Psychiatrist won't diagnose me because I have social anxiety

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Hi everyone, I'm new here. I'm a 40 year old woman (married, mum of 2) and my own mum & sister (also aspie) have both insisted that I am on the spectrum. I've done loads of research and I agree. I'm so happy and relieved because it explains so much about me! My psychologist (who I see for OCD / an eating disorder / anxiety / depression) also agrees, and so does my husband. My psychiatrist who medicates me for anxiety and depression doesn't agree. She said I CANNOT be on the spectrum because I have social anxiety and therefore CAN put myself in others' shoes (whereas people on the spectrum can't, according to her).

What do you think about that? I definitely have social anxiety, but I thought that was part and parcel of having ASD. She has dismissed my self-diagnosis out of hand.

Thanks, Lucy

I have a similar issue.
My therapist says, I have clear Asperger's Syndrome but my psychiatrist just says meh.
The way I sorted it out is, the psychitriast is focused on medications and conditions that can improve with right medications. He does not care much for neurodiversity as it is not really a disorder - I had a lenghty discussion about ADHD with him. He supports social model of neurodiverse difficulties.
Also, if the psychiatrist is not specialized on ASD in adults, they may not know what to look for in an adult female - this is relatively new knowledge, probably absent in general psychiatry course.

Based on the Diagnosic statistical manual, I think, they are not mutually exclusive


If you want get a different psychiatrist

Your psychologist is clueless. Social anxiety and depression are common comorbids of autism. OCD can co-occur with autism also. Constant social failures due to not understanding others and our own atypical nonverbal communication can cause social anxiety really bad.

Try and get a second opinion from a clinician who understands autism and particularly autism in women.

Psychiatrists treat mental illness, not autism. Autism is developmental and not a form of mental illness.

For a proper assessment you should see a Ph.D Psychologist or Neuropsychiatrist who specialises in adult autism.

I got a clip of Judge Judy on my phone to play just for occasions like this when I encounter a doctor like yours who says something stupid. The clip goes: "No no no no no, that's a lot of baloney that you just said to me". Your psychiatrist doesn't know what she is talking about, she is relying on a myth about autism and I would disregard anything further she says on the subject as ignorant and misinformed.

Search for a neuropsychiatrist or neuropsychologist that has experience assessing adults, specifically female adults on the autism spectrum. That is what I did. I searched on psychologytoday's website listings and phoned up each psychiatrist, one after another asking if they specialized in assessing adults on the autism spectrum, if not, if they knew someone who did. Eventually I came across an autism clinic in a neighboring city and paid out of pocket for an assessment which a neuropsychologist used to diagnose me. I used that diagnosis to participate in an autism research study and was assessed with the ADOS along with hours and hours of other assessments/activities, including 7 hours that my mom was interviewed total, and the neuropsychiatrist diagnosed me with ASD lvl 2.

I mean just prior to seeking an assessment I had a stupid psychiatrist just like yours who said "its just OCD, its just social anxiety, you can maintain some eye contact so its not autism" even though I got her to admit she isn't qualified to assess adults on the autism spectrum.

The absolute ignorance I keep seeing that Psychiatrists have about Autism is just astounding to me. Everything you Psychiatrist said is wrong. The idea that those of us on the spectrum don't have empathy (ability to put ourselves in another's shoes) is really outdated now. The more up to date information is that we may actually feel things more intensely - that includes empathy. The reason it seemed the other way actually may have more to do with the fact that we get overwhelmed by the emotions/feelings so we end up shutting down/melting down. Processing is more challenging but that doesn't mean it doens't exist.

OCD, anxiety, eating disorders, and depression are all common co-morbids of Autism. Anxiety, from what I've seen (nothing official) seems to run even more common with Aspergers than regular Autism. I myself have anxiety - primarily social and I have Aspergers. I wonder what your Psychiatrist would say to that? Besides that having social anxiety doesn't necessarily equate that you are able to put yourself in someone else's shoes. o_O

If your Psychologist will back you up, your psychiatrist technically doesn't need to. It's about your comfort level (unless you are going to need a consensus for something) with continuing to see that person who you know has dismissed something about you.

Regarding empathy, I can put myself in people's shoes too. I feel like I have an abundance of empathy, but I don't know how to label or express the feelings because of alexithymia. When I was tested for empathy in my ASD assessment I thought that I'd score off the charts as an empath, but I registered a clinically low EQ score (I think it was 14). I was shocked.

My point is: feeling like an empath, feeling empathetic emotions, or caring about and understanding others' feelings doesn't necessarily mean that a person will score "high empathy" using ASD assessment criteria.

Thank you so much. I feel vindicated. I will try and search for someone more qualified to assess me (although could be tricky in South Africa, I'm not sure). I am happy with a self diagnosis if all else fails. I have to work with my psychiatrist regularly and I feel like she's laughing at me, so maybe it's time for a new one?

These replies are so incredibly helpful to me. Thank you

Just to add my voice to the choir.

One: Putting yourself in other people's shoes, "Theory of Mind," empathy is not mutually exclusive with autism. What is known is that autistics develop Theory of Mind at a later age than NTs and are less adept at applying it. Not that they don't have it at all.

Two: Social anxiety just means you're uncomfortable in social situations not that you're applying a Theory of Mind to other people. Often this arises from having less information on what is happening in a social situation which is consistent with autism. I would say a very high percentage of autistics have social anxiety.

Three: You probably need to find another psychiatrist who understands autism.

Welcome to Wrong Planet. I think you are on the right track.

I would suggest you read a book titled "In An Unspoken Voice" by Peter A. Levine. I suspect it will be a great help to you. It will probably lead you down a different path.

Sounds like the OP needs a new psychiatrist.

That didn't stop me from getting a diagnosis. I told the Dr. up front about my anxiety and if anything it only further added to my getting the diagnosis.