View Full Version : Misdiagnosis - Childhood trauma(PTSD) mistaken for ADHD?


Elanes
05-23-17, 06:00 PM
TL;DR - I put a few key questions in bold.

25 yr old male here - diagnosed with ADHD PI two years ago. Now, after having gone through stimulant treatment (Ritalin, Vyvanse) and Strattera (all having minor effects on ADHD-symptoms, while aggravating social anxiety and increasing irritability) – I suspect my diagnosis is wrong.

While I’m showing most signs of ADHD, and do realize that some ADD’ers don’t respond well to drug therapy – I started considering the possibility that I have PTSD.


You could say I had a “turbulent” childhood, with my father being a central reason for this. I would describe him as short-tempered, with a lack of empathy for others. Violent episodes were not uncommon in our home. He showed a lot of erratic and unpredictable behavior. E.g. our family could eat dinner, and he would suddenly smash plates into the ground in fury because he wasn’t pleased with how the dinner was made, or some other outrageous reason.

If I were to speculate – I’d say he has a form of dissocial personality disorder. I could go on about describing him, but you get the picture.

I went through most of my childhood being in a constant state of stress. “Walking on eggshells” to not cause any incidents at home. Honestly, I don’t know if I witnessed any direct violence to anyone in my family, or myself for that matter. I know my mother was victim of his violent behavior. My childhood is one big blur, so I can’t exclude the possibility that I experienced anything else.

What I associate with PTSD, are more substantial solo incidents – while in my case, I can’t recall any single episode which sticks out. Of course, it is possible that I, in my own mind, have normalized many of the incidents. Or even neglected them.

From what I’ve read about PTSD, I understand most people have so called “triggers” or reminders of the trauma, which amplifies their PTSD-symptoms. I do not have this. This makes me doubt that PTSD is applicable. However, I guess a trigger for me could possibly be my dad – who I haven’t seen for 10 years.

I don’t know if this is relevant at all, but I do have reoccurring dreams – which, as far as I know, doesn’t recap a specific traumatic incident. But I guess it reflects the general feeling of being defenseless against someone. I wouldn’t describe it as a nightmare, but it’s definitely an unpleasant dream. I usually don’t remember my dreams when I wake, but I think I’ve had this same dream several times a week for many years. During my research, I got the impression that people with PTSD “relive” their trauma in some way(?). And this is the only way I relive mine.


From what I describe, is it even possible that I have PTSD? I know I should discuss this with a qualified medical practitioner, and it’s impossible to say for sure from such a brief overview. I’m just wondering if anyone have any input.

Is it normal for people with ADHD to have little to no memory of their childhood?

How are one to differentiate between ADHD and PTSD? Are there any other methods of examining the issues except for visual and verbal testing? I’ve read about SPECT scans or MRI to separate PTSD and TBI (Traumatic Brain Injury) – is this possible to do for ADHD and PTSD? And is it even realistic to hope for such an examination?


I am just really tired of being a test subject for different kinds of medication – which in the end, only seems to worsen my situation and well-being. I don’t want to be the guy who keeps on stumbling his way through life. Always depressed, and seemingly unwilling to do something to improve the situation. I want to live a “normal” life. I want to feel connected to other people, but I don’t know how.

Don’t really know what I’m trying to achieve by writing all of this – I guess it's therapeutic for me in a sense, because on the spot (in front of a psychiatrist), I seem to be unable to put into words what my problems really are.

Excuse my English, it's not my first language. And thanks for reading:)

mildadhd
05-23-17, 07:41 PM
The adult should be aware of her emotional state when setting out to take medications for AD(H)D.

Not infrequently, the AD(H)D adult may be suffering from chronic low-grade depression or anxiety. If this is the case, the psychostimulants may not help, or in some cases may make matters worse. If depression or anxiety is present, it needs to be addressed first, or at least at the same time.

-Gabor Mate, "Scattered", Chapter: "What Medications Can And Cannot Do", p 314.

Elanes

Many people do not like to address the fact that anxiety and depression can exist before and possibly interrupt healthy development of self regulation in early life.

Temperament and circumstances/experiences being possible factors to consider.

I am not a doctor, but Dr. Gabor Mate is, and studying his work, and comparing my own experiences with his insights has helped me tremendously.

I was adopted and experienced obvious abnormal separation distresses early in life before I could explicitly remember.

I have studied how the brain works on my own, and can understand how early anxiety and depression can possibly interfere with healthy development of self regulation resulting in ADHD symptoms. ("When fear is near")

I would ask your doctor about treatment for implicit PTSD and ADHD. (There could be reasons why medication is not right for you and you do not need to take medication if you do not feel it is good for you)

(Gabor Mate has treatment recommendations with and without medication, if your interested in studying his work)

You may not have ADHD but it may be possible, you could have both, implicit PTSD and ADHD.

Side note: I had no problem reading your English.



m

mildadhd
05-23-17, 08:06 PM
Side note:

Understanding of implicit memories is becoming more and more mainstream but your doctor may not know what implicit memories are, and how they can influence development, if not, ask your doctor to research and refer you to a doctor that does.




m

Lunacie
05-23-17, 08:18 PM
Like Mild mentions, it's possible to have both ADHD and PTSD ... I do.

I took a Connor's evaluation after my grandkids were both diagnosed, and the
results were combined-type ADHD, PTSD, depression and generalized anxiety.

Like you, I can't pinpoint any incidents from my childhood that might have
caused PTSD, just an overall unrelenting anxiety.

Luckily I haven't had to do the merry-go-rounds of meds trials because just
about the time I was diagnosed I discovered Omega 3 supplements and they
are very effective at reducing my mental fog.

mildadhd
05-23-17, 08:34 PM
It is possible to have implicit PTSD and then ADHD

And like Lunacie mentions, it is possible to have ADHD and PTSD.


M

Elanes
05-24-17, 06:16 AM
If depression or anxiety is present, it needs to be addressed first, or at least at the same time.
I find this interesting because I was told by my psychiatrist that it was more important to address the ADHD first. His reasoning for this, was that in many cases the ADHD patients experienced what he called “imagined” or “false” social anxiety – because of inattentiveness in social situations, and feeling “different” in a way. Therefore, when treating the ADHD, the other conditions would be addressed as well. But I guess this logic could only be valid if the ADHD is implicit, which it might not be.


I would ask your doctor about treatment for implicit PTSD and ADHD.
Will do! Or at least consider it as a comorbid condition.


Gabor Mate has treatment recommendations with and without medication, if your interested in studying his work
Will look more into it, thanks for the tip😊


Understanding of implicit memories is becoming more and more mainstream
Are you referring to “implicit memories” as its own condition, or as a part of PTSD? As an uneducated individual, I would assume it was the same thing.


Like you, I can't pinpoint any incidents from my childhood that might have caused PTSD, just an overall unrelenting anxiety.
Thanks for sharing this – the fact that I don’t remember any major traumatic episodes, or get triggered by certain things in daily life, made me doubt it’s even possible that I have PTSD. But I guess like with all conditions, there are different degrees of having it. And symptoms vary from person to person.


I discovered Omega 3 supplements and they are very effective at reducing my mental fog.
I’ve read many times that people recommend this, so I guess I should try it. Are there any special type of omega-3 that is more recommended? I’m thinking ratio of EPA / DHA etc. EPA is supposed to be more beneficial for cognitive functions?


Thanks a lot for your replies guys, I truly appreciate it😊

sarahsweets
05-24-17, 06:37 AM
TL;DR - I put a few key questions in bold.

25 yr old male here - diagnosed with ADHD PI two years ago. Now, after having gone through stimulant treatment (Ritalin, Vyvanse) and Strattera (all having minor effects on ADHD-symptoms, while aggravating social anxiety and increasing irritability) – I suspect my diagnosis is wrong.

While I’m showing most signs of ADHD, and do realize that some ADD’ers don’t respond well to drug therapy – I started considering the possibility that I have PTSD.
We were told we are lazy, slow or dumb. Very often children with adhd that do have supportive parents, can make us prone to neglect. Neglect can interfere with our self esteem, bonding with care givers; causes shame and guilt. Especially if you have ignorant family, we do not get our needs met.
I think its possible to have both but IMO swapping one for the other is harder than you think.


You could say I had a “turbulent” childhood, with my father being a central reason for this. I would describe him as short-tempered, with a lack of empathy for others. Violent episodes were not uncommon in our home. He showed a lot of erratic and unpredictable behavior. E.g. our family could eat dinner, and he would suddenly smash plates into the ground in fury because he wasn’t pleased with how the dinner was made, or some other outrageous reason.
chaos, drama and combative family can make us afraid of what will happen next so we live in fear of what we cant control.

If I were to speculate – I’d say he has a form of dissocial personality disorder. I could go on about describing him, but you get the picture.

Or he could just be an as*hole but there is no disorder listed in the DSM for that. (;))

From what I’ve read about PTSD, I understand most people have so called “triggers” or reminders of the trauma, which amplifies their PTSD-symptoms. I do not have this. This makes me doubt that PTSD is applicable. However, I guess a trigger for me could possibly be my dad – who I haven’t seen for 10 years.

Or you are acustomed to living in that constant state of stress but havef devloped coping skills evem though you feel that you are not really coping.



[From what I describe, is it even possible that I have PTSD? I know I should discuss this with a qualified medical practitioner, and it’s impossible to say for sure from such a brief overview. I’m just wondering if anyone have any input.
I think its more likely that you are suffering with both.

.
Is it normal for people with ADHD to have little to no memory of their childhood?

I think its 100% possible to block out chunks of our childhood if we were traumatized.

How are one to differentiate between ADHD and PTSD? Are there any other methods of examining the issues except for visual and verbal testing? I’ve read about SPECT scans or MRI to separate PTSD and TBI (Traumatic Brain Injury) – is this possible to do for ADHD and PTSD? And is it even realistic to hope for such an examination?

There is promise when it comes to these test but as of now I am not so certaim they can be used to diagnose. I think it can help but I dont think the science is there to make it fool proof.


I am just really tired of being a test subject for different kinds of medication – which in the end, only seems to worsen my situation and well-being. I don’t want to be the guy who keeps on stumbling his way through life. Always depressed, and seemingly unwilling to do something to improve the situation. I want to live a “normal” life. I want to feel connected to other people, but I don’t know how.

Medication is trial and error but despite having tried many types of meds, its much more realistic to try different doses of the same meds you have tried.

Lunacie
05-24-17, 12:45 PM
I’ve read many times that people recommend this, so I guess I should try it. Are there any special type of omega-3 that is more recommended? I’m thinking ratio of EPA / DHA etc. EPA is supposed to be more beneficial for cognitive functions?


Thanks a lot for your replies guys, I truly appreciate it😊

There are all sorts of claims made for different brands of fish oil or krill oil.
Honestly, I've simply used whatever was on sale and haven't noticed any real
difference between them.

mildadhd
05-24-17, 02:07 PM
Hi Elanes,

I appreciate the discussion.

(Side Note) ADHD can also be described as deficits of self regulation (they are both the same thing).

Our common genetic emotional systems that modulate our instinctual emotional behaviours originate in our lower subcortical brain systems.

Brain systems that self regulate our lower instinctual emotional behaviours and secondary associated feelings' originate higher in the brain.

Emotional brain systems in the lower subcortex are more developed (mature) in the first few years of life, than our higher brain systems.

(In other words, our higher self regulating brain systems' mature and develop after our lower emotional modulating brain systems')

Brain systems involved in learning and implicit and explicit memories are located in the limbic system between lower deeply subcortical and higher cortical brain systems.

The critical period of implicit development (the most environmentally influenced period of brain development) occurs before birth and the age of 4*.

The critical period of explicit development (the most environmentally influenced period of explicit development) that is built upon the earlier critical period of implicit development, occurs between the age of 4 and 21*.

Implicit memories learned during the early critical implicit stage of development before the critical explicit stage of development fully matures, will not be explicitly remembered, simply because the brain systems involved in explicit development are not fully mature (on line) yet.

Positive emotional experiences through out life strengthen the development of lower positive modulating emotional systems and strengthen and promote the development of higher self regulating brain systems.

Negative emotional experiences strengthen the development of negative modulating emotional systems that originate in the lower subcortical brain areas.

The brains positive (good feeling) and negative (bad feeling) modulating emotional systems originating in the lower subcortex are genetic/instinctual and evolved to promote survival.

The most abundant growth and environmentally influential period of brain development occurs before the age of 4-7, and the rate of environmental influence declines, with age.

ADHD is both implicit and explicit.

The more severe cases are more implicit than explicit.

A healthy balance of positive and negative emotional experiences promote healthy brain development throughout life.

A unhealthy unbalance of positive and/or negative emotional experiences promote unhealthy brain development.


ADHD can be a commoribity of unhealthy unbalanced of emotionally distressful experiences (like anxiety, depression, PTSD, separation anxiety, etc) early in life.

(Like AD(H)D can be a commorbidity of autism, etc)

And after the development does not occur associated with ADHD, the 3 most common commoribities due to unhealthy emotional experiences living with ADHD throughout life, are anxiety, depression and addiction. (Which are the types of commorbidities I think your psychiatrist may be referring to after the person gets ADHD)

There is also other important factors involved to consider like individual inherited more sensitive temperament many people who get ADHD are born with and the normal early decline in the rapid rate of early development after about the age of 1-4*.

(The mammalian genetic unconditioned instinctual emotional response systems originating deeply subcortical in the brain are the dopaminergic SEEKING system, RAGE system, FEAR system, LUST system, CARE system, GRIEF system and PLAY system)


* (give or take)


m

mildadhd
05-24-17, 04:02 PM
The most abundant growth and environmentally influential period of brain development occurs before the age of 4-7, and the rate of environmental influence declines, with age.



Addition:

While the rate of development and environmental influences on brain development decline with age, the brain plasticity remains throughout life.


There are all sorts of claims made for different brands of fish oil or krill oil.
Honestly, I've simply used whatever was on sale and haven't noticed any real
difference between them.

Like Lunacie, I find omega 3 fatty acids also helps, but be sure to take as directed/recommended.

Both, SB_UK and my doctor warned me that taking to much omega 3 fatty acids can have negative effects.


m

someothertime
05-25-17, 02:28 AM
You have good insight, key to getting treatment.

Mindfulness around anxiety / triggers will aid further.

More focus on symtomatology ( treatments that are effective ) will help more in the begining..... at least in regard to your own effort.....

Seeing your wellbeing on two levels.... "work/development" and "living/general" might also help.

SunshineBarf
06-02-17, 10:30 PM
There seems to be a lot of cool information in this thread! I'll revisit it when my meds are active.

Have you ever read The Body Keeps the Score by Bessel van der Kolk?

Cyllya
06-04-17, 07:53 PM
From what you describe, your symptoms and circumstances don't match my understanding of PTSD (as a layperson with an interest in psychiatry and psychology). However, there's a separate proposed condition called Complex PTSD which seems more applicable. (Description and comparison on Wikipedia (https://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder).) Not sure of the aforementioned "implicit PTSD" is the same thing. Another proposed name for C-PSTD is developmental trauma disorder.

But "adverse childhood events" are correlated with an increased chance of all sorts of problems in adulthood, from mood disorders and ADHD to stuff like cancer and diabetes.

Either way, it's well-understood (and intuitively logical) that constant or frequent bad things happening over a long period of time, especially during your childhood, can make a person a nervous wreck.

When things happen to you that your animal instincts consider good or bad, it affects your inclinations for behavior, as your brain attempts to make good things happen more and bad things happen less. (Like, the reason animals eat isn't because they understand they need food to survive, or even because they get hunger pains and know food will make the pain stop. It's because they feel an instinctive urge to eat.) The process unfortunately works off correlations rather than logical cause and effect; your instincts may associate rewards or punishments with something you weren't actually being rewarded or punished for. (Hence why so many of us are compelled to eat tasty food when we want to feel better, even when we don't need to eat and we know the food is unhealthy.) So frequent and sporadic bad things happening will make you anxious or aversive or hypervigilant to all sorts of circumstances. Unfortunately, if your human intellect tells you one thing and your emotions tell you another, you still have to endure the emotion.

Established diagnostic labels for those sorts of long-term misery are major depressive disorder, persistent depressive disorder, dysthymia, generalized anxiety disorder, and borderline personality disorder. (Not a complete list.)

Unfortunately, the diagnostic criteria for psychiatric conditions (effectively the definition of what each condition is or isn't) is based on symptoms, behaviors, and circumstances, not on biological abnormalities. Even when the condition is highly associated with or known to be caused by certain biological abnormalities, the abnormalities aren't the deciding factor for whether someone does or doesn't have that condition. So you could get some kind of procedure to find out whether you have the neurological traits associated with ADHD or PTSD, but it can't provide a yes-or-no diagnosis for either. However, you might find a practitioner who would want you to have such a test so they could use it as part of forming their diagnostic opinion. (TBI, which in the domain of neurology, has a more concrete definition. That's why TBI-versus-other-stuff is easier to distinguish through brain imaging or whatever.)

What are your symptoms?

If depression or anxiety is present, it needs to be addressed first, or at least at the same time.I find this interesting because I was told by my psychiatrist that it was more important to address the ADHD first. His reasoning for this, was that in many cases the ADHD patients experienced what he called “imagined” or “false” social anxiety – because of inattentiveness in social situations, and feeling “different” in a way. Therefore, when treating the ADHD, the other conditions would be addressed as well. But I guess this logic could only be valid if the ADHD is implicit, which it might not be.

I tend to cringe at the treat-the-mood-disorder-first philosophy. (As far as I know, it is indeed the prevailing professional opinion.) This is partly because the diagnostic system sucks and it's just as hard figure out whether someone has a mood disorder as it is with any other condition.

I conceptualize mood disorders as emotions not matching the circumstances. For example, you feel anxious when there's nothing to be anxious about, you feel more anxious than you should when there is something to be anxious about, and/or you get stuck feeling anxious after the anxiety-inducing thing is long gone. (Not everyone would agree with me on that idea, but I figure if you're sad because sad things are happening to you, that's normal, not a medical problem.) However, disordered emotions feel the same as regular emotions, you can easily have negative emotions for both normal and disordered reasons simultaneously, and there's no system for figuring out what your emotions are "supposed" to be.

If someone is miserable because bad things are happening, I figure step one is to make the bad things stop happening, not give antidepressants.

Untreated ADHD is a bad thing. Not only does it make sense it would make someone miserable, it's almost required for the diagnostic criteria. (Everyone occasionally misplaces things, impulsively puts their foot in their mouth, etc. The difference between normal and ADHD is that the problems are frequent enough to cause "clinically significant impairment" in multiple settings, aka it's all but ruining your life.) A mental health professional can easily see this ADHD-induced misery and decide you have a mood disorder when you don't or mistake your mood disorder for being more severe than it is. I've heard a few anecdotes on here about practitioners insisting that a mood disorder be in remission before allowing a person to have ADHD treatment, which is effectively saying you have to stop being miserable before you're allowed to stop being miserable. In other words, "Beatings will continue until morale improves."

Personally, I do have major depressive disorder and dysthymia, in addition to ADHD. I also have a history of childhood abuse. I'm taking an SSRI that effectively turns off the depression, but my current ADHD treatment is less complete. So of course I try to seek additional treatment for ADHD, and I keep running into practitioners who want to zero in on the depression or anxiety or abuse. Such a pain. (I've started lying by omission and leaving the abuse off any intake forms that ask about it, but I have to list the antidepressant in the meds I'm taking.)

Is it normal for people with ADHD to have little to no memory of their childhood?

Not sure how common this is among ADHD people or people generally, but personally... I don't have a very clear "mental video" of childhood events. I can't imagine things the way they happened. However, I still have most of the information. The fact that various events happened, names of playmates and deceased pets, names of the streets we lived on, names of teachers, which year we went on which field trips, when I met various people, most of the classes I took, various hobbies I had, and so on.

Is that what you mean by having no memory?

mildadhd
06-05-17, 05:38 PM
Yeah, and I didn't give myself a chance to relate to my experience. Wtf?

I am interested reading about and learning from your experience. I do not know, but maybe Elane is reading and considering these discussions as we write?



M

Pilgrim
06-05-17, 05:57 PM
I am interested reading about and learning from your experience. I do not know, but maybe Elane is reading and considering these discussions as we write?



M

His story was similar to mine. I was bought up by an abusive mother who you always had to be careful around. I must say that my ADD didn't really surface till my early 20's.
There's definitely some PTSD stuff there, some years were bad.

mildadhd
06-05-17, 09:24 PM
His story was similar to mine. I was bought up by an abusive mother who you always had to be careful around. I must say that my ADD didn't really surface till my early 20's.
There's definitely some PTSD stuff there, some years were bad.

Hi Pilgrim,

Have you heard the books "The Body Keeps the Score", by Bessel van der Kolk

I have not read or listened to the book yet, that SunshineBarf recommended earlier (quoted below) in this thread, but I looked online and ADHD is mentioned in the index.

There is a few books on the subjects that I hope to get in audiobook including that one.

I am presently listening to the book, "Waking the Tiger, Healing Trauma", by Dr. Peter A Levine and "When the Body Says No", by Dr. Gabor Mate, I would recommend them to everyone.

As well as read and explore Kunga Kanga Dorji's threads and posts posted here at ADDForums. Kanga has been posting about Dr. Porges and his own work on somatic experiences and ADHD for years here at ADDForums and I am only beginning to understand his insights.

I am new to Dr. Peter A Levine's work but I consider his work already among my favorites on my list of recommended, among Dr. Kunga Kanga Dorji, Dr. Gabor Mate, Dr. Bruce Perry, Dr. Temple Grandin, Dr Gordon Neufeld, Math Teacher/Statistic Expert/Journalist Alan Schwarz, Dr. Panksepp, SB_UK, Peripatetic...and I suspect I am forgetting others and I will be adding more new to my list in the up coming months as I learn more.

One of many reasons I really like the audiobook "Waking The Tiger" is because Dr. Levine recommends stop reading/listening the book if the reader experiences certain negative feelings and seek profession help if so.

(Advice which also might help some readers (no matter the specific book/author on the subjects), who may experience serious negative feelings when triggered by reading certain subjects, help the reader unsure where to begin discussion with their doctors, find a starting point)

m

There seems to be a lot of cool information in this thread! I'll revisit it when my meds are active.

Have you ever read The Body Keeps the Score by Bessel van der Kolk?

userguide
06-07-17, 10:19 AM
Excellent question and a funy thread :)

Am I right that PTSD is a relatively term in psychiatry, an mostly related to war-zone environment ?

Perhaps this is the reason why the psych community is reluctant to reframe it into childhood events.

I am going to make a poll :)

namazu
06-07-17, 10:40 AM
Am I right that PTSD is a relatively term in psychiatry, an mostly related to war-zone environment ?

Perhaps this is the reason why the psych community is reluctant to reframe it into childhood events.
PTSD is not a "new" diagnosis, though the description has morphed over time. The term been around since the 1970s (and the concept has been around far longer, if you count "shell shock" and other descriptions); PTSD was formally adopted as a diagnosis in 1980 by the American Psychiatric Association.

The current (DSM-5) diagnostic criteria (https://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp) require, among other things:
Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):


Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma
Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)


Someone in a war zone could indeed have these exposures.

But it is also possible for people who were targets of (or witnesses to) domestic violence, sexual abuse, other violent crime, serious accidents, and natural disasters to meet this first criterion.

There is also a good deal of work being done on the long-term consequences of exposure to high levels of discord or distress. While any of the instances may or may not rise to the level of life-threatening/serious injury/sexual assault-type trauma, chronic exposure to highly distressful situations may also have profound effects on people. The term "complex PTSD" is sometimes used in these cases, though to my knowledge it is not a formal DSM diagnosis.

There are also other conditions, like attachment disorders, anxiety, and depression, that can arise (at least in part) as a consequence of stressful events that don't necessarily meet the criteria for PTSD. Sometimes these may look (at least on the surface) like ADHD or coexist with it.

Fortune
06-07-17, 12:47 PM
Locking thread for review.