Possible Misdiagnosis

I am posting on behalf of my boyfriend who met with a psychiatrist today who diagnosed him with OCD and prescribed him fluoxetine. I believe that his symptoms fit much more closely with a dissociative disorder from what I have learned. Here are his symptoms:

-hearing a voice inside his head that does not sound like it's coming from the outside. he has heard the voice since 4 or 5 years old. the voice "gives" him thoughts and shows him violent images. The voice told my boyfriend he can take control of the body whenever he wants, but has not acted on this yet.
-frequent headaches, especially when the voice is talking a lot
-convulsion "episodes" (I thought he was having a seizure) where he cannot speak but remains conscious
-memory loss. he will write and say things that he does not remember doing. One time he told me that the voice thought I had a "cute smile" but when I asked him about it later he didn't remember saying it.
- a possible incident when he was young where the "voice" took control of his body and he was able to watch the voice's actions but he is not 100% sure

He does not report any anxiety and does not have any compulsive behaviors. His only symptom that seems to fit with OCD are the recurring thoughts, which don't appear to be his thoughts at all. We are definitely going to be getting a second opinion from a professional but do any of you have experience with being misdiagnosed?

Im glad you said you were going to get a second opinion. there are many different problems, normal, mental and physical that can share the same symptoms.

like you have already figured out he shares some symptoms of OCD and what you have read about Dissociative disorders...

one thing that jumps out at me is there may be a reason why the psychiatrist diagnosed him OCD rather than a dissociative disorder.....please dont take this as a diagnosis..Im just making ....guesses.... according to what jumps out at me in your post...

for one thing the appearing to have seizures.. the way the diagnostic criteria for dissociative disorders are wrote up in the DSM 5, a person can not be diagnosed with a dissociative disorder if they are having seizures.

you can read more about the american version of what the dissociative disorders are here....

http://forums.psychcentral.com/disso...s-dsm-5-a.html

Another reason the psychiatrist may have not used the diagnosis of dissociative disorders is because there is a diagnostic process for dissociative disorders. one part of this process is ruling out things that share the same symptom like OCD, and other physical/mental health issues that share the symptom of hearing voices.

yet another reason why the treatment provider may have not diagnosed the person with a dissociative disorder is that the new diagnostics state the symptoms cant be better explained by other mental disorders. there are many different ways to present with OCD ....

some people with OCD do have

audio hallucinations (hearing voices)
psychosis (perceiving the voices as separate entities that take over, ....)
delusional thoughts actions....

maybe while he was with the psychiatrist he was in constant or repetitive movement that only a trained professional is trained to look for....

gosh there are so many different reasons why a treatment provider diagnoses someone in a way in which we may not agree with or not see those things in ourselves or others.

my suggestion contact the psychiatrist, ask him why he diagnosed the way he did, your boyfriend can even get a copy of the write up about the appointment that may explain to him why he was diagnosed the way he was.

Your best bet is to find a Psychologist who has worked with Dissociative Identity Disorder patients. Most Psychiatrist spend one semester developing their interactive therapy skills. Psychologist spend the greater part of their education on interactive therapy. They are better at diagnostic skills than Psychiatrists. Psychiatrists are closer to being medical doctors and learn more about the human body and medication. That's fine if you already have a diagnosis.

I am quite familiar with the DSM because I almost have my B.S. in psychology (just a few more months). I don't believe what I saw was an epileptic seizure, I think it was a non-epileptic seizure which I have read extensively about. If that is the case then I do not believe a dissociative diagnosis could be ruled out.

I am aware that with OCD you can experience voices but my boyfriend's voice is not repetitive. The voice has his own opinions and thoughts. He seems to have an opinion on everything. I can see why from a certain perspective he could be diagnosed with OCD but if you look closer I don't think it fits at all. There is a big difference between intrusive thoughts and a distinct personality.

Thank you for your reply, I agree that we need to seek a second opinion. The reason I am so wary of this particular psychiatrist is that it is through our college and I have had bad experiences with their mental health facility. I talked with my psychiatrist about it and she says that she does not trust their program either and encouraged me to get him an off-campus referral.

It really bothered me that she told my boyfriend she could not explain the memory loss, headaches, or the convulsions. The only reason she diagnosed him with OCD she said is because of the recurring thoughts he has (which aren't even his thoughts). I was supposed to go with him today but I had a final. I am going with him next week though to his next appointment so I will get to ask my questions then!

OCD is an anxiety disorder. What is typical for someone with it is that they feel like they must act a certain way, but they know they shouldn't have to. Their feelings are leading and their reasoning is intact, just that the reasoning does not win the battle. Meaning, they are not psychotic. It is not an illness of either hallucinations or delusions. OCD can give you intrusive thoughts but that is not the same as hallucinating.

actually in some people OCD can cause a person to have psychosis, hallucinations and delusional thoughts...

example...me.

when I am home alone one of my compulsions is constantly pacing from room to room. I have a ritual i do in every room in order for me to feel safe. it is a repetitive motion with my hands, where I am constantly flexing and fisting my hands as I enter each room. I also have the compulsion of listening at doors and windows when I am alone, making sure no one is on the other side, making sure the doors and windows are locked. then even though I already know all the windows and doors are locked I pace around from room to room again. sometime I get so fixated on this compulsion that I begin to hear voices that are not there, start seeing peopled shadows that are not really there (my treatment providers call this OCD induced psychosis and OCD induced hallucinations) Sometimes it gets beyond this to where my thoughts are on the delusional side.....someones out there, he's going to get me, whats that, got to find something to protect my self, I know Ill turn into being like the eagle and fly away from here I can do that I bet if I tried...my treatment providers call this OCD induced delusions.

OCD affects people in many different ways just because you dont have the symptoms of hallucinations/psychosis and delusions during your OCD problems does not mean every person with OCD is like you.

hallucinations/delusions and psychosis can happen to anyone regardless of which mental disorder or physical problem has. and they can happen as part of any mental disorder or physical problem...

if you type in a search bar .....OCD plus hallucinations ......you will find there are millions of people out there that have OCD where it presents itself with hallucinations. the same with delusions and psychosis.

I think that you know your situation and your treatment providers best. I think if you EVER question a treatment provider, no matter who they are or where, you should be getting a second opinion, or at the very least questioning things. Your boyfriend is lucky to have someone in his life who is as supportive as you.

As far as talking about diasgnoses and symptoms, I don't believe anyone on this site has the ability to know what goes into someone's specific diagnosis or not. First of all, we are here for peer support, second, the only qualified people for that are those who are professionals (eg doctors, psychologists). Any good professional will steer clear of ANY diagnosing over a short message online. Just because one person knows something about mental health does not mean that others are wrong, or misguided. It simply means they are coming from a different place. All of us on here have been trained (professionally and through experience), and we will all have different ideas. Even the highest professionals have differing views on things. That's the intrigue into sciences like mental health: it's constantly changing.

Hope all goes well with the appointment next week!

IJ

some dissociative disorders do come with pseudo seizures as part of the package of symptoms. it depends on where in the world you are whether dissociative motor disorder is classed as a dissociative or conversion disorder, but it definitely comes with pseudo seizures.

I thought that when a person with DID goes into an imobile state where they can talk or move or interact, was them switching to an alter who's job was to just be there physically, So if they are being physically abused the body is there in this motionless state and the mind is protected from what is happening. Is that different from a seizure?

If someone has OCD and psychosis they simply have OCD AND psychosis. At least where I live, if you get psychotic you get a diagnosis of psychosis no matter how it happened that you got psychotic.

Yes some people may have the type of alters who's job, purpose reason for being is to not talk, not move and not interact but they still have a mood, behavior, affect....basically everything that makes them an alter. example an alter of this kind may have a neutral mood, angry mood, may clutch their fists, maybe they suck their thumb, maybe they squeeze their eyes shut, maybe they pinch their mouth shut... an alter with DID has human traites/characteristics that distinguish them from the host and each other.

with epileptic seizures the body twitches/convulses/ loss of bladder control (most not always), pupils dilating, sometimes the person looks like they passed out after the seizure, sometimes the person looks like they are just staring and sitting still while their body is having a petit mal epileptic seizure, and other physical changes in the body and brain. non epileptic seizures mimic/presents itself like a copy of epileptic seizures.

I bet if you went to youtube there might be some vidoes of what a pseudo seizure/conversion disorder seizure/epileptic seizure looks like and what a person looks like when they are switching into and out of their alters.

The DSM-V changed that. There is now a delusional variant of OCD which is not classified as a psychotic disorder anymore (was in DSM-IV).

Hallucinations though are another story. Not a symptom of OCD that I know of.

I have a hard time understand how OCD has a delusional variant in itself (that isn't for example dysmorphophobia). I have looked around for a definition in DSM-5 but pretty hard to find.

You have a link?

I see the problem you are in a different country then I am...I am in the United States. You are in EU according to your profile....

here in the USA the mental disorder diagnostics and groupings/categories have recently changed. here in the USA OCD does include the symptoms of hallucinations/delusional/psychosis type symptoms...and OCD is no longer listed as an anxiety disorder here in the USA....

http://www.dsm5.org/Documents/change...to%20dsm-5.pdf

This change also emphasizes that the presence of
absent insight/delusional beliefs warrants a diagnosis of the relevant obsessive-compulsive or related
disorder, rather than a schizophrenia spectrum and other psychotic disorder.

I know its confusing but psych central is made up of members from many different locations and that means everyone is not going to be going by the same standards for mental disorders definitions/treatment options....for example you and I...

your country sees /treats and thinks of OCD one way and here where I am in the USA we now go according to the new diagnostics published in the DSM 5. in the new diagnostics OCD does allow for symptoms of hallucinations and delusions and no longer labels someone with a psychotic diagnosis just because the person has OCD and hallucinations, or OCD and delusions or OCD and Delusions and hallucinations. its now just the person has OCD with a specifier of symptoms hallucinations/delusions...

kind of like the standards we go by for DID now has a dissociative disorder that has specifiers and subsections that takes into consideration people with alternate personalities things that was not considered to be part of the disorder in the past. like taking into consideration people with alternate personalities that dont lose time, or having dissociation symptoms because of coersion/brainwashing (other specified dissociative disorder) or like the mental disorder PTSD now has a specifier/subsection for people who have a PTSD/dissociation combination of symptoms.

here in America OCD now has specifiers that include psychotic symptoms like hallucinations and delusions.

you havent found it online yet because it just got printed only a few months ago and very few people other than treatment providers have a copy of the book..and even then some treatment providers are still waiting for their copy that they pre ordered before the book was printed.

the book is at amazon.com.

This describes briefly the findings in the DSM V in relation to delusional thought.

Quote: American Psychiatric Publishing

"
Specifiers for Obsessive-Compulsive and Related Disorders
The “with poor insight” specifier for obsessive-compulsive disorder has been refined in DSM-5 to allow
a distinction between individuals with good or fair insight, poor insight, and “absent insight/delusional”
obsessive-compulsive disorder beliefs (i.e., complete conviction that obsessive-compulsive disorder
beliefs are true). Analogous “insight” specifiers have been included for body dysmorphic disorder and
hoarding disorder. These specifiers are intended to improve differential diagnosis by emphasizing that
individuals with these two disorders may present with a range of insight into their disorder-related be
-
liefs, including absent insight/delusional symptoms. This change also emphasizes that the presence of
absent insight/delusional beliefs warrants a diagnosis of the relevant obsessive-compulsive or related
disorder, rather than a schizophrenia spectrum and other psychotic disorder. The “tic-related” specifier
for obsessive-compulsive disorder reflects a growing literature on the diagnostic validity and clinical
utility of identifying individuals with a current or past comorbid tic disorder, because this comorbidity
may have important clinical implications"

Thanx Clarity, that was the stuff I was looking for.