posted by Crystalinne at 1:27 AM on December 14, 2016 [3 favorites]
-Ask/tell directly that you're looking for a solution, that this is affecting your "quality of life", relationships, sleep, and job.
-It's helpful to acknowledge the mental health aspect of health, especially when it comes to mood. However if they dismiss this as "just anxiety or depression go work on it" without concrete solutions like "try seeing a therapist, here are some I like, and we'll run some bloodwork" or similar, then get a new doctor. Dismissing physical causes that aren't mental health as mental health is extremely frustrating and dismissing mental health issues as something to "Deal with" on your own is also very bad doctor-ing.
For example if they mention that it may be depression or anxiety or something, ASK again, "What should I do for that? What do you suggest? What do we do if X/Y/Z doesn't work? Could there be a physical aspect?"
(My health issues have anxiety as a symptom and are often misdiagnosed as an anxiety disorder, when it's a nervous system disorder. So I had to awknowledge that it was physical and that my therapist agreed it was not "just anxiety" and that it was something I was aware of, but it did not account for all of my physical symptoms. This goes the same for if your doctor isn't willing to offer medication if you've been working on therapy, etc, as a first step or if it's worthy of trying medication first.)
- This may sound crazy. But dress down. (Especially if you're a woman or female-presenting.) When I would dress down (t shirt, jeans, barely any makeup) I was taken more seriously than if I even wore something as simple as a button down shirt. (Because I guess you're not sick enough if you can button a shirt?)
posted by Crystalinne at 1:27 AM on December 14, 2016 [3 favorites]
In my experience, medical professionals are looking for Duration and Intensity and Consequences. How long is this problem lasting? How bad is it, honestly? And how does the patient see it as effecting their life?
Changes in sleep schedules is often something to make note of too, so I'd mention that; with the prepared counter of 'no, this seems well above and beyond normal tired-cranky' when they inevitably ask 'can this be due to lack of sleep?'
If it helps, your job is to give the doctor as much info as you can so they can make a professional diagnosis. Their job is to listen, hopefully dig a little, and then help you. So nobody gets to be professional when either side fails in their job.
posted by Jacen at 1:30 AM on December 14, 2016
Changes in sleep schedules is often something to make note of too, so I'd mention that; with the prepared counter of 'no, this seems well above and beyond normal tired-cranky' when they inevitably ask 'can this be due to lack of sleep?'
If it helps, your job is to give the doctor as much info as you can so they can make a professional diagnosis. Their job is to listen, hopefully dig a little, and then help you. So nobody gets to be professional when either side fails in their job.
posted by Jacen at 1:30 AM on December 14, 2016
Do you think it's mental? Do you think it's physical?
Make sure it's not hypertension, that can lead to grumpiness!
posted by benadryl at 2:11 AM on December 14, 2016
Make sure it's not hypertension, that can lead to grumpiness!
posted by benadryl at 2:11 AM on December 14, 2016
Are you a woman? If so, is it like bad PMS all the time? Then it could be hormones and be sure your doc checks those levels. If you're a man, I suppose it could also be hormones?
posted by mareli at 3:02 AM on December 14, 2016
posted by mareli at 3:02 AM on December 14, 2016
If you've had any thoughts of self-harm or along those lines, be sure to mention them, even if they feel unrelated to the anger.
posted by lakeroon at 4:20 AM on December 14, 2016 [1 favorite]
posted by lakeroon at 4:20 AM on December 14, 2016 [1 favorite]
I don't think you have to snap at your doctor to get him to realize you have a problem with irritability. Your list above is good. I think it would also help to be clear that this is not normal for you. If you can identify when it started, or at least when you noticed it, that's probably also a good idea.
"I snapped at my boss, something I have never done before" and "I used to love cuddling with my dog, but about 2 months ago I noticed I couldn't stand having her in my space."
Can't speak for your doc, but it doesn't strike me as a problem that you don't want to cuddle with your dog unless I know that's not normal for you.
Good luck, OP. Glad you are getting help!
posted by bunderful at 5:29 AM on December 14, 2016 [1 favorite]
"I snapped at my boss, something I have never done before" and "I used to love cuddling with my dog, but about 2 months ago I noticed I couldn't stand having her in my space."
Can't speak for your doc, but it doesn't strike me as a problem that you don't want to cuddle with your dog unless I know that's not normal for you.
Good luck, OP. Glad you are getting help!
posted by bunderful at 5:29 AM on December 14, 2016 [1 favorite]
Your list is great, but I also think you should be prepared for the possibility that your doctor may blow you off anyway, especially if you're a woman. Do you have a family member or close friend who would be willing to come along and attest to these changes--in particular (I hate to say this) a man?
posted by mchorn at 6:49 AM on December 14, 2016 [1 favorite]
posted by mchorn at 6:49 AM on December 14, 2016 [1 favorite]
Your list includes many symptoms of depression. Depression isn't always about being "sad." The PHQ-9 is a depression screening tool used by medical professionals. Perhaps find it online and complete it by yourself and bring it to your doctor?
posted by Burn.Don't.Freeze at 7:00 AM on December 14, 2016 [1 favorite]
posted by Burn.Don't.Freeze at 7:00 AM on December 14, 2016 [1 favorite]
I realize it's not this easy, but I like how closed-loop the problem is on paper - if they'd like evidence of your illness, get irritated, lose your cool, and yell at the doctor.
posted by aimedwander at 7:11 AM on December 14, 2016
posted by aimedwander at 7:11 AM on December 14, 2016
Your list includes many symptoms of depression. Depression isn't always about being "sad."
I had a conversation about this with my therapist. She says that many time men (and sometimes women, I am female) can get atypical depression where you're just short tempered and irritable and not enjoying life without the sad/morose/anhedonic feeling. I had a much easier time managing the sudden onset of these (very similar) feelings when I started looking at them through a "this might be depression" lens. They key words to remember are "This is negatively impacting my life and I've tried this, this and this to manage it and it's not working which is why I am coming to you"
And then think a little what sort of outcome you are looking for: medicine? bloodwork and tests? referral to a specialist? validation of your feelings? and then work towards those.
My depression was pretty much minor and situational and what helped for me was Vitamin D, ramping up the exercise, ramping down the caffeine and giving myself the space to take some of the pressure off so that i could feel better. Might be something different for you. Best of luck.
posted by jessamyn at 7:21 AM on December 14, 2016 [4 favorites]
I had a conversation about this with my therapist. She says that many time men (and sometimes women, I am female) can get atypical depression where you're just short tempered and irritable and not enjoying life without the sad/morose/anhedonic feeling. I had a much easier time managing the sudden onset of these (very similar) feelings when I started looking at them through a "this might be depression" lens. They key words to remember are "This is negatively impacting my life and I've tried this, this and this to manage it and it's not working which is why I am coming to you"
And then think a little what sort of outcome you are looking for: medicine? bloodwork and tests? referral to a specialist? validation of your feelings? and then work towards those.
My depression was pretty much minor and situational and what helped for me was Vitamin D, ramping up the exercise, ramping down the caffeine and giving myself the space to take some of the pressure off so that i could feel better. Might be something different for you. Best of luck.
posted by jessamyn at 7:21 AM on December 14, 2016 [4 favorites]
Plenty of good advice here, and I'll add one more piece for examination - a shift in hormones can produce some of this, either as peri-menopause/andropause (we are not that different)
I say this as a stoic that recalled being un-stoic through adolescent change while facing temporarily medically induced hormonal fluctuations.
Also, make a list of what's new/changing/resurfacing for either volume of change or trigger points, which can be a go-to for This Is Serious Even If I Sound Smooth.
posted by childofTethys at 8:35 AM on December 14, 2016
I say this as a stoic that recalled being un-stoic through adolescent change while facing temporarily medically induced hormonal fluctuations.
Also, make a list of what's new/changing/resurfacing for either volume of change or trigger points, which can be a go-to for This Is Serious Even If I Sound Smooth.
posted by childofTethys at 8:35 AM on December 14, 2016
Your list includes many symptoms of depression. Depression isn't always about being "sad." The PHQ-9 is a depression screening tool used by medical professionals. Perhaps find it online and complete it by yourself and bring it to your doctor?
Seconding this. Your doctor is going to try to find a plausible cause of your irritability and try to rule out certain common and important causes. In addition to the PHQ-9, the GAD-7, the Cohen Perceived Stress scale and the MDQ can help her assess any connection between your irritability and anxiety, stress or bipolar symptoms. Even if you're pretty sure what that the cause isn't one of these, filling out the testing prior to your appointment and taking them to the appointment will communicate good information and allow your physician to focus on other causes.
Also, be prepared to discuss any chemicals (alcohol, drugs, tobacco, supplements), your sleeping patterns, pain and hormones.
Sometimes it helps to bring in someone close to you who can vouch for your irritability and provide an outside perspective on how you're doing.
posted by Emmy Noether at 8:47 AM on December 14, 2016 [1 favorite]
Seconding this. Your doctor is going to try to find a plausible cause of your irritability and try to rule out certain common and important causes. In addition to the PHQ-9, the GAD-7, the Cohen Perceived Stress scale and the MDQ can help her assess any connection between your irritability and anxiety, stress or bipolar symptoms. Even if you're pretty sure what that the cause isn't one of these, filling out the testing prior to your appointment and taking them to the appointment will communicate good information and allow your physician to focus on other causes.
Also, be prepared to discuss any chemicals (alcohol, drugs, tobacco, supplements), your sleeping patterns, pain and hormones.
Sometimes it helps to bring in someone close to you who can vouch for your irritability and provide an outside perspective on how you're doing.
posted by Emmy Noether at 8:47 AM on December 14, 2016 [1 favorite]
Don't be embarrassed to write down your symptoms and hand your doctor a piece of paper. That way, you don't have to recite everything, and you can write it down when it's fresh in your mind.
posted by MuppetNavy at 8:55 AM on December 14, 2016 [2 favorites]
posted by MuppetNavy at 8:55 AM on December 14, 2016 [2 favorites]
I just wanted to mention that this could be a version of mania, rather than depression. For some people, mania presents as severe irritability and tides of anger and lashing out. In that case, anti-depressants would increase the problem, and are usually strictly avoided. A mood stabilizer might be more appropriate in that case. Just something to take into consideration (or it might be totally irrelevant, but wanted to pass along the info just in case.) I am not a doctor, but I have epilepsy, and have read a vast number of studies and people's experiences with my medication, which doubles as a mood stabilizer.
posted by thegreatfleecircus at 9:19 AM on December 14, 2016 [2 favorites]
posted by thegreatfleecircus at 9:19 AM on December 14, 2016 [2 favorites]
Definitely write everything down including symptoms, history, questions. Take notes during the appointment.
posted by radioamy at 11:43 AM on December 14, 2016
posted by radioamy at 11:43 AM on December 14, 2016
This is negatively impacting my life and I've tried this, this and this to manage it and it's not working which is why I am coming to you"
I found that this kind of phrasing made my own doctor much more responsive when I felt like she was downplaying my complaints about a certain prescription I was on. And phrasing combined with a timeline of how things had been escalating got me satisfactory results. (in my case, I mapped out how my insomnia was being triggered by hormononal changes, ie, not sleeping two days before my period every month, and the insonmia was then also leading to irritability and other issues. I brought up a calendar on my phone to show her how I'd mapped the insomnia and that got her to think productively about treatment).
posted by TwoStride at 2:55 PM on December 14, 2016
I found that this kind of phrasing made my own doctor much more responsive when I felt like she was downplaying my complaints about a certain prescription I was on. And phrasing combined with a timeline of how things had been escalating got me satisfactory results. (in my case, I mapped out how my insomnia was being triggered by hormononal changes, ie, not sleeping two days before my period every month, and the insonmia was then also leading to irritability and other issues. I brought up a calendar on my phone to show her how I'd mapped the insomnia and that got her to think productively about treatment).
posted by TwoStride at 2:55 PM on December 14, 2016
FWIW, this may vary based on where you live, but in my experience medical professionals are seeing a LOT of this kind of stuff in the last month, and they are primed to recognize and address it. Post-election mental health is a serious thing 'round these parts.
posted by instamatic at 3:12 PM on December 14, 2016
posted by instamatic at 3:12 PM on December 14, 2016
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It's not like taking your car to the mechanic and suddenly the noise stops happening. Doctors know that some health issues won't manifest right there in the office.
posted by Sara C. at 1:10 AM on December 14, 2016 [9 favorites]