Veterans Affairs Mental Health Clinic won't Diagnose Me

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Hello, I hope someone can assist me in figuring out what I should do. I have been in the mental health system since 2005. I have been diagnosed with the following: Cognitive Disorder NOS, Dysthymic Disorder, and ADHD in 2005; Bipolar Disorder in 2006; Chronic PTSD in 2010; Major Depressive Disorder w/ psychotic features in 2010; and finally Psychotic Disorder NOS in 2012. I brought up the possibility of ASD with my psychiatrist in March of this year. He scheduled me for a personality assessment in May (Coincidentally the DSM-V came out too, shady business on his part). I took the MMPI2 and they must have noticed I was overly literal in my interpretation and had trouble with context. Now I have the psychotic disorder nos removed and everyone is treating me too nice. I mean a noticeable degree of niceties that is actually annoying me. I do all these observational schedules for diagnosis and in the end I am diagnosed with ADHD, Anxiety disorder nos. I know it is more than that. I am now 32 years old, I haven't worked steady in 6 years and can't seem to get out of the house nowadays. I'm on a very tight budget and can't afford a neuropsychological evaluation. If someone could check out my original scores to see if I have a legitimate gripe and whether I should go for another evaluation outside the VA health system.

WAIS-III
Full scale IQ 113
Verbal 108
Performance 117

Subscale Scores
Verbal Subtest

Information 14
Vocabulary 15
Comprehension 11
Similarities 9
Arithmetic 11
Digit span 9
Letter-Number 10

Performance Subtest

Picture Completion 15
Block Design 9
Matrix Reasoning 12
Picture Arrangement 17
Digit Symbol 10
Symbol Search 10

INDEX SCORES
Verbal Comprehension 114
Perceptual Organization 111
Working Memory 99
Processing Speed 114

WIDE RANGE ACHIEVEMENT TEST - 3
Reading standard score 118
Spelling standard score 114
Arithmetic standard score 96

I believe I meet NLD by test score but I am very athletic. I also feel that ASD or subtype is appropriate. I know block design is very high usually for ASD but I have a developmental anomaly in the area of the brain that affects my spatial awareness and motor planning. My California verbal learning scores are garbage and I am impaired on the seashore rhythm test. My visual memory is in the superior range with a visual reproduction II SS of 15. My logical memory II is an 8. It seems I am not quite NLD and not quite ASD. I may be diagnosed as screwed. Any input is appreciated as I am getting desperate.

Thanks,
Brian

Let me get this straight ... are you concerned that you did not get the diagnosis that you were hoping for; or are you concerned that you may have reason to believe that these mental-health professionals may have given you the wrong diagnosis?

In the DSM-IV I met the criteria for a diagnosis on the Autism spectrum. My symptoms, Dr. confirmed today, cancel out symptom criteria needed for either NLD or Aspergers. I have the symptoms of both disorders, unique and overlapping weaknesses, but none of the strengths. The DSM-V criteria leaves me without diagnosis on the ASD. I have to maintain regular employment with symptoms of two disorders that are disabling by themselves. Without a diagnosis, I will have a rough time supporting my position for temporary unemployable status. My symptoms leave me in a no mans land. The severity of my condition, I feel, won't be fully appreciated now as far as on paper.

Visuospatial strengths would go further than visual perception for finding work. I could be an artist or musician except my fine motor deficits from the NLD accompanied by rhythm impairment from Aspergers leave me unable to do either very well.

Can you clarify something? Are you seeking an ASD diagnosis because you want to apply for disability benefits?

All right, one last try. Yesterday my psychologist told me I present clinically with the core deficits of BOTH NLD and Aspergers. Three months ago I would have had a diagnosis based on DSM-IV criteria. Since it is not three months ago and the DSM-V has replaced the DSM-IV's atypical autism, NLD, PDD-Nos diagnostic labels; I have nothing to put on paper that will protect me from being labelled as a lazy, malingering, money seeker. Right now, I am labeled as psychotic disordered but I am not psychotic.
I thought this site was for people struggling with the current system of medical care for Autistic spectrum people. I get the same inferences from the VA. It seems I am damned if I do and damned if I don't. A diagnostic label doesn't fix my 32 years of dealing with people. It fixes the look in peoples faces when you tell them it's hard to keep a job. It helps with paperwork you file for benefits you are entitled to for defending your country. People apparently kill themselves from the crap life you lead with NLD, I completely get that.

I think the main issue is that the diagnosis he has now (ADHD) is not sufficient to get necessary services.

Have you had a talk with them, outlining your everyday problems, and explained that whatever is holding you back probably requires some kind of assistance?

I don't know if you have autism or whether it's some other thing, but if you need help and you're not getting it, then that's really the important factor; a diagnosis isn't a magic ticket to getting help (ask any of us who have the diagnosis and are still falling through the cracks).

Make your point something along these lines: "Look, I'm unemployed, I'm struggling, no matter how I try I can't get back on track. I need help so that I can get a job and solve these problems I'm facing. I want to get into vocational rehabilitation services, or occupational therapy, or whatever might help."

If you can make that point without having a diagnosis, without ever answering the question of whether you have an ASD or not, then the uncertainty may not be so much of a problem anymore. It's entirely possible to have ASD traits without being diagnosable, and to have a disability related to ADHD and an anxiety disorder, so... they could be right. But the real problem is that you're not getting the services you need, and if you can solve that you'll be doing good.

Have you specifically been told by your psychologist, which traits (or lack thereof) have made the difference between you being eligible for an Asperger's diagnosis with the DSM4 but not the DSM5?

Yeah, I played team sports and am sociable when it is necessary. The label isn't important to me so much as the end of my search. I am not ADHD either, I can focus for hours. I read both "Driven from Distraction" and "Driven to Distraction" back-to-back in one sitting. I have the ADHD profile except I can hyperfocus when interested. I was also given the Cognitive disorder nos diagnosis after the neuropsych testing. I don't fit any one profile and criteria is not met for DSM purposes. I have been navigating military mental health care for 8 years. The difficulties in daily functioning haven't changed. I just have to contend with the adjudicators that go over the paperwork who only read diagnostic labels from doctors. ADHD and anxiety disorder on paper don't sound so debilitating, the screening process is where I slip through.

Have you read the DSM5 diagnostic criteria yourself or just taken on board what your psychologist said? Psychologists make mistakes like anyone else.

There is nothing (to my knowledge) about being unable to play team sports or saying you can never socialise in the DSM (they strike me as ridiculous reasons and non-clinical). In fact some subtypes of AS approach others to socialise but have an awkward interaction and some Aspies are extroverts.

http://www.dsm5.org/Documents/Autism%20 ... 0Sheet.pdf

I would challenge your psychologist and ask for a detailed explanation in writing and ask them to also explain why they did not diagnose you before the DSM5 came out and why they are not diagnosing you now.

"Cognitive disorder NOS"... Hmm. That might be your ticket. It is such a vague diagnosis that they will pretty much have to ask what it means for you.

DSM definition:
So they already know that you think in an atypical way. I think it is probably something they diagnose in people after they get meningitis and have problems thinking after that, but this is better than nothing... it implies that you have some deficits that'll show up on neuropsych testing. I don't know if you have some history that could have caused brain damage--a concussion? Illness?--but this diagnosis is "NOS" and that pretty much means "miscellaneous".

It might just be enough for you to get some help. Can you go to the doctor who diagnosed this and get them to write you a note that says, "Yeah, this person could use some voc rehab/OT/whatever"? Or at least, an evaluation to figure out what kind of help you might be able to use.

Ahh ... now it's obvious! Sometimes I can be so dense ...

The VA in West Los Angeles is trying to "clean up its act" with regard to non-physical disorders. If the OP can't get there, then maybe a county health service would be more helpful.