"Avoidant Behaviour" -- How do I convince my psych

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that he is mistaken?

I've been seeing a psychiatrist for a while now. I was referred for depression (for help with depression, not because my doctor thought that a bit of depression was just the thing I needed) and a possible AS diagnosis.

The psychiatrist picked up pretty much right away on the fact that I have incredible amounts of anxiety. This is fine, but what is not fine is that he is blaming everything on anxiety and "avoidant behaviour" due to the anxiety. Social problems? Just anxiety. it doesn't matter how many times I tell him that I don't fear social situations, he won't listen. Not knowing how to socialise? Obviously that's because I avoided social situations so much that my inbuilt social skills disappeared. No interest in socialising? Well, of course that's fear. Everyone knows there's no difference between uninterest and anxiety. Body language looks like a foreign language?
...let's just ignore that; it doesn't fit in with the "just anxiety" theory.
Sensory problems? Those are caused by anxiety too. They happen in situations that would cause me no anxiety if they weren't physically painful; and also, I'm familiar with the sensory problems that anxiety can cause, I get that very rarely and it's quite different from my usual sensory problems. But no, it's just anxiety. My brain is not miswired at all.
Lack of organisation/inability to get started on things/(insert other signs of executive dysfunction here)? That's because I'm so scared of failure that I refuse to start anything.
Routines that hurt to try to break out of? A near-inability to do things differently even when I know that how I'm doing things is in no way beneficial to me? Anxiety. Fear of change. (Yes; that time at university when my clarinet lesson time was changed so that I had to go home early and it bothered me? Fear of change; because seeing one's music teacher at a different time is just terrifying.)
Getting so absorbed in interests that I forget to do other things (I failed a semester at uni partly due to this (and severe depression); I got fixated on the computer and couldn't leave to do assignments); including, occasionally, things like eating? Getting "stuck" for hours playing the same repetitive game over and over (which, even though I enjoy each game, has part of me screaming in frustration that I can't do anything but the game)? Well, it's not quite clear how that's anxiety, but it's anxiety.

How can I get my psychiatrist to stop dismissing my problems as being only caused by anxiety and due to "avoidant behaviour"? I only avoid things when they become too painful/exhausting/overwhelming to handle. I struggle every minute of every day against my brain, and it hurts to have that struggle dismissed by being told, essentially, "you're just afraid".

Oh, that. You need a new psych. They're quite like horses, and need to be broken first. Lab Pet IS the Therapist Slayer after all - earned the distinction.

Just get a new one since it's not as if you're attached to that one - they're quite disposable.

Quote from some movie, related if one substitues 'psychiatrist' for 'men.' "I like my men like kleenex. Soft, strong, and disposable."

Precisely. Shopping list: NEW psych. Just say, "It's just working out between us darling....." or something to that effect. No need to convince the guy he's wrong since coginitive dissonance means just that. I am not dismissing your dilemma, but merely pointing out the obvious.

Hope you find a better one and with probability you might (after you run out places to hide the bodies.....) < kidding!

Quote from Jeffrey Dahmer (NOT an Aspie, but still funny): "The court appointed psychiatrist is not your friend."

You pay this guy money for that ?

Seems like "Experts" are the core problem.

had the same problem once. get a new one.

I pay him money because he's very good with depression and anxiety. *EDIT* (Actually, I pay him nothing at the moment besides what I owe him from before Medicare started paying all his fees for treating me.)

I just discovered that I have twice as much money in my savings account as I thought I did; it might actually be possible for me to afford to see an ASD specialist to get diagnosed.

Attwood's is quite good for assessment (plus, it doesn't cost much), but I've found them lacking in actual treatment; they try CBT for secondary anxiety that's induced by primary symptoms of an ASD, which doesn't work at all. The psycho I saw there after the initial assessment individual (a different psycho altogether), refused to acknowledge the fact that my anxiety wasn't from a primary source, like sensory overload or being overwhelmed in general due to basic life being so damn hard, and she somehow thought that it'd get better the more and more I did (ah, no, it made me worst actually).

I'd safely recommend Minds & Hearts at West End for an initial assessment [as they know what an ASD "looks" like], but beyond that, they're shooting blindly like everyone else.

Does this person actually have any business giving clinical opinions about AS?

I would think that this is a very backwards relationship. Surely it is the professional's job to convince you that their diagnosis is correct, not the other way around.

Have you asked this person, if they concede that AS exists? If so, what would be the material differences between someone who is experiencing your symptoms due to AS and someone experiencing them due to anxiety?

Too many health workers think they know what AS is, but really are simply manifesting the amateur-error of grossly over-estimating their skill/competency/knowledge (in other words they do not even know enough to realistically evaluate how much they know). This is inexcusable as they have an ethical duty (and in many instances a legal duty) to not practice outside their field of competency and to not discriminate against our human rights by harming us as a result of basing their clinical decision making on subjective stereotypes about "people like us".

I understand that you want to get an aspergers diagnosis and from the sounds of it you should probably have one, perhaps you could find a better psychiatrist... But your psychiatrist is right however when he says your behaviours are caused by anxiety and avoiding anxiety. The truth of the matter is, you can't treat autism, autism is a part of who you are. Even if you did find a psychiatrist who diagnosed you with aspergers, he's still going to come straight back to your anxiety.


Your psychiatrist cannot do anything about your sensory problems, he can't give you any techniques or drugs that will help with them, the only thing that works is avoidance and he's not going to suggest that. It looks like he's trying to use the placebo effect on you, if you believe you don't have a sensory problem, then you'll experience less pain.


Yet again, he can't do anything about the root cause of your organisational abilities. And subconciously, someone who has poor organisation will avoid organising, not because of fear, but because of a learned response.

It seems to me that you would like the label of being autistic, i'm not suggesting this in any negative way. For many people, having their suspicions confirmed and having a reason for how they act makes things a lot easier to deal with, if this is important ot you find another psychiatrist. It seems to me however that the pyschiatrist is making the right observations but making the wrong conclusions about the observations. He doesn't sound like a bad psychiatrist and his solutions to your problems will more than likely be similar to any other psychiatrist.

If someone has AS, a psychiatrist telling them that their symptoms are avoidance caused by anxiety is not right at all. This is a clinical encounter, the psychiatrist is offering clinical opinions, and making clinical diagnoses. So the psychiatrist is not talking about any old anxiety or avoidance, but clinical anxiety and clinical avoidance. This is an important difference.

A person late for an important job interview could feel very anxious without experiencing clinical anxiety. A person who chooses to avoid putting their hand on a hot element, is not engaging in clinical avoidance, a person who steps aside to avoid being hit by a projectile is exercising avoidance, but not clinical avoidance.


For people who have epilepsy, that is part of who they are. It does not follow that there cannot be therapeutic services for people with epilepsy. Whether or not AS can be treated, people with AS can need psychiatric services just like anyone without AS might. We are as entitled to have appropriate services that meet our needs and uphold our dignity as anyone else, and unnecessary diagnosis with psychiatric conditions and illnesses does not uphold someone's dignity at all. We no more deserve to have our disability diagnosed and treated like a psychiatric illness than do short-sighted people, or amputees, or non-hearing persons.

If someone has AS, and wish to be appropriately assessed for clinical anxiety, then they need someone who can competently differentiate between clinical anxiety and circumstantial anxiety in someone with AS. Obviously the assessor will need to know that the person has AS, so it is not as simple as you describe it.

Very significantly, ASDs increase the risk of adverse reactions to some medications and this is something both the prescribing physician and the patient need to take into account when making decisions about these medications; since some of the risk includes increased risk of fatality, this is not a merely academic issue.

Which is a problem in the event that avoiding a particular thing is the best course of action for a particular patient.

I hope this is not an attempt to employ the placebo effect. In the first instance, the placebo effect would not be predicted to work in the circumstances described. It would also be unethical in the circumstances, not least because it is might be dangerous.

It might be a learned response, but if it is not clinical avoidance, then it should not be described or treated as such.


If that is the case, then this is not a minor failing.


If this person has an appropriate body of experience working with people with ASDs, engages actively with other practitioners specializing in ASDs, and keeps up to date on literature, research and emerging theories within the field, then perhaps they are not a bad psychiatrist.

Um, no, he is not. The only reason I avoid things is if they don't interest me, if they become too physically painful to handle, or if the mental effort involved in doing them is like giving a lecture on rocket science while performing brain surgery. If I don't avoid things like that, I end up getting sick. Avoiding such things is not an unhealthy response.
Coming back to my anxiety is fine; but refusing to acknowledge that there are actual causes behind it (which would make most people anxious if they had to experience them) and that it's not just anxiety for no reason; that makes it worse. It's like telling someone who's just lost a child that their grief is a pathological response.
If I know that I'm anxious about something for no good reason, I don't avoid it. Quite the opposite: I go and do it to prove to myself that it isn't dangerous.


Your psychiatrist cannot do anything about your sensory problems, he can't give you any techniques or drugs that will help with them, the only thing that works is avoidance and he's not going to suggest that. It looks like he's trying to use the placebo effect on you, if you believe you don't have a sensory problem, then you'll experience less pain.[/quote]

I know he can't. There are other things that work besides avoidance: as an example, I use noise-cancelling headphones when my environment gets too loud. They help. I've tried thinking that I didn't have a sensory problem. I ended up exposing myself to more sensory input than I could handle, and I was awful pain later. If I don't experience painful situations as painful, the pain hits me 10x harder later.


Yet again, he can't do anything about the root cause of your organisational abilities. And subconciously, someone who has poor organisation will avoid organising, not because of fear, but because of a learned response. [/quote]

How are my constant attempts (and failures) to get organised compatible with "subconsciously avoiding organisation"?
It would be nice if my psychiatrist would actually make useful suggestions to help with this, instead of "make lists" and "try harder". I made a thread once about how to overcome executive dysfunction, (http://www.wrongplanet.net/postt92574.html) and the responses in the 2 days that the thread got replies for were a lot more helpful than anything my psychiatrist has said on that topic in the years I've seen him for.


I would like the label of Asperger's Disorder, not of autism. I don't meet the criteria for autism. (Sorry for probably having taken you over-literally; I just wanted to be clear.)I want it officially acknowledged that my problems are not due to fear, lack of confidence, laziness, or stupidity. I also want it acknowledged that my problems are genuinely problematic, and that I'm not just exaggarating things as an excuse for not being good at the things I'm not good at.
I am planning to find another psychiatrist. These things take planning and money. Right now I have pretty much enough money, but I'm too overwhelmed for the planning part.
He's making some of right observations, and a lot of wrong conclusions.
He is a good psychiatrist for depression and anxiety, which is his area of specialisation. I don't think he knows enough about ASDs to be good with them.

Pandd: Thanks for your response; especially for spelling out the difference between rational avoidance and clinical avoidance.

Hey, thanks for replying, your reply puts many of your original statements into perspective. I wasn't trying to belittle your troubles, or even trying to suggest you're lazy or stupid. Actually when i read your post i was thinking that your *autism* is more than likely causing your problems. However people with personality disorders usually lack insight, anxiety and fear can be very irrational and subconcious, some people can even forget how to socialise because they are affected by mind-fog or excessive anxiety. I guess the point i was trying to make (and i was mostly influenced by the numberous posts suggesting the guy is an idiot), is that what the guy is saying makes rational sense, personality disorders and autism are not mutually exclusive. Personally i don't think he's right, but for me as an observer or anyone else to completely dismiss him, doesn't seem productive. The only person here who could answer the question you asked is yourself, and you've answered it in your reply. I personally don't think there is a way to change a psychiatrists mind, the main questions are always "How can this guy help me" and "How much can this guy help me".


* I generally use the term to apply to the whole spectrum, although i tend to interchange all the different names a lot.

I know you weren't trying to belittle my troubles, and I didn't read your reply as trying to do that.
Regarding insight: my psychiatrist has remarked on more than one occasion that I have a lot of insight. I don't lack insight. I make a point of challenging my own thinking so that unhelpful thought patterns don't stop me from functioning as well as I should.
I know that people can forget how to socialise because of anxiety, but if that's the case for me, then it happened before I was 4 (I can't remember anything before then), because as far as I know, I've never known how to socialise, and I've always lacked social intuition: everything I've learned about how to deal with people has been a slow, painful, one-tiny-rule-at-a-time process.
I'm not denying that personality disorders can coexist with ASDs. However, I know that "avoidant behaviour" is most likely to imply AvPD, which I do not have. I have a lot of the behaviours, but its diagnostic criteria also include reasons for the behaviours. These reasons do not apply to me.

Who_am_I: I think you can find a different MD. You're very introspective (AS trait, by the way) and may be more aware than your doctor - I can imagine this would be frustrating. So many psychs are oblivious as to ASD and truly do not know, then they guess and that doesn't work.

I don't know...maybe you could locate a diagnostician who specializes in ASD? May be worth the investment. Good luck.

This shrink seems to have some confusion about causes and effects. I agree with Danielismyname about seeing Atwood or someone on his staff since his clinic is close to you. Aside from a dx I don't believe there is much that a shrink can do for AS/Autie people. I have been considering talking to the shrink that I got my dx from to clarfy a couple of minor things. I can afford a couple of sessions but I don't think I give a s**t right now.