I ‘m Afraid to Be Misdiagnosed with Depression

27 April, 2020
Q Many doctors misdiagnose patients to either depression or anxiety when in fact they have depersonalization or dissociation.

you feel unreal, like a robot, like your body is on autopilot, devoid of emotions, ruminating endlessly about whats wrong.

Arms and legs do not feel part of your body. And most importantly it may appear side by side with a psychiatric disorder like depression.

Many psychiatrists and therapists are not trained in this sickness. Any ideas please because each patient is also unique?

Answer


In this counseling answer:

Depersonalization is an aspect of disassociation; it is targeted at the detachment from oneself and one’s identity. 

Anxiety is unique in that it can be a cause of or a result of dissociation.

Interestingly, in some cultures people seek to attain depersonalization through religious or meditative practices and in this case it is not a disorder.

It is important to inform psychiatrists and therapists of symptoms of Dissociation-depersonalization. So appropriate intervention methods for treatment can be utilized.



As salamu alaykum, 

Thank you for your question regarding mental health, diagnoses, and dissociation-depersonalization.

As I understand, your concern is you feel that many doctors misdiagnose patients with depression or anxiety in fact they may have other disorders such as depersonalization/dissociation. 

I 'm Afraid to Be Misdiagnosed with Depression - About Islam

Dissociation-depersonalization

In the case of dissociation-depersonalization, one feels that the body or mind is detached.  Depersonalization is an aspect of disassociation; it is targeted at the detachment from oneself and one’s identity. 

Some even express a dream like state and being outside of reality looking in. Those with the disorder often describe it as “if you’re watching your life on a movie screen”. In some severe cases, people even feel robotic and are unable to control speech or movement.

The whole thing with depersonalization disorder is that depression, severe stress, and anxiety, are common triggers in the  development of the disorder, hence the possible reason many are initially diagnosed with depression/anxiety. 

It is commonly reported that the use of recreational drugs may trigger dissociation-depersonalization, such as alcohol and hallucinogenic, weed and other substances.

Oddly, the DSM-5 does not include this as the criteria so it may be a separate category relating to SA. Other risk factors are having depression, OCD,  epilepsy, PTSD, and other disorders from the mental health Spectrum (1). 

Anxiety and Dissociative Identity

Anxiety is unique in that it can be a cause of or a result of dissociation. The National Alliance on Mental Illness (1) states that depersonalization can come in the form of dissociative identity disorder.

In this case,  people are confused about who they are. They often feel like a stranger to themselves. Depersonalization disorder which can involve out of body experiences, feelings of things being unreal, and an inability to recognize one’s image in a mirror (1).

Dissociative Amnesia is when people forget information about themselves or things that have happened to them.

Interestingly, in some cultures people seek to attain depersonalization through religious or meditative practices and in this case it is not a disorder (1). 

Recognition of Dissociation-depersonalization by Professionals

Reasons that it may appear that doctors and psychiatrists may not know as much about dissociation-depersonalization as they do about depression and anxiety may be because depression and anxiety are more prevalent worldwide.

Anxiety and depression can develop into dissociation-depersonalization after a diagnosis of anxiety/depression. Clients may fail to disclose the additional symptoms of dissociation-depersonalization to their therapist/ psychiatrist.

Most psychiatrists are well versed on depersonalization dissociative disorders. In fact, depersonalization disorder is in the DSM-5 and has a set criteria with guidelines (1).

People with depersonalization dissociative disorder who are seeking therapy need to be very clear on their symptoms.

And advocate for themselves if they feel that their psychiatrist, therapist, or doctor is missing some of what is being experienced.

Often times it’s difficult for those with mental health needs to cover everything when they are in a session with their psychiatrist.

This can be due to many reasons such as inability to think or process thoughts correctly, leaving out important points, inability to express oneself, etc.

It is very helpful insha’Allah to have someone that you trust go with you to appointments if you are not able to adequately describe and discuss what is going on with you.

Having someone you trust, who knows you and what you are feeling, and will advocate for you concerning your mental health needs is sometimes crucial.

Importance of Diagnosis and Treatment

Usually psychiatrists will screen a person for Dissociation-depersonalization disorder if the client discusses new symptoms.

Or if a screening uncovers new information. Or if the psychiatrist/therapist observes new behaviors,  affect, mannerisms, etc. Sometimes neurological tests are conducted to rule out any medical causes such as epilepsy.

It is important to inform psychiatrists and therapists of symptoms of Dissociation-depersonalization. So appropriate intervention methods for treatment can be utilized.

This is especially important for those already diagnosed with depression or anxiety as these two disorders can act as a mask resulting in an underdiagnosis of Dissociation-depersonalization.

As stated earlier most people with depersonalization disorder see a psychiatrist for presenting symptoms of depression and anxiety, rather than depersonalization.

In fact, a lot of people talk about symptoms of depression and anxiety and downplay dissociation-depersonalization disorder symptomatology. This in itself may be a reason why depression and anxiety are diagnosed more often.  

Discussing Symptoms

If one does not specifically discuss the symptoms unique to dissociation-depersonalization , the psychiatrist/therapist may be led to think that it is a case of depression or anxiety. Not dissociation-depersonalization, disorder as some of the symptoms may overlap.


Check out this counseling video:


Again, if one is unable to thoroughly explain or express the symptoms and how they are feeling, then having an advocate may be the best way to present the full spectrum of symptoms which the client is experiencing-to the psychiatrist.

It is true that  in some cases a psychiatrist may fail to further screen for new symptoms or follow up on symptoms which are exhibited in depression or anxiety that become worse or altered.

Psychiatrists may feel it is an intensification of the original diagnosis and may alter treatment in an attempt to assist the client therapeutically.

As dissociation-depersonalization disorder is becoming more prevalent, assessment and diagnosis is getting better.

Especially since it is strongly associated with common diagnoses of depression and anxiety. More professionals are including periodic screenings for their clients. 

Treatment and Recovery

There is no specific treatment yet for dissociation-depersonalization disorder but medications and counseling may help.

Cognitive behavioral therapy (CBT) and SSRIs may be effective in treating this disorder (1). Over time, the symptoms of dissociation-depersonalization may go away.

As this disorder frequently coexists with depression or anxiety, those disorders may linger, while dissociation-depersonalization may recede. 

Conclusion

Oftentimes when people have depersonalization and derealization, they may be afraid to discuss how and what they are feeling.

This may be related to the stigma attached to mental health disorders, or they may fear that they may have to go into the hospital. They may already have diagnoses of anxiety and/or depression and feel it is due to these conditions.

People with dissociation-depersonalization may not be able to effectively verbalize to their psychiatrist or therapist what they are feeling and experiencing. Thus, cases of dissociation-depersonalization may be missed.

If this is the case, advocates are recommended. Psychiatrists/therapists should also carefully screen clients periodically for dissociation-depersonalization disorder. Especially if a diagnosis of anxiety and/or depression already exists.

If able, being one’s own advocate is desirable. If needed, a mental health advocate should be sought assistance when the client is unable to adequately verbal needs, challenges, and changes in their mental health status. 

1. https://www.medicalnewstoday.com/articles/262888#treatment

Disclaimer: The conceptualization and recommendations stated in this response are very general and purely based on the limited information provided in the question. In no event shall AboutIslam, its counselors or employees are liable for any damages that may arise from your decision in the use of our services.

Read more:

https://aboutislam.net/counseling/ask-the-counselor/mental-health/feel-stigmatized-bipolar-disorder/

https://aboutislam.net/counseling/ask-the-counselor/mental-health/should-i-disclose-my-mental-illness-to-others/

https://aboutislam.net/counseling/youth-q-a/save-me-from-depression/

About Aisha Mohammad
Aisha received her PhD in psychology in 2000 and an MS in public health in 2009. Aisha worked as a Counselor/Psychologist for 12 years for Geneva B. Scruggs Community Health Care Center in New York. Aisha specializes in trauma, depression, anxiety, substance abuse, marriage/relationships issues, as well as community-cultural dynamics. She is certified in Restorative Justice/ Healing Circles, Conflict Resolution, Mediation, and is also a certified Life Coach.
Aisha works at a Family Resource Center, and has a part-time practice in which she integrates healing and spirituality using a holistic approach. Aisha plans to open a holistic care counseling center for Muslims and others in the New York area in the future, in sha' Allah. Aisha is also a part of several organizations that advocate for social & food justice. In her spare time she enjoys her family, martial arts classes, Islamic studies as well as working on her book and spoken word projects.