The DSM V, or the “Diagnostic and Statistical Manual -5th Edition,” just came out last year. In this new edition, many new diagnoses were added, changes were made to the criteria of some of the DSM IV disorders, and some diagnoses were removed all-together. The process through which I imagine all of the new criteria and categories coming together (a bunch of experienced and respected psychologists and psychiatrists sitting around a conference room, shaking their fists and turning red as they debate theory and research) is not far from the actual process that occurs.
Yes, each change is subject to great scrutiny, review, thinking and overthinking, and often debate: Should Asperger’s be in the same diagnostic category of autism? Yes. Is it helpful to split hairs about the different types of schizophrenia? No. Is it technically depression if the person’s state exists as a result of prolonged bereavement? Yes. Should ADHD-Inattentive type be categorized as something completely different, having nothing to do with the hyperactive type? No. How do we minimize the over-diagnosing of pediatric bipolar disorder? Add Disruptive Mood Dysregulation Disorder as a possible differential diagnosis.
And all of this categorizing is important. To an extent. When I’m treating someone, I need to differentiate the volatility that is confined to the context of attachment figures (Jimmy keeps biting his foster mom) vs the irritability that comes with a hypomanic episode (Jimmy is talking fast and punched a hole in the wall after staying up all night)vs the outburst that comes from PTSD flashback (Jimmy attacked a guy that looked like his assaulter and is having flashbacks) vs the anger that comes from lack of impulse control with ADHD and a learning disability (Every day during math, Jimmy gets sent to the office). These nuances make the difference between initiating family therapy vs DBT and medication vs a tutor, behavioral intervention, and an IEP. And the psychiatrist had better get that right as well, since diagnostic subtleties can make the difference between sending the patient out the door with no medication and sending the patient out the door with a mood stabilizer.
SO. While diagnoses can clearly be incredibly important, here are three ways in which diagnoses can actually be unhelpful.
- When the diagnosis is explained (or interpreted) as overly-limiting. The hairs on the back of my neck get prickly whenever I hear a person with anxiety say they’ll never drive or a person with depression explain how they will never be able to finish college. Sometimes it’s a big deal just to get out of the house. Oh, what’s that? There’s such thing as online classes and accommodations? Solution: Discuss your goals with your therapist, and devise a realistic plan to start moving toward those goals in the context of treatment.
- When it’s wrong. I had a young woman in therapy who had gone her whole life being diagnosed with anxiety (preoccupied, insecure). Once an evaluation revealed ADHD inattentive type (often overlooked in girls who don’t “get in trouble”), she was prescribed a stimulant and behavioral therapy. Her well-being, relationships, and work functioning improved dramatically. Solution: Make sure you ask your therapist and/or psychiatrist an important question: “What are the differential diagnoses, and how did you come to the conclusion that your diagnosis is correct?”
- When it becomes your identity. Sometimes, instead of a person thinking “I am a person who has unique struggles,” a person begins to think “I am a unique struggle.” His/her growth as well as personal relationships may become stunted as a result. (“Hi. It’s nice to meet you. I am anxious and depressed, and I’ll probably lead most interactions with how anxious I feel that day, and completely ignore other aspects of who I am, what I feel, and what I think.”) Solution: Try to incorporate at least one conversation or activity into each day that is completely unrelated to your diagnosis. You are a multifaceted and complex person who happens to have a diagnosis.
Yes, a mental health diagnosis can offer understanding, provide relief that you are not alone, and inform therapy. However, when thinking about your own diagnosis, please also consider these common ways such a label is actually not helpful at all…..
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