Difficult psychiatrist not accepting aspergers diagnosis

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I saw my psychiatrist on Friday of last week and gave him the report from my testing for aspergers and informed him of my diagnosis. I see him for my depression, but I felt it was important for him to know the reason for some of my "atypical" behaviours that he had previously attributed to a personality disorder. His response was "I don't know anything about aspergers and as far as this practice is concerned you have borderline personality disorder." I was not at all sure what to say to that because it seemed so unprofessional. I am looking into seeing a different psychiatrist, but the referral process may take 7 to 12 months to see a psychiatrist outside that practice.
I would like to go back to have a discussion with him now that I've had time to process what he said and how ridiculous it was. I feel it is very unprofessional for a doctor to ignore a diagnosis that was obtained after hours of psychometric testing and interviewing in favour of one that has had no testing, or even met diagnostic criteria. I am certain that I have acquired the diagnosis of borderline personality disorder by being a good self-advocate, which can be viewed as "being difficult" by psychiatrists who feel threatened when clients think for themselves. And, of course, I can be somewhat abrasive at times due to my obsession with correctness.
Anyhow, my question is, has anyone else had to deal with a "difficult" psychiatrist? I feel like I should give him the benefit of the doubt for now and give him the chance to explain what he meant before I make any kind of complaint about him. I know he will likely continue to be "difficult" and that even if I did make a complaint, it likely would not really make a difference. I just feel like I need to stand up for myself in order to feel like I've done what I can and to have a sense of closure with this situation. Also, I feel like this falls under some kind of "autistic rights" issue, and the activist side of me feels angered by the injustice.
Any advice regarding this situation would be appreciated.

I'm kind of going through the same thing. Oh, his psychologist he spends an hour a week with is wrong. I see him for 5 minutes and I can tell you that he does not have bipolar because when you're manic you can't sleep, and he sleeps so he isn't bipolar and your therapist is wrong. Lets not take into consideration that he is taking a med that knocks him out. WTF????


Go with your gut. Don't waste your time. This is too important. Find someone else. I find that most "professionals" don't know what the heck they are talking about.

Being in Canada, especially the city I live in, it is very difficult to get a psychiatrist at all. I could transfer easily enough to another psychiatrist at the same hospital, but since my current psychiatrist is the chief of psychiatry it is unlikely any of the psychiatrists working under him would disagree with him. I can get a referral to a psychiatrist through the family health team once I officially "fire" my current one, but that will take 7 to 12 months and then I may only receive a consultation. I have been unable to get a referral to a psychiatrist in Toronto, who may know more about ASDs, because I live in a different area. There are 150,000 people in the city I live in and only 7 psychiatrists (three of which are only part-time, and four of which work at the hospital) so it just makes it very difficult to find a new one.

XD oh yeah I've had my share of them. I was diagnosed with Aspergers at 17. I don't know what is up with this borderline stuff but it seems like if they can't figure out whats wrong with you they slap that diagnosis on you, thats how i feel anyway. I was diagnosed with traits of borderline personality disorder when i was 14. Despite all of the obvious signs that were out there I think doctors tend to ignore it in females or they are just uneducated. My doctor acknowledges me having Aspergers but I have never had a proper therapist that actually helps me deal with my everyday issues.

I agree with the previous posters; you should find another doctor. That he disagrees with your AS diagnosis doesn't trouble me; any doctor could do that, and sometimes when they do they're right. What is really worrying is that he isn't looking at the neuropsych report, isn't even considering getting in touch with the evaluator, and assumes that a Borderline diagnosis is the best one simply because it's what he knows more about.

I tend to think that the neuropsych evaluation is the correct one, because of how you describe it as thorough and systematic, as opposed to an evaluation done by someone who doesn't know much about AS which resulted in a Borderline diagnosis--a common misdiagnosis for adult AS females. (It's possible to have both, of course.)

There's the possibility that your current doctor is right and you do have Borderline Personality Disorder and not Asperger's. But, even if he were right, it would still not make him a good doctor. It would be a lucky guess made without taking relevant data into account. If he had looked at your neuropsych report and read up on ASDs in adults and compared the two carefully, and then said the AS diagnosis was wrong and you actually had BPD, I might trust his opinion. But not when he dismisses things like that. That's just not good practice. You can dismiss the more far-fetched possibilities unless you have good reason to consider them; and there comes a point at which enough data is enough and more will just confuse the issue--but this isn't the case. This guy just seems to be stuck on Borderline because it's what he knows.

You need to find a different doctor. It needn't be an AS specialist; just find someone who is either familiar with ASDs or willing to learn about them, and flexible enough to understand that ASDs present differently in adults and children.

I was also diagnosed with BPD initially, due to my problems with self-injury. I fit no other criteria to any great degree, and since the ASD diagnosis things have made a lot more sense and more than one professional has laughed at the idea that I am Borderline--because, knowing me, it's pretty ridiculous. I have the exact opposite problems that people with BPD have. My misdiagnosis did result in one benefit for me, though: I joined a BPD support group and met people who have BPD, and learned what their lives were like and how they saw the world. Without that, I think I might have begun to pick up the idea that BPD means "difficult, manipulative patient", and to look down on them for having BPD. But, having gotten to know them, I can't do that. They are no more mean or nice than anybody else; they are just more intense and extreme, and trying to hold on to their emotions long enough to find out who they are. I hate that the psychology profession looks down on them. Yes, it's a hard thing to recover from BPD, but if you went into counseling because you wanted super-easy magic cures, you should probably quit and start directing Hollywood movies, because in real life, recovering from an emotional/cognitive/personality thing like BPD is often a long, hard journey.

Psychology and psychiatry rely to a certain extent on intuitive findings for a diagnosis. A person may meet the criteria for more than one dx so they have to decide which disorder they believe the patient has. You could go to three different people and get three different dx's.

Also, borderlines often deny that they have it. Difficult patients are dx'd with it many times, but I believe that you should keep an open mind as to the possibility. He may have thought you were bringing up the AS dx as manipulative behavior, to have your treatment changed or your dx changed. If you explain that you were dx'd by a professional (I'm assuming that you were) and that you simply wanted him to keep that in mind while treating you, and not to stop your regular treatment but to only adjust it accordingly, he may be more receptive. If you dx'd yourself, even after hours of testing etc, I wouldn't expect a professional to accept that. Most, even regular doctors, will not accept your own dx of anything. They have to verify it for themselves, unless it's a chronic problem that you are familiar with and it's the same dr that you have seen for it before. I know that at times, with a new dr (psych or gp) when I ask for a script for my antidepressants (I give them the name of the meds and the dose) I am asked lots of questions about my depression and also have I tried this or that.

The most important thing in therapy is honesty, and you should tell the dr how you feel about what he said. Treatment is hindered if you harbor a grudge against him, and a grudge can interfere with trust, and trust is very important if therapy is to succeed.

If talking to him doesn't result in an outcome that you are both satisfied with, and you both may need to compromise on the outcome, then I'd suggest looking for another dr.

_________________
I'm giving it another shot. We will see.
My forum is still there and everyone is welcome to come join as well. There is a private women only subforum there if anyone is interested. Also, there is no CAPTCHA.

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My situation is milder. I can't agree with the psychs who evaluated me that they've given me a PDD-NOS diagnosis instead of the regular AS. It might seem to be a minor issue but I feel otherwise. I made my point, though, and explained in as few words as I could why I don't agree with them.

I think it's a good starting point to explain him why you don't agree with him and ask him why he thinks you have borderline, not AS. But, as you wrote, he should have accepted a professional opinion (aka a diagnosis) if it's well underpinned.

Would anything change with this doctor if he agreed with the AS diagnosis? His job is to treat your symptoms not the name of a diagnosis.

The psychiatrist won't acknowledge my depression as it's own diagnosis because he says I have borderline personality disorder. I was denied entry into a psychotherapy program because of the diagnosis of borderline. He has diagnosed me with borderline personality disorder based on my sporadic history of self harm and because I don't have any friends. I don't fit the criteria in any other way and my GP of 22 years as well as my case worker think that the borderline diagnosis is ridiculous. I prefer to be alone, obsess over safety and emergency preparedness, don't use any substances, I don't even have outward meltdowns that could be misinterpreted as explosive anger. I was diagnosed with aspergers as well as major depression and generalized anxiety disorder by a reputable neuropsychologist after a lot of testing and interview time. What annoys me so much is that he won't read the report, which explains all of the symptoms of aspergers that I display as well as my test scores that indicated a diagnosis of aspergers. This psychiatrist has seen me for a total of perhaps 3 hours over the past couple of years and has asked me very few questions and does not provide therapy. The neuropsychologist had me fill out a questionnaire and send it to her before our appointment and then spent 7 1/2 hours interviewing and testing me. We even ate lunch together. She looked at all of my previous diagnoses and mental health records before deciding on the aspergers diagnosis.
I just feel like he is being incredibly unprofessional, and really it's the principle of the thing. I do think I will likely be making a complaint about him to the college of physicians and surgeons by the time this is all over. I know he wouldn't be punished, but again it's the principle of the thing.

You should definitely make the complaint. This guy is ridiculous.

Why is it so easy to be diagnosed with borderline personality disorder? Diagnosis of ASD involves testing and interviews with self and parents, while diagnosis of borderline personality disorder seems to be totally effortless and devoid of formal procedures.

^^ A dx of borderline can sometimes mean "You are a difficult patient". Really. There are many people with BPD, but I've read in several different places that it's a dx that is sometimes given to difficult patients. It can be used in an almost punitive manner.

_________________
I'm giving it another shot. We will see.
My forum is still there and everyone is welcome to come join as well. There is a private women only subforum there if anyone is interested. Also, there is no CAPTCHA.

The link to the forum is http://www.rightplanet.proboards.com

I remember reading in several places that it's common for someone with AS to be misdiagnosed with BPD. Would your GP be comfortable of taking over your medications until you can get in to see a new psychiatrist?

Armed with the new information and letters from your GP and your case worker maybe you can get into the psychotherapy program. It would be worth a try. If you decide to go this route make sure your GP to emphasize your very long term relationship. People with true BPD often have histories of "doctor shopping."