Ensuring you get the correct diagnosis can often be more difficult than it should be. In episode 287, I answered a question from a listener who experiences symptoms that overlap diagnoses and feels their ADHD diagnosis is incorrect. In this post, I explore this further and take a look at what you can do if you feel you’ve been misdiagnosed.
Hey there, I just have a question I am hoping you’d like to address on the podcast. A bit of background: I am a 33 year old woman diagnosed with Bipolar 2 (29) and Borderline (31) – (though I think the latter could be a misdiagnosis given to me while in the middle of a severe depressive episode- more on that later). I have been in a lot of therapy, both outpatient and inpatient, am medicated, and am in a very good place mentally. However, since the bipolar symptoms are at bay and I am not currently in an episode, my psychiatrist wants me to go through ADHD diagnostics as concentration and other ADHD like symptoms are still problematic and can’t be explained away by a Bipolar episode. However, I think these symptoms might not actually be ADHD, but trauma symptoms from childhood SA (something my therapists were aware of but not treated or addressed directly). This is also why I think the Borderline diagnosis might be incorrect – that symptoms of trauma are being mistaken for symptoms of ADHD and Borderline. Do you have any experience with similar misdiagnosis / overlapping symptoms and how could I go about getting the correct diagnosis?
Thank you for the question. I’m happy that you are alive. It sounds like you have had to endure way more than any human should.
I am glad that you are questioning your diagnoses. I think that’s totally valid and important to do. You are right that sometimes diagnoses are given due to symptoms from something else.mThese things should always be reconsidered and re-evaluated. One that unfortunately does not happen enough is removing old diagnoses from the problem list, letting them stack up more and more over time until your problem list looks like a CVS receipt. Most often ADHD is something that is present in childhood. There may be uniquely adult versions of it, but most often it’s something that is present from a young age and in multiple settings. I’m not sure how far back your trauma goes, but did you have symptoms of inattention before your traumatic experiences? It might be really hard to separate out because things like trauma, depression, bipolar, and anxiety can all cause you to have trouble maintaining attention.
You also want to consider whether the symptoms of inattention that you are noticing are causing a real functional impairment. Are they getting in the way of your life in a significant way? Sources of personal annoyance and quirks are certainly worthy of paying attention to, but if it’s really not holding you back or negatively impacting your life to a significant degree, do you really need to torture yourself digging so hard for answers?
There are absolutely overlapping symptoms in the things that you are dealing with. Symptoms of traumatic responses and depression can be mistaken for ADHD. For instance, if you have PTSD, one of your symptoms might be hypervigilance. Always scanning your environment for danger and responding in exaggerated ways to things that seem scary. When you’re in that state, your attention is pulled in multiple directions. So whatever you would like to focus on is competing for mental real estate with your hypervigilance about your environment and about the sensations happening in your own body. Depression often causes attentional difficulties as well. It can cause trouble concentrating and also make it more difficult to care about putting in the effort you should put into tasks. All of this is to say that the diagnostic picture is definitely murky due to overlapping symptoms.
Diagnosis Attention Deficit Hyperactivity Disorder
When it comes to getting evaluated for ADHD there are some things you should know. The actual diagnosis process for ADHD does not really rely so much on objective measures. There ARE tests of attention that show issues like impulsivity or lack of vigilance over time. These would be things like your continuous performance tasks. The thing is, someone can have ADHD and ace these tests. You can also have people that perform poorly and do not have ADHD. They are not diagnostic. They are just additional info. Truly, ADHD assessment is more focused on looking at personal history, grades, work history, behavior ratings in multiple settings, and ruling out other possible diagnoses. You tend to see things like trouble on attentional tasks, executive functioning difficulties, etc. on cognitive testing, but that is only one piece of the puzzle and actually not required for a diagnosis. If you are smart and generally a high performer, you might fly under the radar when it comes to testing.
That said, getting a cognitive assessment can be helpful in that it helps you to better understand your strengths and weaknesses. You can learn what is and is not an issue for you. This can enable you to better organize or adapt your life regardless of the source of those issues. Even if you DON’T have ADHD, you may still have attentional issues due to your other conditions that are still worth paying attention to. Getting a correct diagnosis is helpful in some respects, but it is not everything. Learning more about the functional impact of how things actually play out in your life is probably more helpful. Even pushing to find the perfect name for it and the perfect source of each symptom might not be the most useful thing. The actions you take might be more important.
Exploring other avenues
Now, you said that your trauma is something that is known but not actively treated or worked on. I’d be curious about that. Getting some focused treatment from someone trained in working with trauma would be the next logical step here. Sometimes it is only over time and with effective treatment that we can start to tease apart where our symptoms come from. Time and treatment can be part of the diagnosis process. A lot of people don’t realize that. This is also why I said that diagnoses should be revised and refined over time.
There’s also the issue of medication – I’m not sure what medication you are on, but for instance, in many cases anticonvulsant medications are used to treat anxiety and bipolar. These medications can cause slowed processing speed and some attentional issues. It makes a lot of sense really if you think about it because they are designed originally to slow your brain down to prevent seizures. For example, gabapentin operates on GABA – the primary inhibitory neurotransmitter in your brain.
All in all, there are many different threads here. It might be unreasonable to take every individual symptom and assign them to a nice clean-cut disorder they apply to. There is definitely overlap in symptoms with the various issues you deal with. What you can do is work toward ruling things out. If you don’t think that you have borderline, definitely honor that. Express that concern to your providers. If you need to get a second opinion from someone that has more experience in working with personality disorders, then do that. But overall, I think that it is totally valid to take a step back from the labeling and take steps toward coping, treatment, and the adjustment of your life given your day-to-day experience.
You can listen to this on Episode 287 of the podcast!
Thank you for the great question!
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