Robb North via Compfight
Last week, Dr. Drew suggested a caller’s fiancée had a history of childhood sexual abuse based on her medical diagnoses.  She did, but since 1 in 4 women experience sexual assault before the age of 18, it wasn’t exactly a long shot. He also enraged a lot of women when he referred to her diagnoses (endometriosis, institial cystitis, lactose intolerance) as “garbage bag diagnoses” and said that they aren’t things that are “pathologically discernable,” which according to my doctor friends mean that there aren’t lab tests for them and that that’s not true.

Medical diagnoses aren’t my expertise and plenty of people have addressed the flippant nature of his response to her illness.  But how did trauma get dragged into that phone call?  Can you diagnose past trauma based on someone’s current medical conditions? Is there a connection between these and PTSD?

Is there a connection between medical conditions and trauma?  Yes, there is.  In a recent post, I talked about the mind-body connection.  There is evidence that suggests that chronic stress from something like neglect or abuse can result in a dysregulated neuroendocrine system, which is central to our stress response system.  A brand new meta analysis of 196 articles found that sympathetic nervous system predominance is present in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. The sympathetic nervous system is key in the stress response, particularly the “fight or flight” response, and one theory is that if people experience chronic stress, then they may continue to have an overactive sympathetic response system. So if people with the above 4 disorders tend to have an overactive sympathetic nervous system, then that would seem to endorse the idea that they’re connected with chronic stress, which is what the researchers concluded. A relationship with trauma also doesn’t mean that these are “in their head.” Child abuse is related to higher levels of heart disease and COPD—but the relationship doesn’t mean that those aren’t real medical conditions.

Can you diagnose a particular type of trauma based on someone’s current symptoms?  Nope.  You can guess that saying there is a connection between these medical conditions and an overactive stress response is a long way from saying that an individual with interstitial cystitis can be assumed to have experienced childhood sexual abuse by a psychiatrist they’ve never met.

We also can’t diagnose PTSD with just trauma symptoms. To get that 309.81 diagnosis code, an individual has to be able to report a qualifying event. One reason is that a lot of mental health symptoms overlap.  Another is that even if there was an event that was forgotten or blocked or whatever, there’s no telling what it was.  I’ve read case studies where the recalled event turned out to be a frightening thunderstorm where no one came to comfort a child, or a someone who accidently walked in on a parent in the bathroom. Others are less benign, but you can’t diagnose childhood sexual abuse based on symptoms. It doesn’t mean that someone with trauma symptoms wasn’t sexually abused, but the symptoms themselves aren’t the evidence for that.

Can he diagnose someone with Somatoform Dissociation without having met them? Not ethically.  If his Wikipedia page is correct, he is a Licensed Physician and Surgeon in the State of California. Licensed professionals aren’t supposed to give out diagnoses to people we’ve never spoken to, for obvious reasons.

So if you’ve experienced stress symptoms or medical conditions and you think it might be related to something in your childhood, you probably aren’t crazy. Just don’t let any strangers tell you what it was.