Why was Eric misdiagnosed? Why luvox failed to help?

Let us first present some information about a particular symptom of OCD that, as I will try to show later, caused Eric to be misdiagnosed.

The symptom is called INRUSIVE THOUGHTS (source quoted: [You must be registered and logged in to see this link.]

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Intrusive thoughts, in the spectrum of OCD, are where a person generally suffers with obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature. For example, thoughts of causing violent or sexual harm to loved ones.

Because the intrusive thoughts are repetitive and not voluntarily produced, they cause the sufferer extreme distress - the very idea that they are capable of having such thoughts in the first place can be horrifying. However, what we do know is that people with Obsessive-Compulsive Disorder are the least likely people to actually act on the thoughts, partly because they find them so repugnant and go to great lengths to avoid them and prevent them happening.

(...)

Violent Intrusive Thoughts – obsessive fears of carrying out violent acts against loved ones or other people. Intrusive thoughts include:

•Violently harming children or loved ones.
•Killing innocent people.
•Using kitchen knives and other sharp objects (compulsion will include locking away knives and sharp objects).
•Jumping in front of a train or fast moving bus.
•Poisoning the food of loved ones (compulsion will include avoiding cooking for family).
•Acting on unwanted impulses, e.g. running someone over, stabbing someone.
•Thoughts about accidentally touching someone inappropriately, with the aim of hurting them.
Most sufferers with these types of fears often end up labelling themselves as a bad person, simply for having the thoughts. They falsely believe that having the thoughts mean they are capable of acting upon them. The constant analysing and questioning of these disturbing aspects of OCD becomes incredibly upsetting and because of the nature of the thoughts many sufferers are reluctant to open up to health professionals to seek help, fearing they may be labelled.

A person with these types of intrusive thoughts will avoid public places like shopping centres and other places, where social interaction may be required, to avoid coming into close contact with people that may trigger the obsessive thoughts.

To sufferers and non-sufferers alike, the thoughts and fears related to OCD can often seem profoundly shocking . It must be stressed, however, that they are just thoughts, and they are not voluntarily produced. Neither are they fantasies or impulses which will be acted upon.

So, Eric came to the psychologst and at ome point described his violent thoughts. If Eric presented these as involuntary from the very begining, or if the psychologist asked Eric if these are involuntary and Eric just lead her on - we will never know.

Now, before we continue: OCD is somewhat common among teenagers, psychopathy and sadistic tendencies are far more rare.

Knowing the fact above and what Eric told her, the therapist assumed that what Eric describes are intrusive thoughts and not fantasies. There is KEY difference between the two: Intrusive thougths are involuntary. Theya re like the silly song refrain that keeps going around in your head even if you don't want to hear it. Moreover the OCD person will almost never act on these toughts, as he is himself disturbed by them.
Fantasies on the other hand are conscious constructs made by the mind and the person can likley act on these given a chance.

Here is where IMHO the therapist went the worng way with the diagnosis and there ws not turning back. He decided taht these are intrusive thougths. That Eric has no control of them, that they disturb Eric and that Eric needs help to free himself from them, that this is what he wants.
Eric mentioning suicide just make the diagnosis more firm, as OCD people are at sime suicidal and the intrusive thoughts create a great anxiety for them.

OCD patients who suffer from violent intrusive thoughts often mistakingly fear that they may be psychopaths. Eric was the real deal however. Still, because OCD is so common and prbably because Eric did not tell the full truth (about his real life experiences with fire, explosives etc), he was diagnosed with OCD and not with ASPD, psychopathy or anything similar. His fantasies treated as involuntary products of a troubled teen's subconsciousness.


And that is imho how and why Eric was misdiagnosed. He was given treatement and medicine for a mental ilness he never had. No wonder this did not help him.

I don't know what Eric's exact diagnoses would be. I know many of his symptoms like an inability to deal with anger, deep depression ,deep insecurities and so on. I don't however believe he was a psychopath at all.
I don't really want to get into a debate about it however as it is nothing but a circular argument. One side presents their reasons for why they believe he was, the other side presents their reasons for why they think he wasn't. And I don't think either side ever convinces the other.

I'm not saying its not worth discussing if people wish to .I just wearied of the extensive debate about it a long while ago.

PaintItBlack wrote:

I don't know what Eric's exact diagnoses would be. I know many of his symptoms like an inability to deal with anger, deep depression ,deep insecurities and so on. I don't however believe he was a psychopath at all.
I don't really want to get into a debate about it however as it is nothing but a  circular argument. One side presents their reasons for why they believe he was, the other side presents their reasons for why they think he wasn't. And I don't think either side ever convinces the other.

True enough, though I think the evidence is clear that whatever he had it was certainly not OCD. At the same time, there are very real and valid reasons why the therapist was under the impression that it migth be OCD.

The problem is he may not have needed the meds. If someone who takes an SSRI doesn't actually need it then it can make them sick. Its called Hypo-Mania. Too much serotonin will cause great mood swings and violent thoughts and actions are common. I can speak from experience as my doctor diagnosed my depression wrong once and the next month after that was hell for me. I have scars left on my arm because one night I had the compulsion to see blood. It can get bad. From the sound of things Eric went through something similar. I'm not saying he didnt have problems, but I don't think OCD was one. It honestly sounds like a misdiagnosis or a doctor not taking their patient seriously. Eric didn't even have to lie for that to happen. I was always honest with my doc and there were a couple times where he clearly thought I had problems that I don't. Doctors do get sloppy. Personally I think the Luvox was a big part in him carrying the attack out. Chemically induced anger is the worst kind. You can't talk out the chemicals flowing through your veins.

Thank you for your perspective Nirvana. I think the meds and him cycling on and off on them must have played some part in what happened. We are our brain chemistry in a fundamental way.

Nirvana92 wrote:

The problem is he may not have needed the meds. If someone who takes an SSRI doesn't actually need it then it can make them sick. Its called Hypo-Mania. Too much serotonin will cause great mood swings and violent thoughts and actions are common. I can speak from experience as my doctor diagnosed my depression wrong once and the next month after that was hell for me. I have scars left on my arm because one night I had the compulsion to see blood. It can get bad. From the sound of things Eric went through something similar. I'm not saying he didnt have problems, but I don't think OCD was one. It honestly sounds like a misdiagnosis or a doctor not taking their patient seriously. Eric didn't even have to lie for that to happen. I was always honest with my doc and there were a couple times where he clearly thought I had problems that I don't. Doctors do get sloppy. Personally I think the Luvox was a big part in him carrying the attack out. Chemically induced anger is the worst kind. You can't talk out the chemicals flowing through your veins.

I can't even imagine cycling on and off SSRIs. His brain was probably fried and his attention span shot by the time NBK came about. I do kind of understand what he meant by doing it to gain self awareness. I've seen it mentioned on here before, but SSRIs are in the same family as LSD, mushrooms, mescaline, etc. Does it make one "trip"? No. But it does make a person delusional to the point that they think they're godlike. Its a hard experience to describe. This is what makes me believe he was hypo-manic. Of course that's just my theory.

Nirvana92 wrote:

The problem is he may not have needed the meds. If someone who takes an SSRI doesn't actually need it then it can make them sick. Its called Hypo-Mania. Too much serotonin will cause great mood swings and violent thoughts and actions are common. I can speak from experience as my doctor diagnosed my depression wrong once and the next month after that was hell for me. I have scars left on my arm because one night I had the compulsion to see blood. It can get bad. From the sound of things Eric went through something similar. I'm not saying he didnt have problems, but I don't think OCD was one.

I entirely and full heartedly agree, as I was hoping my first post would be a clear indication of.

Nirvana92 wrote:

It honestly sounds like a misdiagnosis or a doctor not taking their patient seriously. Eric didn't even have to lie for that to happen. I was always honest with my doc and there were a couple times where he clearly thought I had problems that I don't. Doctors do get sloppy. Personally I think the Luvox was a big part in him carrying the attack out. Chemically induced anger is the worst kind. You can't talk out the chemicals flowing through your veins.

I'm sure it is a misdiagnosis, but I also think that given the information available, it was not a stupid thoughtless mistake by the therapist. Even if Eric presented the issue clearly, the homicidal and suicidal ideation symptome realy does happen with people who have OCD. OCD is also far more common in teenagers than what Eric seems to have had.

I'd be very carefull about blaming luvox as a big part in this. Luvox or other selective serotonin reuptake inhibitors may indeed cause felings of anger or violent thoughts. However, these come and pass. Luvox could explain Eric impulsively reacting to some particular event.

Planning a spree killing for many months, constructing explosives and writing quite clear and coherent journal entries all point to a long-term behavioural pattern and an inner-belief system driving this. Neither looks like SSRI effect, whcih are intense, but short-term in the vast majority of case.