Hello, all! I hope that you are staying healthy and safe. In this episode, I cover two very interesting questions.

In the first, someone has been through almost every treatment for depression and anxiety under the sun, yet they still struggle. Their therapist suggested that they may be on the autism spectrum and the person is wondering whether it would be useful to get an evaluation. We discuss the potential benefits as well as how to go about finding (and affording) an evaluation.

Next, someone has PTSD from their partner’s PTSD reactions. Their partner is a war veteran with multiple brain injuries and the question-asker is wondering how they can stay afloat mentally when their partner does not get help. We talk about ways to avoid codependence, how to establish boundaries, and when to call it quits.

As always, you can send me questions to duffthepsych@gmail.com and find the show notes for this episode at http://duffthepsych.com/episode365

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This episode is sponsored by BetterHelp. Rather than letting your thoughts stay swirling around in your mind, get them out by talking to a licensed therapist. Try BetterHelp today and get 10% off your first month at http://betterhelp.com/duff

Also, don’t forget to check out my new shop.

Question 1:

Hi Dr. Duff, I’m a 35 yo female. I have MDD and social anxiety. I have tried over 15 medications over the years, TMS, and most recently Ketamine infusions as well as many years of talk therapy. I am also a recovering alcoholic (8 yrs) but use marijuana to help with my anxiety/mood.

I recently started seeing a new therapist who brought up that she thinks I might be on the autism spectrum; I don’t disagree and have wondered this myself on and off for years. She said that an official diagnosis is expensive and there is a several month wait list, and little benefit to getting an official diagnosis. Do you agree with this, and in your experience would a diagnosis help aim treatment for my depression and social anxiety? Aside from psilocybin, and ECT I have exhausted most treatments and am still struggling.

Response:

Your journey is awe-inspiring, and your resilience is commendable. Despite the multitude of treatments and efforts, it’s evident that your mood remains a challenge. It brings us to ponder whether exploring a potential autism diagnosis might offer a novel avenue to enhance your well-being, especially when other strategies seem to plateau.

Autism, or Autism Spectrum Disorders (ASD), is a term that carries varied interpretations. Some view it as a neurotype rather than a disorder. Essentially, autism is a neurodevelopmental condition. This means that the brains of those on the spectrum develop distinctively compared to those considered neurotypical. Autism’s manifestations primarily revolve around social communication. This includes challenges with conversation’s natural flow, deciphering non-verbal cues, or even displaying unconventional body language. Additionally, autism is characterized by repetitive behaviors, rigid adherence to routines, and specific fixations. Sensory sensitivities, whether heightened or reduced, are also typical.

The wide spectrum of autism presentations often makes it a challenging diagnosis. For women, the situation is compounded as autism symptoms might manifest differently than in men. This divergence could lead many, like possibly yourself, to operate under the radar. Your described symptoms, especially social anxiety, could indeed be influenced by autism. The distinction between social anxiety rooted in irrational fears and that stemming from autism’s inherent brain wiring might seem subtle but is pivotal. Addressing one through the lens of the other might feel like chasing shadows.

Your therapist’s reservations about pursuing an autism diagnosis are understandable. However, in my perspective, such a diagnosis, especially later in life, can offer profound clarity and validation. For instance, drawing from a friend’s experience who is transgender, understanding and embracing one’s innate identity can provide immense relief and resolution to many underlying mental health challenges. Similarly, recognizing that you might be navigating a world not entirely attuned to your neurotype can be liberating.

While I can’t claim firsthand experience with autism, and perhaps neither can your therapist, seeking insights from someone who has autism might be enlightening. Their lived experiences could offer valuable perspectives.

Additionally, a confirmed diagnosis might reshape your therapeutic interventions. Treatments, even common ones like CBT, would likely be adapted to accommodate the nuances of autism. For instance, addressing social anxiety for a neurotypical individual might focus on challenging irrational fears, while for someone on the spectrum, the approach might revolve around recognizing discomfort rooted in their autism and developing self-regulation strategies.

Practicalities aside, getting assessed for autism isn’t always straightforward. Costs, availability, and accessibility can be barriers. However, I’d encourage you to explore the avenues available in your region. This could range from clinics, specialists, hospital programs to university-led initiatives. Insurance might also be a potential source of support. The pricing spectrum for these assessments is vast, with some bearing the full cost, while others receiving subsidies or even free evaluations.

In conclusion, while there’s no silver bullet in mental health treatment, understanding oneself better is invaluable. Given your journey so far, exploring a potential autism diagnosis seems not just valid but essential. Regardless of the outcome, it might offer you the clarity and direction you’ve been seeking. Wishing you the very best on this path!

Question 2:

Hi Duff- I love your podcast, thank you so much for what you do.

I’ve sought out a lot of my own research and self help for years now (your podcast included) but recently finally found a therapist of my own who I match with well and I am able to be comfortable sharing vulnerable subjects.

I was diagnosed with PTSD, which stems from my husband’s PTSD episodes. He is a combat veteran and also has had two TBI’s during the course of 6 deployments. I’ve been struggling lately with prioritizing my mental health above his, and allowing his mood and episodes to control my emotions and my life. My husband does not see a therapist, and has not been going to his VA appointments for about 2 years now. He is afraid he’s “going crazy” because his memory is getting much worse. He forgets small things, whole events, conversations, and a few times has forgotten up to a week at a time.

Could you talk a bit about how to prioritize my own health – and also when to decide the relationship is too unhealthy to continue. Sincerely, Deeply loving someone with PTSD

Response:

Firstly, I commend you for taking the significant step from self-help to professional therapy. Indeed, seeking professional assistance is a proactive form of self-help. It’s heartening to know you’ve included my podcast in your healing journey.

Your situation underscores the multifaceted nature of PTSD. While an external observer might naturally associate PTSD with your husband’s combat history, it’s essential to recognize that trauma isn’t universally experienced. It varies from person to person. Your PTSD, arising from your husband’s episodes, showcases that trauma isn’t solely about the events but how our bodies and minds respond to them.

Further complicating matters are your husband’s TBIs. These injuries can significantly influence his day-to-day behavior, possibly amplifying the challenges of PTSD. Understanding the intricate ties between TBIs and PTSD is crucial in assessing and navigating your situation.

Your dedication to your husband’s well-being is palpable. Still, it’s crucial to recognize the toll it’s taking on your mental health. Ensuring you have a solid support system, beyond your therapist, can offer some respite. Are there friends or family who are aware of the challenges you’re facing? Their support and understanding can be invaluable, especially in situations where you feel overwhelmed.

Your husband’s reluctance to seek medical help, especially given his TBIs and worsening memory, is concerning. While the focus of your question is on your well-being, it’s essential to consider that his health directly influences yours.

Drawing boundaries is challenging, particularly in relationships marked by trauma and mental health challenges. However, setting and communicating boundaries is vital for your mental well-being. These could involve ensuring you get time for yourself or seeking additional support from friends and family.

Discussing your feelings and concerns with your husband is crucial. If direct communication proves challenging, consider couples therapy or involving a trusted confidante. Transparency about your needs and intentions can pave the way for understanding and mutual growth.

As you ponder the future of your relationship, consider the dynamics between you two. Are there specific patterns that exacerbate each other’s issues? Reflecting on such questions, perhaps through journaling, can offer clarity.

In conclusion, there’s no textbook answer to your situation. Prioritizing your mental health, establishing boundaries, and transparent communication are key. If, despite your best efforts, the relationship continues to undermine your well-being, it may be time to consider what’s best for you. Whatever path you choose, remember that your well-being is paramount.

Take care.