Hello, I’m Jeremy Winn, Licensed Clinical Social Worker. Today I would like to talk about mental health diagnosing and my perspective on its relationship to therapy and how it informs my practice.
One of the reasons why I wanted to address this topic is that it is common when people are looking into therapy that they are trying to find out what is wrong with them. Usually they have exhausted many other options and have yet to find resolution to the issues or problems they are faced with. When people get to a place where their normal way of coping isn’t working they may start to wonder if they are going crazy, especially if it relates to the realm of mental health. When someone makes it to therapy they often ask or wonder, “What is my diagnosis?”.
The DSM-V or Diagnostic and Statistical Manual of Mental Disorders (5th edition) is published by the American Psychiatric Association. The first edition was published in 1952. It is used in mental health clinics, hospitals, and mental health providers wherever mental health diagnoses is used. The International Classification of Disease is another popular diagnostic manual that is published by the World Health Organization. It is on its 11th edition.
In these manuals you will find all sorts of mental health diagnoses; from your childhood disorders like Attention Deficit Hyperactive Disorder (ADHD) and Oppositional Defiant Disorder (ODD), to your Mood and Psychotic disorders like Major Depression, Schizophrenia, Generalized Anxiety, and Bi-polar, to your trauma and eating disorders like Post Traumatic Stress Disorder (PTSD) and Anorexia, to your personality disorders like Borderline, Histrionic, and Narcissistic Personality Disorder.
In order to be diagnosed with one of these diagnoses you have to meet a certain number of criteria. These criteria are related to a persons mood/emotions, thought processes, and behavior. If you have ever read through one of these manuals or looked up a diagnosis and read the criteria you may have thought, “Oh my, I have all of these symptoms”. I remember when taking my first diagnostic class in graduate school I was like, “Oh my gosh, I have this” after each new diagnosis I studied.
While most of us have experienced many of the symptoms listed in the criteria, it is important to remember that there are very specific guidelines about onset, duration, frequency, and intensity of the symptoms listed in order to qualify for a diagnosis. Also, these symptoms have to be causing significant distress or impairment to one’s daily social and occupational functioning. This means the person is not able to or is experiencing extreme difficulty working or keeping a job, performing in school, making and maintaining positive relationships etc. When we consider the level of impairment needed, most of us can give ourselves a break and not think we have every diagnosis in these books.
When you go see a therapist, they will formulate a provisional or working diagnosis. It is based on an initial assessment and may be updated through observations made during treatment. Some may want to get really specific information on their diagnosis and will get additional psychological testing. There they may complete a number of battery of psychological tests that will clarify their diagnosis.
My purpose today is not go through the whole DSM and discuss each individual diagnosis, but I would like to share a little bit about the value I find in mental health diagnosing. First, I think it has helped legitimize and professionalize the behavioral sciences. Second, mental health diagnosing is used by insurance companies for payment or reimbursement of therapy. This promotes people getting the support they need through psychotherapy so that they do not have to carry the burden of the full share of cost.
Third, it is a way for mental health professionals to consult and communicate about cases in quick and succinct way. Instead of having to list every symptoms problems and behavior, the other professionals can get basic or general idea of what is going on with the case by using a diagnosis. Fourth, it is important for doctors or psychiatrists to have an accurate diagnosis when they are prescribing medication for mental health purposes. You don’t have to be a doctor to understand how careful one must me when dealing with the neurobiology and brain chemistry of a human being.
Finally, a mental health diagnosis can give a person who is struggling some clarity and understanding about what is going on with them. This can be very powerful, especially in the beginning phases of treatment. For me, when I see someone for the first time in a therapy session, their diagnosis is not going to have a drastic impact on my approach to therapy. I am still going to start where the individual is at, what is their presenting problem, what brought them in to my office, and what motivated them to seek treatment or therapy.