Can a Physical Illness Masquerade as a Psychological Disorder?

With this article my intention is to offer you some insights into your own psychological and physical health. Don’t simply accept what a professional (like myself and countless others across the globe) tells you. Become aware that misdiagnosis is a common issue, particularly in the field of the psyche. You may be labeled as having B – a psychological disorder – while in fact, you have C – a physical problem. As you can imagine the treatment for B is very different from the treatment for C.

·  Michael and Melanie make separate appointments to see a psychologist, psychotherapist, or psychiatrist for depression. At the end of that first session, and after due probing into his/her state of mind, probably the first two recommend a series of 5 - 20 sessions, and the third recommends an anti-depressant. However, instead of complying, they decide to have their hormone levels tested, and discover several are low. After beginning a course of bio-identical hormone replacement therapy, the depression lifts as early morning mist can dissipate with the heat of the sun. It’s possible that either of these two individuals was going through andropause or menopause, or it’s equally possible, that they are at an earlier stage of their life, but nevertheless suffering from hormonal imbalance due to prolonged chronic stress characteristic of our modern life style. Either way, assuming the situation is as described, hormones are the answer – not therapy. [i]

·     Stephen’s teacher tells his mother he probably has ADHD (attention deficit hyperactivity disorder). After a brief evaluation, the pediatrician concurs, and Ritalin (an amphetamine-like drug) is prescribed. For two years it makes Michael agitated, causes him to lose weight, and keeps him awake all night. However, with a subsequent evaluation by another physician, it was discovered that Stephen has iron-deficiency anemia and elevated lead levels. Both of these caused his irritability for which he had been prescribed the drug Ritalin, and this drug had, in fact, exacerbated his condition. Clearly, assuming the situation is as described, treating the iron deficiency and the elevated lead levels is the answer – not drugs or therapy.[ii]

·       Jonathan makes an appointment for an evaluation due to repeated memory issues - at 57 - an age that might be a little young to consider early-onset Alzheimer’s and is told that it has to be dealt with; it’s part of life, and while there are some brain-training exercises he can do, there are few solutions. Doing some research on the topic, he decides to have his Vitamin B12 levels tested and finds his are not only low, but extremely low, and this may sometimes occasion memory loss (and a host of other issues). After a course of B12 injections and/or sublingual supplementation (as he may no longer assimilate B12 well via his digestive system), his memory improves drastically. Assuming the situation is as described, a vitamin is the answer – not therapy. [iii]

·      Suzanne sought therapy for anxiety and panic attacks, coupled with insomnia, and was counseled to schedule a series of psychological sessions. Again, doing some research on the topic, she decided to increase her magnesium intake, and finds a lessening of all symptoms after a period of time. Assuming the situation is as described, a mineral is the answer – not therapy. [iv]

An internationally accepted “bible” of symptoms, the Diagnostic and Statistical Manual (DSM)[v], came into being in 1952 (with numerous revisions since), and is used by a large part of the community of those professionals who deal with the human mind. In the above examples, certain symptoms were labeled a specific way, and then judged to be dealt with as described, without taking into consideration that there could be other reasons for these symptoms. Dr. Sydney Walker, a psychiatrist and author of A Dose of Sanity, writes:  “… a label is not a diagnosis. Saying someone is “depressed” or “anxious” is a far cry from finding out what causes the depression or anxiety; it’s comparable to a pediatrician saying a child has “spots”, without bothering to find out whether the spots are caused by measles, poison ivy, or staphylococcus. Patients who have been “diagnosed” as having manic depression, anxiety disorder, attention deficit hyperactivity disorder, and so on, haven’t been diagnosed; they’ve merely been described.” [vi]

Ann Japenga writes: "I use the DSM-III-R probably every day," says Marc Graff, assistant chief of psychiatry for Kaiser Permanente in the east San Fernando Valley. "I keep a copy at work, one at home and I carry one on call. It helps me conceptualize what's going on with a patient." But others, both inside and outside the profession, consider the system of categorizing disorders arbitrary at best and dangerous at worse. "It's not really an objective document at all," argues University of Montreal sociology professor David Cohen, who specializes in mental-health trends. "There's really nothing scientific about it. It's really just a list of our sins and deviations; it's a repository of our fears and our dislikes and hatreds." [vii]

·         Joan’s (76) sudden depression turns out to be a side effect of her high blood-pressure medication. Therapy would not have solved her problem. [viii]

·         A young mother’s exhaustion and disinterest in her baby seems like postpartum depression, but in fact indicates a postpartum thyroid imbalance that can be corrected with medication. Therapy would not have solved her problem. [ix]

·         Harry (47), manager, has angry outbursts at work, frequently feeling “ready to explode”. A temporal brain scan reveals temporal-lobe seizures, a type of epilepsy that can be treated with surgery or medication. Therapy would not have solved his problem. [x]

Harvard psychiatrist Barbara Schildkrout, author of Unmasking Psychological Symptoms (a book aimed at helping therapists broaden their diagnostic skills), indicates that more than 100 medical disorders can masquerade as psychological conditions:

What appears to be        May actually be …

Depression: underactive thyroid, low vitamin D or B12, diabetes, hormonal changes, Lyme disease,  lupus, head trauma, sleep disorders, some cancers and cancer drugs

Anxiety: overactive thyroid, respiratory problems, very low blood pressure, concussion, anaphylactic shock

Irritability: brain injury, temporal lobe epilepsy, Alzheimer’s disease, parasitic infection,  hormonal changes

Hallucinations: epilepsy, brain tumor, fever, narcolepsy, substance abuse

Cognitive changes: brain injury or infections, Alzheimer’s Parkinson’s, liver failure, mercury or lead poisoning

Psychosis: venereal disease, brain tumors and cysts, epilepsy, steroids, substance abuse[xi]

Jerrold Pollak, a neuropsychologist, indicates that – at least while further tests are being carried out - some patients may benefit from both psychological counseling and medical help. [xii]

Depression is often the first thing people notice when something is going on in the body, or at least, it’s the one that causes people to get help. In one way this is positive as it might help a therapist diagnose a health problem that could have gone undetected without the advent of the depressive symptoms, but unfortunately, far too often it is treated without going deeper into the patient’s symptoms and history in order to determine what might underlie it.[xiii]

I wish I had the space in this short article to tell you about the appalling number of cases of misdiagnoses that the authors of the books and articles I cite have recorded. A psychiatric diagnosis made too quickly, and on the basis of labels based on a “bible” that by the admission of many within the APA who publish the DSM, may be the wrong one. And furthermore, by treating it with therapy or drugs, may cause even greater damage. I am a psychotherapist and very much believe in my work. However, I also very much believe that blithely diagnosing without taking into account the many physical factors that might come into play, could be lethal for patients. Please inform yourself.

Note: While my interest in this article has been to pinpoint examples of a series of disorders that appear to be psychological, but are indeed, physical, please understand, that in other cases, those same disorders are, in fact, psychological, and will require another kind of treatment.

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[i] Google “symptoms of hormonal imbalance”. Also Google “bio-identical hormone replacement”.

[ii] Walker, Sydney, A Dose of Sanity. New York, John Wiley & Sons, Inc., 1996, p. 60.

[iii] Google “symptoms of Vitamin B12 deficiency”. Also read Could It Be B12: An Epidemic of Misdiagnoses by S.M. Pacholok & J.J. Stuart.

[iv] Google “symptoms of magnesium deficiency”. Also read The Magnesium Miracle by Carolyn Dean, or The Magnesium Factor by M.S. Selig & Andrea Rosanoff.

[v] Diagnostic and Statistical Manual of Mental Disorders V, American Psychiatric Association, 2013.

[vi] Walker, Sydney, A Dose of Sanity. New York, John Wiley & Sons, Inc., 1996, p. 5.

[vii] Japenga, Ann, Rewriting the Dictionary of Madness: Is the Diagnostic and Statistical Manual of Mental Disorders a Work of Pure Science or Just a List of Dangerous Labels. LA Times, June 5, 1994.

[viii] Beck, Melinda, Confusing Medical Ailments with Mental Illness. WSJ, August 9, 2011.

[ix] idem

[x] idem

[xi] Schildkrout, Barbara, Unmasking Psychological Symptoms. John Wiley & Sons, Hoboken, 2011.

[xii] Beck, Melinda, idem.

[xiii] Wasmer Andrews, Linda, Could Your Illness Trigger Depressive Symptoms? Feeling Blue? The Cause Could Be Diabetes or Other Diseases. Lifescript, February 27, 2012.

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