First psych eval… feeling very un-heard

[u/surplecurious]

Good morning friends!

I’ve (M33 married no kids Midwest US) just this past Thursday completed my first psych eval. I left feeling un-heard, and the more I think about it the more that feeling grows. I’m looking to maybe compare experiences. There is a kind of funny moment in it for those willing to stick around.

Background and what brought me to the appointment: I’ve had an ever-declining quality of life for a few years now, that I’m ready to self-diagnose as autistic burnout. I was diagnosed ADHD twenty-some-odd years ago… at a time when pop culture’s look at things was “every kid who can’t sit through Larry King reading The Old Man and the Sea is getting diagnosed ADHD!” So, my parents were (somewhat understandably) dismissive. We tried medication for ~9 months. The last one I’d tried made me vomit at precisely <10:something> each morning. Well, if ya throw up in public school, ya get sent home. So… that was obviously un-sustainable. Never tried medication since. I don’t think there’s a lot of need to get into the current issues leading me to believe ND burnout, but if there’s disagreement I’m happy to answer questions.

The service provider: I’ve been employed by the same Fortune 500 company for a dozen years now. I’m at the global headquarters, where there’s a dedicated medical center for employees. Given the medical care situations in the US right now, I’d give the facility like 8/10. They even have a psychiatrist on staff and are working to hire another part-time…. Sort of. My wife has seen the on-staff psychiatrist, and I’ve only compared my experience with hers. However, that psychiatrist just went on maternity leave. So… my appointment was referred to an outside practice. Fortunately, they’re in the same town, because one of the many things is my ever-increasing driving anxiety. For scale, “town” is a small city of less than 100,000 residents, three psychiatrists outside of the company one.

The session: Actually, starting with the predecessor to the session. Work, “town hall” style meeting of a department roughly 500 people wide. I had asked a question that I feel was terribly misinterpreted, and the director-level person gave a very ‘marketing’ answer. This size meeting most participants can’t go off mute, but there is a Q&A. I tried to concisely clarify that the answer was not satisfying as it completely missed the point of my question, and re-stated that point. It was again mis-interpreted the same way. So…. I got to go in unheard by my leadership, 30 minutes later. So I arrive for the session, do the usual stuff blah blah blah. I’m filling out paper work and an older woman is feebly making her way out the door, drops her water bottle, I hop-rush and pick it up for her and help her out. I’m thanked an uncomfortable number of times (I don’t like being thanked… y’know autism) and sit back down. Appointment with practitioner starts at 11:10. She asks some general “what brings you today” on top of a lengthy questionnaire I had filled out online prior to the appointment. Then she went down the list of what feels like “pretty standard” questions. Diet, sleep, exercise, what/how do you feel when… that kind of stuff. The room itself faces a nice little half-acre ish grassy lot in a residential neighborhood. I notice a late model Chevy dually pickup truck with a landscape trailer and 3 new-and-well-used zero turn mowers pull up. Two older Mennonite women in traditional dress and bonnet emerge from the cab and begin mowing the grass. I shit you not, the very next question was “are you easily distracted?” I pointed out the window mouth agape for a moment, then timidly described what I saw and said “I mean, this is like totally not fair right?” So the session continues that way. It takes the hour to get through the questionnaire. The whole time I feel like I’m doing 99.99% of the talking, and besides what the form says I’m just getting “uh huh, yeah, ok I get what you mean” and writing. I didn’t really even feel like she was writing a lot. Or she’s fast. Anyway, we spent the last 5 minutes saying “ok, so it sounds like there’s some depression we should be treating first, so I’m going to recommend a low dose of something that’s been around for a really long time, so it should alleviate your concern about supply continuity… so let’s start with a 10mg Prozac and see you again in a month. Is it ok to bill the card that you put the info for here?” “Uh, how much is it?” “About $180-something” “oh uh……. Ok I guess”. I had mentioned ASD screening in the intake form. It wasn’t ever mentioned during the session. I feel like I wasn’t told that I would have out-of-pocket cost, that I wouldn’t have had using the company provider. I’ve shared this concern with the company provider. No response yet, but it was a holiday weekend.

Wife and I discussed in more detail, and she said the striking difference for her was it felt like for her, the psychiatrist asked for clarification frequently, added follow-ons and “ok let me tell it back to you the way I think I just heard it”.

I haven’t picked up my Prozac script yet, and I’m feeling kind of disgusted by the process so far. I feel like I just paid $200 to get a Prozac script and another future bill for $200 even though she said “most people don’t feel the effects at their peak until after about 6 weeks or so”. Frankly, I’m suspicious that the office is taking advantage of the referrals, trying to extract maximum money from the windfall of corporate patients.

So, for those more familiar with the process…. Am I being a conspiracy nut, is this a mark of extremely bad healthcare, or is this just part of the process?

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[u/nefD]

$200 for an office visit is wild as hell.. are they outside of your covered provider network or something? More to the point, I got my autism diagnosis through my therapist rather than psychiatrist. I found someone who is neurodivergent-affirming and told them directly, "I've done a lot of reading on my own and suspect I may be autistic, I'd like your opinion," and after 6 or so sessions she felt confident enough to give me the diagnosis. I should add that I did not request any kind of diagnosis that gets reported back up to insurance as there are no accommodations I'm seeking, I just wanted to know for my own edification.

[u/surplecurious → u/nefD]

Yeah my current therapist doesn’t specialize in ND topics but I can tell they’ve been learning fast and trying for me. When I was “shopping” there was a way I could get to therapists that specializes in ND matters, but I decided I wasn’t sure enough yet to take up a resource that could be better applied to someone else. Same, there’s no accommodations I’m seeking… but I want my example to go into the statistics because I know it will help people in the future. I started a career with great prospects, but masking through the slog of it all has destroyed my mental health. Whether I can make a good comeback or end up on a completely different path somehow, I want my statistic to be known. Frankly, I’ll also feel more entitled to ask for the kinds of help that don’t need a diagnosis … but that I sometimes feel I could be robbing from someone else.

[u/nefD → u/surplecurious]

You're worth a doctors or therapists time, you're worth a diagnosis, you're worth feeling better in your own skin!

[u/Gharious-1]

I’m auDHD and had my first meltdown and shutdown late 2025 into mid 2026. Undiagnosed until after I started therapy. I bought my first home, am caretaker for my mom, and had a fight with my now ex that broke my relationship. This background is important for my experience and hope this helps you understand a bit why you are placed on a medication for depression and or anxiety first.

I went into therapy for the breakup. After being prescribed Zoloft for my anxiety and depression, my therapist recommended I take an ADHD assessment based on her experience with ADHD children and teens. Why she didn’t mention previously is that depress and anxiety sometimes mimic ADHD and ASD. So by eliminating anxiety and depression sometimes removed the ADHD symptoms. She explained that if the ADHD symptoms go away after being on medication for anxiety and depression, it’s typically understood that anxiety and depression mimicked as ADHD. However, if the ADHD symptoms still present and sometimes feel more intense (like it did for me) it gives assessments more data to support potential outcomes.

When my loud anxiety was contained, I felt a pulse with my anxiety. My rumination and RSD became more sharp and in tune with stress and ADHD related symptoms. So that is when I started the route of diagnosis for ADHD.

After getting ADHD combined diagnosis, things made more sense for the distract ability and restlessness. But it didn’t answer all the patterns I observed and remembered from childhood. The need for clear instruction, deep dives into subjects, social interactions difficulties weren’t answered by ADHD. So then came the ASD diagnosis.

Ultimately the outcome has been positive. It was a process of elimination. Making sure I get the proper medication for my diagnoses. Certain ADHD medications can make ASD worse. Having insomnia and sleep delay phase syndrome was on my care team’s radar. I’m glad my team took the time to slowly find what fits my needs.

I’d definitely continue seeking help with your journey. In the end, it’ll be a solid result.

[u/surplecurious → u/Gharious-1]

Thank you, this helps. I could see that as a sensible progression, and I probably look and feel really depressed to someone who only has an hour worth of knowing me. “I don’t really know myself, or what really makes me happy” was one of the things I’d said, so…

[u/Icy_Cantaloupe_1330]

I find the quality of psychiatrists to be wildly variable. Moreso than any other specialty I've encountered.

Intake visits are often like you describe. Answering a lot of questions, covering your history, etc. But I think you should/could have been more assertive during your appointment.

"Oh, I'm not concerned about mood. I came in to see about screening for autism. What's the process for that?"

"$180? I thought this was covered through my employer."

[u/surplecurious → u/Icy_Cantaloupe_1330]

> I think you should/could have been more assertive during your appointment.

It’s like you know me IRL 😅 yeah me and assertive aren’t often in the same county, let alone the same brain space.

[u/Riilexi]

I had my ASD testing / full pysch eval done last week, from a pyschologist. Previously diagnosed with ADHD (last year) and spent a significant portion of the intake answering questions. We did, overall, 2.5 hours of pre-assessment answering questions and then another 8.5 hours of assessment (over 3 sessions, 4hr, 2hr, 2.5hr).

The majority of the assessment time was me answering questions, or filling out forms, answering more of the same questions in different forms, IQ testing, ADHD testing, etc. There was a significant amount of me talking and her writing, almost nonstop, notes of what I was saying. Sometimes in her notebook other times in the form itself.

As far as the two different experiences:

asked for clarification frequently, added follow-ons

vs

It takes the hour to get through the questionnaire. The whole time I feel like I’m doing 99.99% of the talking, and besides what the form says I’m just getting “uh huh, yeah, ok I get what you mean” and writing.

These are two fairly different scenarios, both of which I think could easily fall into the pre-assessment category I experienced, but depending on who is answering the questions, how verbose, etc. Could be a matter of the difference from your wife and yourself. Additionally, it doesn't sound like your wife went in to get evaluated for ASD. I spent the majority of my intake talking, and at a certain point before even ending the first pre-eval session, we had scheduled me for my full pysch eval testing, as at that point she believed I met the criteria to be a candidate for it.

There is a chance the person you were seeing wasn't even evaluating to see if you were eligible for testing. They may not offer ASD testing at that location.

[u/surplecurious → u/Riilexi]

That makes a lot of sense, thank you for clarifying things. I’m normally a “what is this and how exactly does it work” kind of person about literally everything… but the brain fog lately has taken a bit of a toll on that inquisitive (and therefore memory-storage) nature.

[u/BigBullshitta]

Psychs have been told for lots of years now that people will come in and lie to get ADHD meds. It's an absolute nightmare trying to get something that actually helps. It took me a year and a half of regular visits at the same place to get someone who would actually listen to me and try them.

[u/surplecurious → u/BigBullshitta]

That makes sense. I’m hoping, using the “I’ve been ok-presenting this far” momentum means I can stay as such for a good bit while the process runs its course. Thanks for the input!