[Shadix]

I have seen several therapists over the years, but none of them were psychiatrists and we seemed to be getting nowhere. My issue is self-esteem problems and I am concerned that there may be a personality disorder or an autism spectrum disorder at play. Right now I finally got health insurance with my new job, and I have decided to switch to a new therapist and asked my old one for referrals. She referred me to one who is a psychiatrist and from what I read about her it seems like she might be a good fit. However, I have recently read that when insurance pays for counseling, the therapist needs to give you a diagnosis in order for her to get paid, and that this diagnosis will stick with you and might impact your life in some situations. I am kind of afraid that the therapist will feel compelled to give me a diagnosis for the sake of the insurance even though it is not necessary or beneficial. She said that she would at first make the diagnosis for "adjustment problems" or something like that and then go from there.

Would getting a diagnosis on my record cause more problems than it would be worth? Or is it not that big of a deal?

[ThisWayOut]

Hmm. Good question. I have not had much of an impact by having diagnoses, but I don't know if it might in the future. I guess it depends on what you are afraid it may impact. It's protected healthinformation in the us, so potentially it will effect bg checks for owning weapons, or perhaps a job that requires security clearance, but I'm not sure what else. It falls under the same protections other health info falls under. The only other thing it may impact would be Insurance costs maybe?
Others may have other info, but these are all the impacts I can think of off the top of my head.

It can cause problems and did for me. I don't know of any way around it if you need insurance to pay for your therapy though. Not everyone can self pay.

[Shadix]

Can anyone specify what problems it causes in particular? And is it that pretty much ANY diagnosis, like social anxiety for example, causes problems, or are we only talking about more serious problems?

I cannot self pay, it would be $140 per session. The insurance would cover like 40%.

It's important, but I wouldn't worry too much. I believe many (most?), but not all, will only use an axis 1 diagnosis except under certain circumstances. This varies by practitioner slightly, and its more common in some countries than others.

You could always ask her about her diagnosis documentation procedures and your concerns about it being in your record.

Those who have personality disorders tend to have multiple, co-occurring axis I disorders, so they'll use GAD, dysthymia, adjustment disorder, MDD etc., without ever using a PD code.

To add to what others said, PD dx can affect ability to join the military, how other providers will treat you, child custody, and even the quality of you're non-mental healthcare. Axis I can affect you in these ways too, but to a much lesser degree. And just because they can affect you, doesn't mean they will.

Better to directly ask. She should be well aware of the implications of recording a PD DX.

Keep in mind the adjustment dx is limited, often used till a Dr. gets to understanding your core issues. Its just a temporary diagnosis.

I've never had any problems resulting from my diagnoses on record. As far as I am aware, no one has ever accessed that information except the people I already knew had access to that information. I've had diagnoses on file since 1983 I think, and so far so good, and I've been hospitalized multiple times. I would not be able to afford me care without using insurance, so it is what it is.

[Shadix]

Originally Posted by mian síoraí

To add to what others said, PD dx can affect ability to join the military, how other providers will treat you, child custody, and even the quality of you're non-mental healthcare. Axis I can affect you in these ways too, but to a much lesser degree. And just because they can affect you, doesn't mean they will.

Better to directly ask. She should be well aware of the implications of recording a PD DX.

Keep in mind the adjustment dx is limited, often used till a Dr. gets to understanding your core issues. Its just a temporary diagnosis.

Thanks for the info. However, does this depend on the specific PD? For example, if you are diagnosed with psychopathy or schizophrenia I imagine that will probably effect things like child custody, but what if it is something like avoidant personality disorder or mild aspergers? Would those have the same effects?

[divine1966]

Good question.

My insurance is same wAy you have to have a diagnosis. But my t says that it doesn't have to be anything severe. Could be anxiety etc i exhibit many signs of mild disturbances (mild depression mild anxiety mild manias mild ocd mild concentration problem etc ) none serious, my current diagnosis is Adjustment Disorder which fits well and is good enough for therapy to be covered

There was time in my life I saw therapist but paid out of my pocket as she couldn't diagnose me with anything. I guess I either hid it well or it got worse with age or old t sucked!

My t says there might be more but she is not sure she says other problems I have might be caused by AD and it fits well

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[Soccer mom]

My insurance has been paying for about 6 months but I didn't know a diagnosis was required for coverage. I think my EOBs say "medical visit" or something like that. Is there a way to find it without asking your T?

[divine1966]

Originally Posted by Soccer mom

My insurance has been paying for about 6 months but I didn't know a diagnosis was required for coverage. I think my EOBs say "medical visit" or something like that. Is there a way to find it without asking your T?

Call your insurance and ask

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[musinglizzy]

Yeah, I think the adjustment thing is pretty commonly used. That's what my T used for me also, because she had to have a diagnosis, and that's pretty broad. She did not offer that information though, I asked her.

I see it as a very reasonable question to ask a T....and had no issues bringing it up.

[Ididitmyway]

The Adjustment Disorder label ( I am sorry, I just don't consider psychiatric dx valid medical dx-s, I call them "labels") won't cause you any problems. It's a very general label that fits virtually every condition and that's why therapists and psychiatrists love giving it away left and right. It's a non-stigmatizing label that cause no problems to anyone and that gets covered by insurance. If there is really something on autistic spectrum going on, then making an Adjustment Disorder dx will be an ethical violation for a psychiatrist and an insurance fraud too. But, hey, when those ethical considerations ever stopped anyone given that the entire insurance system is fraudulent..especially when it comes to mental health coverage..

[ScarletPimpernel]

I don't think I understand how a diagnosis (just the term) can have any effect on your life. Insurances do need one if you want them to pay. A diagnosis might affect how you view yourself and progress. But affecting other aspects?

I have been given a ton of diagnoses over the past 19 years: bipolar, major depression, double depression, anxiety disorder NOS, GAD, agoraphobia, social anxiety, PTSD, BPD... I have even been told I have synptoms of OCD and C-PTSD. Every time I see a new doctor, they ask whay my diagnoses are. They never go check what the previous doctor documented. Many of them choose to just do an assessment themselves. My diagnoses have never crossed over into any other aspects of my life: school, work, volunteering at the hospital... No one ever knew.

The only time that my diagnosis could have affected my life was when I started seeing my Pdoc, primary, dentist, and OB/GYN at the same clinic. My Pdoc wrote BPD as one of my disorders. Well, since all those doctors have access to my files through the computer, they would all see that I have BPD. So I asked her to remove it. Once I explained why, she removed it. But she said when she bills my insurance, she has to include it (which is fine and understandable). But could you imagine: your dentist finding out you have BPD and judging you for it....?

You can control the level of confidentiality. Some things like legal aspects and insurance requirements you can't control. But the doctors need your written consent if they're going to share any information about you to anyone else, even other professionals. If you give absolutely no consent, they're not even allowed to confirm that you're a patient of theirs.

[Seeking_Peace]

Originally Posted by puzzle_bug1987

Just because you haven't been affected doesn't mean that no one has. And you can't always control the level of confidentiality. And sometimes doctors and therapists are very unethical about this information.

^ This is why I pay out-of-pocket and don't get my insurance involved at all. I would never want my OB or any other doctor finding out, even by mistake, that I have a "mental disorder". Most people, even medical professionals, tend to judge if they find out that you are in therapy.

For me the only way to guarantee that NO ONE will find out that I'm even seeing a therapy is to pay cash. There is no paper trail of any kind. And my husband is the only person who knows that I see a T.

Re: Diagnosis. My insurance also requires a DSM diagnosis for mental health treatment. And yes, while a diagnosis for some sort of mild adjustment disorder may not be a big deal.....going into T, there is no way to guarantee that you won't get slapped with something more serious. And once it's part of insurance/medical records, its there to stay.

[Lauliza]

Insurance requires a diagnosis in order to pay contracted providers. "Adjustment Disorder" is the most generic term which just means you have a life event and are having difficulty coping. For longer term care many insurance companies will want more of a justification, since it's assumed that an adjustment disorder will eventually be resolved. My suggestion if you think you may have an autism spectrum dx and you want and need services long term, is to look up a center in your area that provides neuropsychological testing. ASDs often are misdiagnosed as personality disorders, particularly in women. As a primary dx, many providers avoid using personality disorders since insurance usually only pays for limited services. It depends on what you need, but if your focus is insurance coverage, your diagnosis is pretty significant.

Originally Posted by Seeking_Peace

^ This is why I pay out-of-pocket and don't get my insurance involved at all. I would never want my OB or any other doctor finding out, even by mistake, that I have a "mental disorder". Most people, even medical professionals, tend to judge if they find out that you are in therapy.

For me the only way to guarantee that NO ONE will find out that I'm even seeing a therapy is to pay cash. There is no paper trail of any kind. And my husband is the only person who knows that I see a T.

Re: Diagnosis. My insurance also requires a DSM diagnosis for mental health treatment. And yes, while a diagnosis for some sort of mild adjustment disorder may not be a big deal.....going into T, there is no way to guarantee that you won't get slapped with something more serious. And once it's part of insurance/medical records, its there to stay.

That's fine if your mental health issues are relatively mild to moderate, don't require medical treatment/meds/use of a pdoc, or hospitalization, but when a person is dealing with a major mental illness such as bipolar disorder, major depressive disorder, schizophrenia, etc., not involving insurance is pretty much impossible unless you are independently wealthy.

I have found my other health care practitioners to be very professional about my diagnoses, quite understanding, and honestly, they don't focus on it or treat me differently for it. Very fortunate that way.

[ScarletPimpernel]

Originally Posted by puzzle_bug1987

Just because you haven't been affected doesn't mean that no one has. And you can't always control the level of confidentiality. And sometimes doctors and therapists are very unethical about this information.

True. But I simply said that I don't understand. And like you stated, it's probably because I haven't been affected. Never said no one has been affected.

That being said, I have been judged before because of my diagnosis. One person, who verbally attacked me due to the possibility of having BPD, was priveed to my diagnoses. I just haven't had it where it has been "leaked" to people I don't want to know.

[Lauliza]

Originally Posted by Soccer mom

My insurance has been paying for about 6 months but I didn't know a diagnosis was required for coverage. I think my EOBs say "medical visit" or something like that. Is there a way to find it without asking your T?

Your insurance provider will have this on file. You do have to have a diagnosis but it is often simple like anxiety or depression. PDs are not often given as the primary diagnosis.

[Lauliza]

Originally Posted by Ididitmyway

The Adjustment Disorder label ( I am sorry, I just don't consider psychiatric dx valid medical dx-s, I call them "labels") won't cause you any problems. It's a very general label that fits virtually every condition and that's why therapists and psychiatrists love giving it away left and right. It's a non-stigmatizing label that cause no problems to anyone and that gets covered by insurance. If there is really something on autistic spectrum going on, then making an Adjustment Disorder dx will be an ethical violation for a psychiatrist and an insurance fraud too. But, hey, when those ethical considerations ever stopped anyone given that the entire insurance system is fraudulent..especially when it comes to mental health coverage..

Really the diagnoses or labels given by therapists are for insurance coverage purposes only- they don't carry much weight. Only a Psychologist at the doctorate level can diagnose a person with an autism spectrum disorder and they need to do a full neuropsych eval for that. So a T is not unethical for diagnosing someone with an adjustment disorder (or something else) even if they suspect an ASD. They should probably refer such clients for testing but that's about all they can do.

[ombrétwilight]

I was facing a similar problem with records a while ago. My Ts told me to see a psychiatrist but I am sure it was not because they needed the insurance, because my ex-T was paid by my old school and current T is paid by the state. Current T asked me to go to a public clinic to get a referral to any public hospital as it's cheaper this way, but she specifically said not to go to the psych hospital because of issues with a record. The GP at the public clinic however deemed me high-risk and sent me to the psych hospital's A&E because if not, the waiting list would be months. I was assured though that records were non-accessible by even doctors who will need a password.

I think if you need the insurance, a dx could be considered. Maybe call up your insurance and ask them if it will be on your records, or go to a private p-doc (if it works that way where you are) so it doesn't show up on the government's database. The GP also told me that out of the people who seek mental help, they get classified into "the sad, the mad and the bad". Only the mad and the bad who are a danger to others are at risk of being reported by their p-docs. If you get a dx of depression or anxiety etc. I don't think it will affect your future employment prospects that badly as plenty of folks are diagnosed with those.

[justdesserts]

Some diagnosis codes can make it more expensive to get life insurance.

[Ididitmyway]

Originally Posted by Lauliza

Really the diagnoses or labels given by therapists are for insurance coverage purposes only- they don't carry much weight. Only a Psychologist at the doctorate level can diagnose a person with an autism spectrum disorder and they need to do a full neuropsych eval for that. So a T is not unethical for diagnosing someone with an adjustment disorder (or something else) even if they suspect an ASD. They should probably refer such clients for testing but that's about all they can do.

I beg to differ, but I don't want to stir a debate between two shrinks on this forum who will demonstrate their professional education in front of everyone, because such debate will involve discussing some fundamental moral flaws of our profession and our health care system. This type of discussion is way too political to be appropriate for the forum designed for emotional support.

[divine1966]

Therapist would not diagnose ASD. It has be done by a psychiatrist. Psychiatrist is a medical doctor. I teach special education and deal with dx all the time.

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[Lauliza]

Originally Posted by divine1966

Therapist would not diagnose ASD. It has be done by a psychiatrist. Psychiatrist is a medical doctor. I teach special education and deal with dx all the time.

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Yes this is all I meant. A therapist technically can diagnose someone with ASD I suppose but where I am they usually don't. This is mainly because it isn't enough to qualify someone for services provided in the education system or government disability benefits (at least in my state). Without supporting documentation, a dx like that from masters level T doesn't mean much.

So to go back to the original question, a psychiatrist is unlikely to give an autism spectrum diagnosis unless they've discussed it with you and if you both feel it will serve you some benefit- as with SSI or special education for example. You can (I think should) ask what they are diagnosing you with. If you feel strongly that there is something that you do not want on your medical records for some reason you should discuss it. Most doctors will work with you since the diagnosis is for their benefit only in that they can get paid. So on that end, depression and anxiety are sufficient and are pretty benign. Anything more complicated or serious should be discussed with you in depth.

it's your choice.