Was my psychiatrist out of line/manipulative for saying this?

Imverynewhere · 2026-08-08T14:04:03+00:00

Context: I have OCD which is very much focused on climate change and is triggered by heatwaves and news particularly about wildfires. Started 3 years ago and have been on Setraline since and was originally diagnosed with GAD. Last year seeing a new psychiatrist (after therapist suspected ADHD) I was diagnosed with AuDHD and OCD. I found this psychiatrist quite rushed and abrasive at the time and if I questioned her I often felt she misinterpreted what I was asking and it felt like she was trying to pigeon hole me into a diagnosis. Anyway after my ADHD diagnosis she encouraged me to start on Elvanse and have an appointment with her after I’d tried it for a week on a very low dose. She had told me to make sure I tried it on a week I was well (this was in November) - this was then followed by a spate of coughs and colds throughout the winter and spring and then a very busy time at work where I was a little reluctant to try it as I needed to be on my game and wasn’t sure how strongly I’d react to it. We get to June and I try it for a week and have a really positive experience and check in with my psychiatrist. For more context I’ve really struggled with my ND diagnosis- I’ve always believed my “struggles” were just me not trying hard enough so I suppose I had hope I could change (I know this isn’t healthy but for many years it’s driven me) and it felt like I was now, alongside dealing with anxiety, making life an upward struggle and I wanted to be the “successful” driven person I once was. My appointment came during a week when these feelings had come to a head a bit and when I felt my diagnoses were becoming my identity and I was quite tearful out of frustration more than anything. She immediately read this as me being “very unwell again” with my anxiety. Now having been able to barely get out of bed with my anxiety 3 years ago and then a year ago I know what I feel like when I’m really unwell. But I upped my meds last year just enough to get me feeling better enough to engage with my therapy- I’d been doing therapy for the previous 2 years but the meds had done such a good job I hadn’t really been able to practice my therapy. I think most people will have noticed my biggest triggers for anxiety have been very much present this summer and whilst I’ve had low level anxiety for a few months and can feel anxious it’s not stopping my life thanks to the therapy practices I’m putting in. My psychiatrists answer to this was to put me on more medications. I was resistant to this because frankly my therapy is working, I’m already on a medication which does give uncomfortable side effects at times (hello clenched jaw, weight gain and being a sweaty mess). The benefits of taking a medication surely have to outweigh the negatives and the extra medication she was suggesting potentially had significant side effects. When I questioned taking more meds and said I wanted first to try exposure therapy for my OCD her words were “this is your autism speaking and you’re being too rigid in your reluctance to go onto a new medication”. As said I was already uncharacteristically upset during this session, I’m already on meds (showing I’m willing to take them) and tbh I’ve always been suspicious of the Autism diagnosis - I may have some autistic traits but I suspect after reading lots the last year or so my “autistic” traits are perhaps more OCD. The more I’ve thought about it the more I’ve thought her using my “autism” against me into pressuring me to take a medication (saying I’m being inflexible) I feel I don’t need right now and when I’ve shown I’m willing to engage with meds already, is actually pretty outrageous. But then I also feel I’m second guessing my interpretation as maybe this is my ND response to what she’s said and she is trying to highlight I’m behaving in a way that’s unhelpful to my own mental health? AIBU?

carefreedays · Yesterday 15:16

NBU. I’d be upset too.

A couple of things stood out to me:

Medication decisions should be collaborative. “Benefits vs side effects” is exactly the right way to think about it. If your therapy is working and your current meds are helping, then adding another drug with significant side effects needs a really clear reason. Saying no for now is not “rigid”, it’s informed.
Using a diagnosis to invalidate you is not okay. “This is your autism speaking” isn’t treatment planning. Whether it’s autism or OCD, you’re allowed to question, to ask for alternatives, and to have preferences about your own body. You’ve already shown you’re willing to take meds — you’re on Sertraline and you tried Elvanse. That’s engagement, not resistance.
Asking for exposure therapy for OCD is 100% reasonable. ERP is NICE guideline first-line treatment for OCD. With climate/wildfire themes, it can help with tolerating uncertainty, news limits, and the anxiety spikes. If your psychiatrist won’t support that, ask your GP for a referral to IAPT or a therapist who does ERP.

Re: the AuDHD diagnosis doubt — so many of us go through that grief/identity wobble after diagnosis. Years of “just try harder” doesn’t disappear overnight. Questioning it doesn’t make you difficult, it makes you human.

If you feel able, I’d email her/the secretary and say: _“I’d like to try ERP for my OCD before adding another medication, and I’d like to discuss the risks/benefits further. If that’s not possible with you, can I be referred for a second opinion?”

You’ve come so far from “barely out of bed” to “anxiety isn’t stopping my life.” Please don’t let one rushed appointment make you doubt that progress.

Sending solidarity. Heatwaves + news cycles are brutal with climate OCD and you’re handling it with the tools you have. You’ve got this 💛

MyThreeWords · Yesterday 15:42

I agree that it was probably manipulative and inappropriate for your psychiatrist to say “this is your autism speaking and you’re being too rigid in your reluctance to go onto a new medication”. It is in the nature of being a mental health patient that your perspective will frequently be challenged and problematised - rather than being taken at face value. Ovbiously this can be helpful when it is done appropriately, but it creates a power imbalance in which clinicians can, at will, wrongfoot patients who disagree with them by defining disagreement as disorder.

Perhaps the psychiatrist made her claim with no evidence whatsoever - just as an automatic assertion that she was the expert and you, as the patient, were wrong. Alternatively, she may actually have seen evidence that your thinking in this instance was affected by some of the ways in which your autism (if the diagnosis is correct) presents itself. BUT in this case, she should have stated this evidence to you and invited you to consider whether or not it made you feel less certain in your decisions around medication. In other words, it should be a collaborative exploration, with the clinician and the patient each bringing their own expertise and insight.

If that isn't the way in which she approached it, I think she was being lazy and arrogant. I remember when my son was very ill, autistic and psychotic, one of his psychiatrists spoke to me scathingly about his resistance to a particular medication. I don't think she even realised how disrespectful she was being. He was iller than you appear to be and I know that his judgement was impaired at the time, but it wasn't obliterated, and he was speaking of some troubling side effects that can't have been pleasant. She regarded it as something almost like misbehaviour.

dizzydizzydizzy · Yesterday 15:53

I think the “that is your autism speaking” is poor communication but not necessarily manipulation or poor clinical judgment. In fact I think manipulation is unlikely because what would she have to gain? It sounds like she thinks that you have some cognitive rigidness due to your autism and that could therefore be partly behind your reluctance to take more medication. That sounds like a definite clinical possibility.

You are of course perfectly entitled to say that you would rather explore therapy because you are worried about side effects .

I would recommend contacting your psychiatrist because it sounds highly likely that the pair of you have misunderstood each other. Tell her about your weight gain and tension and ask her if they are side effects from the drugs (people often lose weight on Elvanse because it suppresses appetite. Not sure about sertaline). Tell her why you were crying and you were wondering if she had got the wrong impression.

hope you get things sorted. Hopefully the psychiatrist is just a poor communicator and does actually have good clinical judgement.

Original poster

Imverynewhere · Yesterday 19:12

carefreedays · Yesterday 15:16

NBU. I’d be upset too.

A couple of things stood out to me:

Medication decisions should be collaborative. “Benefits vs side effects” is exactly the right way to think about it. If your therapy is working and your current meds are helping, then adding another drug with significant side effects needs a really clear reason. Saying no for now is not “rigid”, it’s informed.
Using a diagnosis to invalidate you is not okay. “This is your autism speaking” isn’t treatment planning. Whether it’s autism or OCD, you’re allowed to question, to ask for alternatives, and to have preferences about your own body. You’ve already shown you’re willing to take meds — you’re on Sertraline and you tried Elvanse. That’s engagement, not resistance.
Asking for exposure therapy for OCD is 100% reasonable. ERP is NICE guideline first-line treatment for OCD. With climate/wildfire themes, it can help with tolerating uncertainty, news limits, and the anxiety spikes. If your psychiatrist won’t support that, ask your GP for a referral to IAPT or a therapist who does ERP.

Re: the AuDHD diagnosis doubt — so many of us go through that grief/identity wobble after diagnosis. Years of “just try harder” doesn’t disappear overnight. Questioning it doesn’t make you difficult, it makes you human.

If you feel able, I’d email her/the secretary and say: _“I’d like to try ERP for my OCD before adding another medication, and I’d like to discuss the risks/benefits further. If that’s not possible with you, can I be referred for a second opinion?”

You’ve come so far from “barely out of bed” to “anxiety isn’t stopping my life.” Please don’t let one rushed appointment make you doubt that progress.

Sending solidarity. Heatwaves + news cycles are brutal with climate OCD and you’re handling it with the tools you have. You’ve got this 💛

Thank you!

I have already emailed her to say I won’t be putting the prescription in and that given I’m
starting with a therapist on Exposure Therapy very soon I’d like to try that first. I got a rather curt reply that she wants to assess my mental
state and to still see her for the appointment we’d scheduled to review the new medication she wanted me to take (at a cost of £300
for 30 minutes!). I’m in the very fortunate position that we’re doing all this privately and tbh I’m at the point where I feel I need to find a different psychiatrist - this isn’t just one rushed appointment or the first time that she’s acted frustrated if I’ve pushed back on something either and it’s certainly one of many times I’ve felt misrepresented/misread by her so I think I’ve lost trust in her.

The thing is she’s quoted to me she has some very high flying clients so it’s made me second guess whether it’s her or me- especially when you already question that about yourself when you’re diagnosed as ND!

OP posts:

Original poster

Imverynewhere · Yesterday 19:18

MyThreeWords · Yesterday 15:42

I agree that it was probably manipulative and inappropriate for your psychiatrist to say “this is your autism speaking and you’re being too rigid in your reluctance to go onto a new medication”. It is in the nature of being a mental health patient that your perspective will frequently be challenged and problematised - rather than being taken at face value. Ovbiously this can be helpful when it is done appropriately, but it creates a power imbalance in which clinicians can, at will, wrongfoot patients who disagree with them by defining disagreement as disorder.

Perhaps the psychiatrist made her claim with no evidence whatsoever - just as an automatic assertion that she was the expert and you, as the patient, were wrong. Alternatively, she may actually have seen evidence that your thinking in this instance was affected by some of the ways in which your autism (if the diagnosis is correct) presents itself. BUT in this case, she should have stated this evidence to you and invited you to consider whether or not it made you feel less certain in your decisions around medication. In other words, it should be a collaborative exploration, with the clinician and the patient each bringing their own expertise and insight.

If that isn't the way in which she approached it, I think she was being lazy and arrogant. I remember when my son was very ill, autistic and psychotic, one of his psychiatrists spoke to me scathingly about his resistance to a particular medication. I don't think she even realised how disrespectful she was being. He was iller than you appear to be and I know that his judgement was impaired at the time, but it wasn't obliterated, and he was speaking of some troubling side effects that can't have been pleasant. She regarded it as something almost like misbehaviour.

This is it- I felt like I was made to be a problem or naughty for questioning it or being reluctant. I do believe she is trying to help me but I also know that doctors aren’t always right about everything- I had months of being gaslit by a doctor that my baby couldn’t have a milk allergy through breast milk and babies don’t get milk allergies. Turns out she was totally wrong and he also had egg and soya allergies which he unusually hasn’t grown out of despite being 8. The dietitian suspects that this is because his gut was damaged by such long term exposure to allergens.

Really hope your son is doing better now!

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Lougle · Yesterday 19:21

You waited 7 months to feel well enough to try a new medication because you took the instruction to wait until you're well too literally...

Original poster

Imverynewhere · Yesterday 19:34

dizzydizzydizzy · Yesterday 15:53

I think the “that is your autism speaking” is poor communication but not necessarily manipulation or poor clinical judgment. In fact I think manipulation is unlikely because what would she have to gain? It sounds like she thinks that you have some cognitive rigidness due to your autism and that could therefore be partly behind your reluctance to take more medication. That sounds like a definite clinical possibility.

You are of course perfectly entitled to say that you would rather explore therapy because you are worried about side effects .

I would recommend contacting your psychiatrist because it sounds highly likely that the pair of you have misunderstood each other. Tell her about your weight gain and tension and ask her if they are side effects from the drugs (people often lose weight on Elvanse because it suppresses appetite. Not sure about sertaline). Tell her why you were crying and you were wondering if she had got the wrong impression.

hope you get things sorted. Hopefully the psychiatrist is just a poor communicator and does actually have good clinical judgement.

If this was one off behaviour from her or if I’d shown reluctance to go on any medication at all I’d agree with you. However I’ve shown I’m not anti-medication by being on the other meds I mentioned (and I’ve increased dosage on one of them so again it’s not that I’m
anti medication or even trying to wean myself off them). The irony is as a chronic people pleaser who doesn’t want to seem awkward I will often just bend to what other people want me to do so it felt quite exhausting pushing back on this and I ended the call with me saying I’d try the medication as I felt cornered in the end (she also told me I won’t get better if I don’t work with her) but on reflection changed my mind especially as I read the side effects.

What does she have to gain is a good question? I do believe she is trying to help but I think it’s a thing I’ve seen in some medical professionals where they want their opinion (which a lot of medicine still is) followed without question. But the thing is in a sense she doesn’t have anything to lose in the same
way I do…it’s clear to me she prioritises medication over therapy. That’s fine and understandable as a psychiatrist over a psychotherapist who may prioritise therapy over medication. One of my pushbacks is when I first went onto sertraline I felt much worse before I felt better - given when I spoke to her recently I was managing my anxiety and functioning and about to have 6 weeks of my kids being home and therefore I didn’t want to feel worse as I really lost my summer with my kids 3 years ago when I had my first anxiety episode. Furthermore some people on SRI’s get permanent side effects which can really affect their lives and relationships e.g. it can severely reduce their libido. If I couldn’t function these are risks I might want to take but I suppose I just felt bulldozed into something she has nothing to lose from where I felt I had a lot.

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Original poster

Imverynewhere · Yesterday 19:52

Lougle · Yesterday 19:21

You waited 7 months to feel well enough to try a new medication because you took the instruction to wait until you're well too literally...

No she was really clear if I had a temperature or unwell PHYSICALLY I wasn’t to take Elvanse as it puts further strain on your heart which can mean you feel unwell for longer or of course do damage to your heart. I literally had week after week, month after month starting with proper flu where I was in bed for a week and then with a cycle of colds and chest infections (something I’m unfortunately prone to) and then Covid. After that I didn’t take it for a number of months because I was a bit nervous about the side effects and it was a busy time with work (when I find actually having ADHD really helps in the short term) and I didn’t want to feel worse and it affect my work.

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Comtesse · Yesterday 20:01

I don’t think this is the right dr for you.

I do think it’s interesting you waited for such a long time before trying the medication, I suspect that is quite an unusual approach. You don’t have to take medication for adhd, you can just say no thanks.

Octavia64 · Yesterday 20:12

Imverynewhere · Yesterday 19:52

No she was really clear if I had a temperature or unwell PHYSICALLY I wasn’t to take Elvanse as it puts further strain on your heart which can mean you feel unwell for longer or of course do damage to your heart. I literally had week after week, month after month starting with proper flu where I was in bed for a week and then with a cycle of colds and chest infections (something I’m unfortunately prone to) and then Covid. After that I didn’t take it for a number of months because I was a bit nervous about the side effects and it was a busy time with work (when I find actually having ADHD really helps in the short term) and I didn’t want to feel worse and it affect my work.

Show quote history

I just wanted to comment on this.

i’m NT and I used to teach autistic teens.

this is a very literal interpretation of what she said and it is very unusual to wait months to try out a new medication.

I understand that you may not want to try what she is suggesting but this is a significant difference from typical behaviour.

(my dd takes adhd drugs and she takes them all the time).

Original poster

Imverynewhere · Yesterday 20:52

Octavia64 · Yesterday 20:12

I just wanted to comment on this.

i’m NT and I used to teach autistic teens.

this is a very literal interpretation of what she said and it is very unusual to wait months to try out a new medication.

I understand that you may not want to try what she is suggesting but this is a significant difference from typical behaviour.

(my dd takes adhd drugs and she takes them all the time).

Show quote history

Maybe it was, but I did check in with her several times but given I was trying it for the first time she said to wait until I was feeling physically well. I'm also not talking the odd sniffle I'm talking about feeling pretty unwell for a signifcant amount of time. I suspect having had flu absolutely blasted my immune system which is why I felt out of sorts for months with persistent chest infections. And as explained above I then didn't take the Elvanse for a few months as I was nervous of the side effects at a busy time (because some people do find them to be quite significant). But as soon as life quietened down again I tried them!

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Original poster

Imverynewhere · Yesterday 21:03

Comtesse · Yesterday 20:01

I don’t think this is the right dr for you.

I do think it’s interesting you waited for such a long time before trying the medication, I suspect that is quite an unusual approach. You don’t have to take medication for adhd, you can just say no thanks.

Yes I agree and I've actually just written to her cancelling our next appointment.

Yeah I did take a long while as I've explained above - partly because I was physically unwell for a long time, partly because I was nervous about the side effects at a busy time. Also my pharmacy messed up my prescription with it when I first got the prescription meaning (as a medication which is controlled) it had to be reissued which by the time I then got the medication I was mid one of the first full blow chest infections I had.

I was nervous about starting it and I've found it hard coming to terms with being ND- as said above I still sometimes have the mentality if I just tried a little harder I'd be more organised/able to do tasks in a timely manner. So maybe subconsciously I held back for a while.

However with my anxiety it's not a case of coming to terms with it- it's there in my mind and body! And it wasn't that I was saying I'll never take these medications to help- it was just that I wanted to discuss options whereas I felt I was being pushed one way. SRIs can have such significant side effects I don't think it's unreasonable to see if there are other options to try, and I also don't think it's unreasonable to question a doctors position. She has been very much of the opinion because I have OCD I'll be on medication for life, whereas my therapist believes there is the possibility I may be able to come off it at some point. I don't know who is right but I think given I'm the one who has to suffer the side effects/live with the anxiety it's reasonable for me to ask questions/push back a bit?

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