Do you rank your disorders?

My therapists and the in-patient hospital I visited this summer appear to rank my disorders based on what will get them paid by my health insurance so that they can treat me. This is not a critique. I want to owe less money and to be treated for my mental health concerns.

Post-Traumatic Stress Disorder (PTSD) appears to be the most clinically accepted of my diagnoses that would require therapy four days per week (currently) and an in-patient stay of 20 days (this summer). Based on the fact that my health insurance keeps paying claims, they must accept this hierarchy. Therefore, PTSD is often the engine that pulls the other disorders along. 

Dissociative Identity Disorder (DID) is usually next on the list. This is interesting to me and noteworthy because the medical profession is not in agreement that this disorder exists, even though in some form or another it has been in the DSM since the 1960s, whereas PTSD wasn’t added to the DSM until 1980, relatively recent by diagnostic standards (arguments about how the USA’s participation in two World Wars and subsequent military engagements in Asia affected the exclusion/inclusion of PTSD in DSM are interesting and beyond the scope of this post). 

Something that startled me is how the in-patient facility coded DID on my paperwork, which I was shown multiple times during my 20-day stay: “Out of touch with reality.” 

If DID is in DSM-5, why does it need to be termed “out of touch with reality” and not its clinical name? I didn’t quibble while I was in-patient, and I won’t quibble now. I was and am definitely out of touch with reality from a mental health perspective. It’s just insider language that I would rather have not seen. 

I remember the first time I had to ask my therapists to document my case for the benefit of my disability insurers. One of my therapists handed me a thick envelope for me to deliver to my disability insurer, and she said, “There is a lot said in here that is industry-speak and insurance-speak that would upset you if you read it. Please do not read it. Forget the ‘please.’ Do not read it.”

So you know what I did?

I didn’t read it. I’m the kind of person who, when I used to listen to talk radio or watch television news, would turn the station as soon as I heard the warning, “The content to follow may disturb some listeners/viewers.” No thank you! My reality is disturbing enough without hearing more true horror stories. 

So maybe out of fear that I wouldn’t get the treatment I need, my mental health providers list DID second. 

Third on the list is always Obsessive-Compulsive Disorder (OCD). And herein lies the purpose of this post: OCD hasn’t been getting the priority it deserves in my mental health treatment goals and plans. Maybe seeing it third has led me to rank it third also. OCD is not less pervasive or influential in my mental-health struggles. And maybe by itself it would not justify four days per week of therapy (though there are in-patient and out-patient hospitals for OCD; namely, Rogers Behavioral Health). That said, my putting OCD symptoms on the back-burner has led to a wave of new problems that I am beginning to attribute to neglected OCD.

Before my DID diagnosis, I saw an OCD specialist, and I made progress on rituals (I can touch doorknobs now, even sometimes when I leave a public restroom; I wash my hands less often and for a shorter time; and I was generally more aware of my obsessive tendencies). Yet I’ve neglected this diagnosis during the past two years, maybe because it’s listed third–the caboose on my mental-health diagnostic train (I have a chronic, permanent physical disability, too–Selective IgA Deficiency–a permanently suppressed immune system; this also gets virtually no attention from me since my near-disappearance from society these past two years has dramatically reduced my exposure to infection). 

I am going to start giving OCD more attention. It’s not impacting me less because it is third on health insurance’s radar. In fact, my neglect of it has increased its influence on my mental health. 

While we are not our diagnoses–none of us–those of us with diagnosed disorders may be wise not to neglect aspects of our mental health that garner less attention from others. We have to check in with ourselves and make sure we are receiving the care we need to cope and heal.

I have struggled with eating, and my therapist’s question if my resurgent food concerns might be OCD symptoms is what sparked my attention. Initially, I shrugged off her suggestion and assumed my reduced eating was attributable to self-punishment. Now, I’m not so sure.

I’m not sure how I will incorporate more OCD treatment into my therapy–maybe using that available fifth day per week? Insurance is likely to allow it if the specialist I see lists OCD as the primary diagnosis of our work. A new train specifically for OCD? Toot toot!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s