In Episode 29: Mental Illness & Suicide we touched on the difficulties in diagnosing mental illness. Mental illness is usually diagnosed by the symptoms. There is a lot of overlap between diagnostic groups and symptoms. A particular symptom may be characteristic of numerous diagnoses. For example, depressive symptoms such as sadness and lethargy, are associated with the diagnosis of major depression. However, persons with schizophrenia, bipolar disorder, substance abuse, borderline personality, and even physical ailments like heart disease may present with depression.
Diagnosing Mental Illness from the Internet
People often search the web and find a description of certain mental illnesses. They can become convinced that they or a loved one has a particular condition. Of course the same thing happens with physical ailments. “Dr. Google” can lead us to think we have all kinds of medical conditions. There are also certain fads or trends of internet diagnoses. Right now, everyone coming into my office is married or dating a “narcissist” (a person with a narcissistic personality disorder). Having a diagnosis may feel reassuring and explanatory. “So that’s why he does that!” https://www.youtube.com/watch?v=uic_3vlI5BE
It’s understandable that we want to have a label for what is wrong. Generally speaking it is best to leave diagnosis to a professional. In addition, we are usually too closely involved to be objective. The role of a concerned person should be to encourage them to seek help rather than diagnosing.
Severity of Problems in Diagnosing Mental Illness
The mere presence of a mental health symptom is not indicative of mental illness. It is the severity of the symptom that is often the most important. For example, after a traumatic event, such as a car accident, almost everyone will experience increased anxiety or perhaps nightmares. However, for most people those symptoms abate after a few weeks. For people with PTSD those symptoms persist far longer, months or even years. The symptoms experienced by persons with mental illness are also much more severe, negatively affecting multiple aspects of the person’s life. The problems they experience are not just inconvenient, but limiting. The mentally ill person may find it difficult to have relationships, hold a job, refrain from substance use, sleep normally, or even leave their home.
Medical Tests in Diagnosing Mental Illness
For the most part we do not have medical tests for diagnosing mental illness. There’s no blood test or physical marker that we can look for to aid us in diagnosis. There have been some studies that show promise for the use of advanced techniques like brain imaging, however, such methods are expensive and not very practical at our current level of technology. For the most part clinicians must look at the presenting symptoms. Another important aspect in diagnosis is gaining a clients trust. After all, people don’t generally open up about their deepest traumas the first time you meet them.
Getting a New Diagnosis
Patients express concern when they have received a new or additional diagnosis after visiting a different mental health professional. “My new doctor says that I have bipolar disorder, not depression.” As with physical medicine, mental health professionals have differing opinions about the best diagnosis for health conditions. Often, those opinions are informed by the experience of the professional in treating certain conditions. The really important thing is the treatment itself, not the diagnosis. This is especially true because of the symptom overlap issue.
In Summary…
Diagnosing mental illness is based on a sophisticated understanding of the symptoms the patient presents. Diagnosis is determined by the specific symptoms, the experience of the professional, the personal history of the patient, the severity of the symptoms, and how long they have lasted. There is a lot of overlap of symptoms across diagnostic categories. Different professionals may give varying diagnoses. More important than the diagnosis is how the condition is to be treated. The goal is to reduce the negative symptoms of mental illness and improve the overall quality of daily life.