Misdiagnosis or Missed Diagnosis: Nasty Business (Part 1)

She sat in front of me once again. Well, last time she actually laid in front of me because she’d been transported to the E.R. by EMS. This time around her mother brought her to Intake.

But the thread that wove itself through both encounters was a session with her counselor just hours prior. Two months ago her counselor was so taken aback by what she’d said she sneaked away and summoned EMS. This time around she recommended she be taken immediately for a psychiatric evaluation, her mother reluctantly agreeing.

My friend is a 17-year-old young lady with a history of mood and anxiety issues. Given I’ve not spent more than four hours total with her it’d be difficult to assign diagnoses; however, my gut tells me she’s enduring a recurrent major depressive disorder, as well as generalized anxiety disorder. Nice, kid – and I’ve enjoyed working with her, and her mother.

Okay, so what did her counselor hear that had her push her own panic button?

It seems as the session began, and her counselor asked what had been going-on over the past week, “Jessica” chimed right in with two issues of note. She first reported a self-injury episode, which had occurred the day before. I, indeed, saw the four or five one-inch superficial lacerations on the inside of her left arm.

She then went on to say she’d been having thoughts of killing people, and the mode of action would involve fire or explosives. Well, that was all her counselor needed to hear. And it was a similar statement that led to her EMS transport to the E.R. two months ago.

The fact of the matter is, she’s had similar thoughts over the past three years. Incidentally, Jessica has never made an attempt on her life, or anyone else’s.

And to upset the apple cart all the more, Jessica reported the same symptomatology to a counselor at her therapeutic day school. In response, the counselor phoned her mother reporting another round of “psychotic” statements.

I could see Jessica’s entire presentation calm as she observed I wasn’t at all alarmed by her report. Nor was I alarmed the last time I saw her and didn’t advocate for a psychiatric admission.

It was my perception and belief Jessica was experiencing intrusive thoughts, just as she likely has over the past three years. And with that in mind, and the fact that her overall functioning had been very good, I had no reason to be alarmed or push for an admission. Furthermore, her mother was not at all concerned about Jessica’s safety.

For the record, I endured intrusive thoughts rivaling Jessica’s some 30 years ago.

I understand how horrifying Jessica’s thoughts may have sounded; however, I have a major problem with her counselor’s inability to connect some dots and think outside of the box. Granted, the counselor works for a non-profit agency, and liability is always a consideration; but to subject Jessica and her mother to such drama and trauma borders on irresponsibility.

Misdiagnosis or missed diagnosis involved here? I sure think so. And it’s led to a perpetuation and exacerbation of Jessica’s symptoms – as well as a Wellbutrin, Risperdal, Prozac, and Trazodone regimen.

That ain’t right.

Stop by tomorrow and absorb Part 2 of the series. In the meantime, how ’bout some comments? What are your feelings and thoughts?