Over the years I have read many times people express that they’ve been diagnosed with PTSD from a bad drug trip, or believe they have PTSD from a bad drug trip. Unfortunately, something, or someone, is amiss in such statements. Diagnostically, you can not be diagnosed with PTSD from a bad drug trip.

In reading such claims, I’ve read many explanations. I felt like I was going to die. I was being tortured over and over again in my mind for days. I didn’t know what was real anymore.

Yes, all of those things are certainly traumatic, and you may honestly feel / believe you were going to die. People do die from drugs. Every day. But the problem is this:

  1. You’re lying about being diagnosed,
  2. You’re not telling the full story, i.e. you had trauma prior to this event that meets PTSD diagnosis,
  3. Your therapist / psychiatrist is one of those, pick and choose diagnosis based on their belief system, type physician, or
  4. Any combination of the above.

I got a laugh the other day before writing this, a person believes that anyone who follows diagnostic application is a diagnostic purist. Their belief was that anyone who experienced trauma should be eligible for PTSD. Pathologize society, in other words. Insane was one word that came to mind. Troll, another. Misguided was up there too. Based on such beliefs, we should burn all diagnostic manuals and make shit up as we feel. Unfortunately, there are physicians who pick and choose what diagnoses to believe, what they will use, what they will never use, whether or not they will diagnose based on established criterion or their own criterion.

Don’t get me wrong, mental health diagnosis is already best guess, but its best guess based on decades of data. Science is trying to follow each diagnosis with evidence, some are harder than others to validate. Neurology has a long way to go. Its a foundation of something versus no foundation at all. Or foundation of individual beliefs. Argh! You may not agree with a diagnosis, but does that give any one person the right to deviate as they deem fit without discussing it within a psychiatric peer group for feedback? I think not.

Don’t believe me? Lets use the biggest of all lies within the mental health industry. CPTSD is a diagnosis come 2017/18 with the ICD 11 release, complex post traumatic stress disorder. Until just this year, this diagnosis did not officially exist anywhere with diagnostic criterion, a code for registration and insurance, na da. Yet there are physicians giving out this diagnosis to patients for a decade or more. They register PTSD, BPD or DID, and other diagnoses on the official documents, yet they tell their patient they have something that does not officially exist. There are many ways to say things to patients, but this is what happens in mental health. Physicians lie to their patients.

Want more? When I first started to struggle with PTSD symptoms I was sent to an Army psychiatrist. Just so happens that this very psychiatrist was a Vietnam veteran who did not believe in the PTSD diagnosis. Low and behold, when I was sent for independent civilian assessment the psychiatrist asked me whether I had seen this Army shrink. He informed me that, in his professional opinion, the Army shrink suffered PTSD from his combat exposure in Vietnam. They were actually friends. A psychiatrist in the Army who did not believe in PTSD, and would not diagnose PTSD! Go figure.

Mental health is based on causation. Look to the cause, that provides a diagnostic category. Causation: bad drug trip. There is a category for substance use and affect. We always pick the most appropriate category for cause, narrowed by symptoms. The cause for PTSD is trauma. Combat, rape, torture, motor vehicle accident, natural disaster, etc. There is a category for trauma and stressors. PTSD resides within it. PTSD does not reside within the substance use/abuse category.

With such logic, the psychiatric teams that have pieced together diagnoses through the decades, included a criterion in many diagnoses to exclude exactly this happening, due to more relevant diagnostic availability for substance effect and medical conditions. It states (DSM 5):

  • H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

If you feel like you’re going to die from a bad drug trip, you are excluded from PTSD diagnosis. Just as you’re excluded if you developed such symptoms due to cancer. Sure, these are traumatic — but the cause is a substance or medical condition, not trauma itself. Again, cancer is a medical condition which brings with it certain psychological components. These related components are better explained from other disorders, even though symptoms may match PTSD, you are excluded because there are more accurate diagnoses based on cause.

Causation is key for mental health diagnosis. The mental health symptoms endured after a heart attack, for example, are explainable with other diagnoses, whether anxiety, panic, sleep problems, flashbacks of the event, combination of, etc. If the medical condition is the cause, PTSD is excluded. If a substance is the cause, PTSD is excluded. That simple.

PTSD is used where trauma is the cause (direct), based on current diagnostic criterion, both from the World Health Organisation (WHO) who publish the ICD and American Psychiatric Association (APA) who publish the DSM.

Still don’t believe me? Lets use examples from the online ICD11 beta version (so everyone can follow along). Lets say you become severely depressed or manic after an opioid (heroin, oxycontin, morphine, etc) trip. Whether given legally or illegally, its irrelevant. The diagnosis of Opioid-induced mood disorder would be given due to causation. You would not be diagnosed with a depressive or bipolar disorder, nor PTSD.

You take too much cocaine and present with psychotic symptoms, including hallucinations. The disorder Cocaine-induced psychotic disorder with hallucinations would be used, again, as the cause is cocaine. The symptoms may manifest to look exactly like severe PTSD, yet the more accurate diagnosis is used based on cause and effect. You may get multiple versions of similar diagnoses dependent upon presented symptoms.

This is where psychiatric evaluation shines. Once a physician narrows the diagnosis, they use evaluation questionnaires and screening to confirm their suspicion and diagnostic validity. When such evaluation is skipped, it increases misdiagnosis / confirms you need another physician to assess you correctly. You should always seek two or three independent assessments for mental health diagnosis, without telling any of prior diagnoses given. If you get the same outcome, the physicians are doing their job correctly and the system validates your actual health concern. If you get different outcomes, start evaluating the discrepancies.

Please don’t try and self-diagnose. There is much procedure related to mental health diagnosis, it’s highly unlikely you will get it right.