By Dr. Carol Paris

NOTE: In 2009, Dr.Carol Paris, a psychiatrist, created a diagnosis of Private Insurance-Induced Stressed Disorder (PIISD, pronounced “pissed”) to describe the suffering that people experience at the hands of private health insurance. Since then, the increasing privatization of health care in the United States, including privatization of public insurances and consolidation of private health facilities, necessitated that the diagnosis and criteria be updated. Thus, the new diagnosis is Pivatization-Induced Stress Disorder (PISD, still pronounced “pissed”).

Diagnostic Criteria for PISD:  Privatization-Induced Stress Disorder

The essential feature of Privatization-Induced Stress Disorder (PISD) is the development of characteristic symptoms resulting from the privatization of the US healthcare system (including public insurances, e.g. Medicare and Medicaid).

Similar to some forms of Post-Traumatic Stress Disorder (PTSD), this disorder is prone to be severe and sometimes fatal because the stressor is of political/corporate design.

Diagnostic Criteria for PISD include:

  1. Exposure, including at least one of the following:

  1. Uninsurance, due to cost or inability to qualify for Medicaid,
  2. Underinsurance, due to cost,

resulting in intense anxiety, fear, helplessness and anger caused by financial considerations that seriously complicate one’s timely medical treatment and recovery.

  1. Reexperiencing, in one (or more) of the following ways:

  1. Feelings of anger, frustration and shame at the thought of one’s inability to access care when it was needed,
  2. Feelings of alienation from and abandonment by one’s elected officials, precipitated by encounters with elected officials and/or exposure to any form of corporate-controlled news media misinformation about the cause of the epidemic,
  3. Avoidance of seeking needed medical care due to fear of serious financial strain or even bankruptcy.
  1. Persistent Avoidance of any stimuli associated with the epidemic, including:

  1. Efforts to avoid thoughts, feelings or conversations about the privatized health care system,
  2. Efforts to avoid interactions with physicians, hospitals, or health centers other than free clinics,
  3. Restricted range of affect (unable to experience feelings of well-being),
  4. Sense of foreshortened future, chronic illness or untimely death due to the privatized health care system.
  1. Persistent Symptoms of Distress, as indicated by the following:

  1. Difficulty falling asleep or staying asleep due to chronic worry about the privatized health care system,
  2. Irritability,
  3. Difficulty concentrating,
  4. Hypervigilance (eg, won’t let children play on playground equipment for fear of an accidental injury resulting in possible retraumatizing need to interact with the privatized health care system).
  5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With bankruptcy
With home foreclosure
With chronic inadequately-treated illness
With death

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