≡ Topic: New and confused.

New and confused.
14.01.2016 by Columbus

Hi! I recently heard about this condition and was a little confused about how to approach it.

I was hospitalized for a little over a month following a suicide attempt. I was under the care of a psychiatrist who diagnosed me with alexithymia, major depression, and PTSD. Upon leaving, I saw a new psychiatrist. She insisted that I could not have alexithymia, because that would mean that I could not also have major depression.

I'm pretty confused as to who I should listen to. The test here scored me as strongly alexithymic, and while an internet quiz can't beat an actual doctor, the two doctors I have seen are giving me conflicting opinions. Should I get a third opinion?

The first doctor's reasoning was that, even though I do have intense emotional episodes, I struggle to identify emotions in myself and others. EX: My friends make fun of me when we watch TV because I can never tell if a character is supposed to be a love interest until they kiss; when I cry, it feels like something that's happening to me instead of something I'm doing, and I can't figure out why it's happening without backtracking and making a list of potential causes. I think I feel nothing 90% of the time, and I don't notice feeling anything unless there's an accompanying physical sensation (crying, increased heart rate). When I notice the physical sensation, it's difficult to tell the difference in feelings if the symptoms are similar (EX: anger and fear both have increased heart rate. I have the hardest time trying to find the difference).

The second doctor's reasoning was that an alexithymic should not cry at all. She said that, because I sometimes experience emotional breakdowns, it doesn't matter that I think I feel nothing the grand majority of the time, or that I cannot identify why the feelings are happening to me. She said that, while my case was more extreme, separation from emotions was common in victims of abuse and that my emotional inability probably stems from PTSD rather than a separate disorder.

I've been this way for as long as I can remember. I didn't even know it wasn't normal until my brother told me that he doesn't have to backtrack to figure out what he's feeling and why it's happening; it's just intuitive to him.

Has anyone here gone through anything similar? The second doctor's treatment plan is completely different from the guidelines I was given when I left the hospital. What should I do?

new & confused
14.01.2016 by hpesoj

In a way, both are right. I think alexithymia is a spectrum, and by your suggestion that is 90% for you at the moment, with a high score on this site; combine this with the stress of whatever underlies the PTSD and depression is a predictable happening and a suicide attempt part of that process - well done for getting through that bit. Without the PTSD perhaps you would quote a number less than 90%

In my 30 years of contact with psychiatry I have observed that often opinions can differ - after all there aren't absolute tests like an Xray for a broken bone, and there are multiple overlapping views which can often seem to conflict in places, and over time you will also see what can only be described as changing fashions - so pick up both opinions & find the best way forward for you. If you seek a third opinion, leave a time interval & get your own bearings first, and compare it with your own understanding of who you are and how you tick.

Thanks for your help.
14.01.2016 by Columbus

I guess my primary concern is that the sudden change in treatment plans was jarring. My new doctor mostly wants to rely on medication. While I don't doubt that it works for most people, I've never noticed a difference. The hospital doctor told me that that may be because the changes caused by the medication were too subtle to break through my emotional inability, and that seems reasonable to me.