Prior to the turn of the 20^th century mental health disorders weren’t viewed as something that belongs to the medical domain. Then came the work of Sigmund Freud, Carl Jung, and other notable psychiatrists. This triggered what some call the modern era of mental health. As a result of this paradigm shift, mental health conditions came to be viewed as a part of the spectrum of medical conditions.

With this view of mental health conditions came the application of the standardized medical model which includes:

1. Observation: The collecting of pertinent information regarding the bio/psycho/social aspects of the patient.
2. Assessment: A review of observations, including interviews and testing results in a collection of data.
3. Diagnosis: Based upon the data collected a systematic process the most appropriate diagnosis is made.
4. Treatment: Usually driven by diagnosis, treatment for the condition is introduced.

As treatment begins, typically one of the most common questions asked by a client is, “What do I have Doc?” For many the answer comes quickly and often easily. Others can present as a moving target, making it difficult to establish a diagnosis.

On a more cautionary note, it must also be acknowledged that there are mental health professionals who prefer not to communicate the diagnosis to clients. For some it is viewed as labeling the client and depersonalizing them to being a symptom rather than a person. They feel that applying standardized medical model of doctor-patient relationship to mental health conditions is detrimental for therapeutic effects. That is why mental health patients most often called “clients”. Whether you agree or not the diagnostics remain a critical part of treatment, whether it’s communicated to clients or not.

Why is a Diagnosis Important?

If you fell and broke an arm you would expect more from your doctor than a simple response to your explanation of what happened then, “Sounds like you sprained a muscle. Just apply some hot packs for a couple of days and it will be fine.” No, you would expect him or her to follow the above medical model protocol.

As with any condition several factors are impacted by a diagnosis. These include more than the prescribed treatment for the condition. It also points the treating professional to available options, recommended treatments, tests, certain preferred medications, the need for a specialist, probable prognosis, need for hospitalization, and billing for services.

The Tools of the Trade

When making a mental health diagnoses, the treating professional has a whole bag of tools available. An experienced practitioner will begin with a sense of your presentation formed by their observations. Depending on the complexity of your situation they may consult with peers and specialist, conduct additional personal research, and make use of the bible of mental health treatment, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

For most practitioners use of the DSM-5 is the backbone of their diagnostic work. Periodically updated the DSM series is a collection of clinical and research based data filtered through panels of experts. The goal is to provide a reference document for professionals. This 947 page book contains all of the accepted mental health diagnoses, a list of symptoms for each one, a history and overview of the condition, and related conditions. There also are several decision making tools to assist in making the best diagnosis.

The DSM-5 also serves as the “gold standard” for the U. S. Government, state funding agencies and all insurance companies for qualifying for reimbursement.

Diagnosing: Science or Art?

One of the most misunderstood activities in medicine is clearly identifying the problem.  Most patients simply trust their medical professional with having the right opinion about a condition. Unfortunately, in many situations coming up with the “right” diagnosis isn’t always easy. Based on volumes of collected data, experiences, and the use of science some specialty areas have a reasonably clear path to making the right decision. Others do not.

More than in any other field of medical specialty making a correct mental health diagnosis can be as much an art as a science. Intuition, experience, and observations are the primary resources available. To further complicate things, over time new information and additional observations can require a change of diagnosis.

Diagnostically Driven Treatment Planning

The current model of delivery of mental health services in the U.S. calls for the development and implementation of a diagnostically driven treatment plan. Below are the broad DSM-5 classifications of mental illnesses:

• Anxiety Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Disruptive, Impulse-Control, and Conduct Disorders
• Feeding and Eating Disorders
• Neurocognitive Disorders
• Neurodevelopmental Disorders
• Obsessive-Compulsive and Related Disorders
• Personality Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Sexual Dysfunctions
• Sleep-Wake Disorders
• Somatic Symptom and Related Disorders
• Substance-Related and Addictive Disorders
• Trauma- and Stressor-Related Disorders

Within each of the above headings are specific diagnoses included in the category. For example, under the heading of depressive disorders are eight separate types of depression. Within Bipolar and related disorders are seven forms of Bipolar.

Each diagnosis takes into account several unique features present. Areas such as psychotic features, age, what if any, social/cultural Influences can affect the condition, and other general medical conditions that may contribute.

Another factor contributing to a mental health diagnosis being more art than science is how often treating professionals disagree among themselves over a diagnosis. What one sees as major depression another might view it as a bipolar condition.

Other Considerations

So what? Having a working diagnosis comes with its own set of unique treatment approaches. While most often minor there can be significant treatment repercussions if a therapist is not aware of the proper diagnosis. Treating someone for depression and finding your client swinging into a manic phase of a bipolar condition can be troublesome.

This same principle holds true if medications are prescribed. In the pharmacological world of today more and more drugs are symptom specific. If a client is experiencing psychotic symptoms and the therapist is unaware of it, this can lead to major misunderstandings about the behavior of the client.

Providing the best data available and translating that data into an accurate diagnosis can be the key to giving a client the tools to live a more meaningful life.

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