In 2010, I desperately wanted a diagnosis of Asperger's syndrome. Yes, you read that right: I wanted to be clinically aspergic. You see, I was already certain I was aspergic, based on my poor social skills and weird personality. The reason I wanted the diagnosis was confirmation: proof that my weirdness wasn't my fault. So imagine my disappointment when the doctor refused to diagnosis me with Asperger's, merely on the grounds that he didn't think I had it.

If you're interested, the full report is below.

Dear Dr Knight

Re: Paul PIETRZAK

Thank you for your referral. I assessed Paul at Turbary Park Outpatients on 19th May 2010. He is a 23-year-old man, he is single and has not had any previous relationships. He lives in a private rented flat where he has been for the past 10 months. He has been working as postman, he is originally from Birmingham and has lived in Bournemouth for the past year. His parents live in Birmingham. He is a car driver. In terms of finances he says is careful with money and has some savings.

Paul feels he has Asperger's Syndrome, however he did not think anything was wrong with him until a few months ago, and subsequently he started keeping a diary. He had noted that he had been anxious at times. He only felt safe in his bedroom, he was anxious being around people. He was always worried what people thinking about him, one months ago he had phoned his mother, at which point she had informed him that his brother had been diagnosed with Asperger's Syndrome many years back, and his mother had told him that he may have problems similar to Autistic Spectrum Disorder. He feels his brother has always been quite different to him, his brother has OCD and he touches and taps things quite often. He says his brother has a narrow repertoire of interests.

In terms of mood, he feels he is not happy. His appetite is variable, he does not feel hungry much, with regard to sleep, he feels he is sleeping much better now. He used to have insomnia, he attributes the difference in appetite and sleep due to him starting a gluten free diet about two weeks ago which made a big different to his way of thinking and the way he felt about himself. In terms of interests he says there are not many, he does watch TV, goes on his laptop often, surfs the internet and plays the guitar, he also does snowboarding. He has been volunteering at clubs to meet people as well. He had done martial arts for 6 months while at university. He describes his concentration levels have been good but energy levels variable.

Self Harm

He has never previously self-harmed. Never tried to end his life.

He denies psychotic symptoms

Past Psychiatric History

No previous contact with psychiatric services.

Family History

His mother is currently in a psychiatric ward with depression, she has tried to end her life and taken overdoses. No history of suicide in the family. He has 3 siblings.

Medical History

Nil of note. No known allergies to medication, currently not on any prescribed medication.

Personal History

He was born in Birmingham where he grew up until about a year ago when he moved to Dorset to start his job as a postman. In terms of childhood, he was happy until the age of 11 years when he had to move to secondary school, he was bullied there, he is quite bright, he has been a member of Mensa from the age of 14 and has an IQ of around 150. However, he says that he did not like the Mensa group meetings, as they were mainly older men who he thought were "geeky". His parents are still together and they brought him up, he was close to both of them. He denies any childhood abuse issues. While at school he had some friends, especially after the 6th form, he hung around with a group of people. He did A levels, he managed a B, C and a D and went to University and completed a 3-year course in biology and environmental science, obtaining a BSc. As he did not feel ready to get a graduate job he initially did a temporary job at Sainsbury’s and then had been successful at getting a job as a postman in Dorset.

Relationships

He had girlfriends around the age of 11-12 but not since. He says this is due to lack of trying, as he is not particularly interested currently. He describes his libido is quite good but may have been adversely affected by the recently started gluten free diet but he could not be certain regarding this.

He smokes occasionally, drinks alcohol also very occasionally and does not use illicit substances regularly. He had taken methadrone about a month ago but denies any heavy or regular illicit substance use.

Forensic History

Nil of note. No history of being aggressive.

Pre Morbid Personality

He describes himself as serious, quiet and an unhappy person.

Patient needs

He wants to know whether he has Asperger's Syndrome and he just wants to diagnosis clarified. No other requirements or needs.

Mental State Examination

Well dressed pleasant Caucasian man with good self-care, had good rapport and eye contact. Spoke well at normal rate and volume, was able to engage well and showed he could appreciate humour. There were no specific problems relating to reciprocal social interactions. Mood subjectively low, objectively euthymic, has a reactive affect. No formal thought disorder, no paranoia, no delusional ideations. Denies ideas of suicide or self harm, no thoughts of harm to others, denies experiencing abnormal perceptions. Well orientated in time, place and person and shows good insight.

Assessment

1.    Need further assessments with regards to Asperger's Syndrome but there is not initial impression of him having strong features of Asperger's Syndrome.

2.    No evidence of clinical depression.

3.    No evidence of psychosis

4.    No ideas of suicide or self harm, no thoughts of harm to others.

Management Plan

1.    He remains free of psychotropic medications

2.    I will review his progress in 4 weeks

3.    Based on current presentation all his risks appear to be low

Yours sincerely

Dr Chamath Rampathirana

Associate Specialist

North Bournemouth CMHT

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Clinic: 21st June 2010

Typed: 5th July 2010

Dear Dr Knight 

Re: Paul PIETRZAK

I reviewed Paul's progress at Turbary Park outpatients on 21st June 2010 and together we went through the diagnostic criteria for Asperger's disorder. Paul agrees that he does not seem to meet the criteria formally. My impression is that he does not have strong features of Asperger's disorder but could have traits of it. However, he is able to function reasonably well in the community and is able to hold down a job apart from the fact that he may appear somewhat aloof from his colleagues. In my interviews with him on both occasions, there was no evident problem of reciprocal social interaction and he seems to have a good sense of humour.

There are no other concerns regarding his mental health, his mood is well settled, clearly he doesn't have severe mood disorder or psychotic symptoms, he doesn't have thoughts of harm to himself or others. He remains free of psychotropic medications currently.

Management Plan

I have not arranged any further outpatient appointments and have discharged him back to your care.

Based on current presentation risk of violence = low, suicide = low, neglect = low.

Yours sincerely

Dr Chamath Rampathirana

Associate Specialist

North Bournemouth CMHT