When Your Adult Child Breaks Your Heart

Coping with mental illness, substance abuse, and the problems that tear families apart

The Importance of Your Diagnosis

Why your diagnosis matters and how to get the right one.

If you're contemplating therapy for the first time, you might think of this new adventure as little more than a chance to talk about your feelings and ventilate your frustrations. To the millions of Americans who experience mental health disorders, though, a therapist isn't just a paid friend, and no mental health professional should view therapy through this lens. The diagnosis you receive affects everything from the medication you'll need to how long therapy will take, and you shouldn't tolerate mental health care that doesn't aim for a clear diagnosis.

Why Your Diagnosis Matters

Put simply, your diagnosis should direct the course of treatment. While making general lifestyle changes and talking about your problems can aid in treating just about any mental health condition, this alone is not enough. Every mental health disorder has its own set of treatment protocols. A person with generalized anxiety disorder, for example, is much different from a person who is anxious because she suffers from post-traumatic stress disorder. A clinician who doesn't realize that anxiety is spurred by trauma may spend months or even years treating the anxiety without seeing any progress. Likewise, many disorders can cause symptoms of depression, but this doesn't mean the person with these disorders has depression. A man who struggles to get his work done due to ADHD may become depressed, and the exhaustion of managing schizophrenia can be similarly depressing.

Sometimes misdiagnosis can lead to serious problems. Bipolar disorder, particularly in its early stages, can look a lot like major depressive disorder. Among people with bipolar, though, antidepressants can spur manic episodes and do little to treat the condition. Astute clinicians engage in careful diagnostic tactics to prevent such misdiagnosis, but some clinicians rush through diagnostic interviews and assume that, because depression is common, it's the most likely option. You will get better more quickly and experience fewer treatment-induced side effects if you get the right diagnosis early in the treatment process.

The Right Diagnostic Methods

There are several different ways to diagnose mental health disorders, but they inevitably require a time investment. A treatment provider who rushes through your first session or who doesn't ask any questions may miss your diagnosis. Until there's a blood or other medical test for mental health conditions, you should judge your treatment provider according to how much effort he or she puts into determining whatif anycondition you have. Our clinic has a special diagnostic screening procedure that is tailored to the individual patient. The goal is to get a baseline of the patient's symptoms and functioning, which can help create a roadmap for treatment. This process includes paper/pencil inventories as well as computer-based assessments. We also make sure to obtain feedback from a collateral source, whether a spouse, parent, teacher, friend, or combination thereof.

Treatment teams who do not have a formal diagnostic testing procedure in place should take extra care in their interview to get as much information as they can. Things to consider include:

• Does the clinician accept everything I say, or does she ask probing follow-up questions?

• Does my treatment provider ask for information from close family members or my spouse? A mental health professional can only do this with your permission, but clinicians are more likely to get an accurate diagnosis when they strive to get the perspective of an outside observer to whom you are close.

• Do you feel rushed? If so, it could be time to move on.

• Does your clinician explain what tools he or she is using to diagnose you?

• Does your treatment provider seem interested in getting feedback from you?

• Does your clinician ask about your lifestyle? He or she should be screening for environmental hazards, relationships challenges, substance abuse, and similar issues that can undermine your mental health.

• Do you feel comfortable sharing your opinions? Does your treatment provider adjust her own perceptions based on information you give?

• Does your treatment provide seem to have any biases? For example, does he harbor stereotypes about women or does he advocate for a specific religion? If so, you might not get an accurate diagnosis.

• If you have other treatment providerssuch as a second therapist, a medical doctor, or a marriage counselordoes your treatment provider collaborate with them?

• Is your clinician interested in getting a full history of your mental and physical health?

• Does your clinician ask about specific symptoms?

Advocating for Yourself

Ultimately it is the responsibility of your treatment provider to accurately diagnose you. However, by being a good advocate for yourself, you can expedite the diagnostic process and ensure the first diagnosis you get is the right one. Try some of these tips for the best possible outcome:

• Ask close loved ones for input on your symptoms, and consider inviting your spouse to sit in on a session and offer feedback.

• Try to provide some objective measure of your symptoms. For example, you might keep a log of your feelings for a week or rate your depression on a scale of one to 10 over the course of a month.

• Be honest about your previous history of mental illness, as well as your current symptoms. Withholding information only stalls the diagnostic process.

• If you disagree with something your treatment provider says, speak up. And if your treatment provider pushes a specific philosophy or disregards your values, find someone else.

• When your symptoms change, let your treatment provider know, particularly if you begin experiencing new symptoms.

• Let your doctor know if you're struggling with side effects or if there are particular side effectssuch as sexual dysfunctionthat you feel you can't tolerate.

• Track your progress. If you're not getting better after a few months, it may mean it's time to try a different treatment option.

• Ask your treatment provider specific questions about why she has chosen a particular treatment and how long you can expect to wait prior to seeing progress.

Everyone hopes there will someday be a time when mental health diagnoses are as easy as diagnosing a bacterial infection, but that day may never come. And until it does, clinicians and their patients must work together to get the best diagnosis possible. Doing so can be an ongoing process rather than something that just happens once, as diagnoses can change and evolve over time.

References:

Diagnosis of mental illness hinges on doctor as much as symptoms. (n.d.). Retrieved from http://behaviorhealth.org/diagnosis_of_mental_illness.htm

Ghaemi, S. N., Wingo, A. P., Filkowski, M. A., & Baldessarini, R. J. (2008). Long-term antidepressant treatment in bipolar disorder: Meta-analyses of benefits and risks. Acta Psychiatrica Scandinavica, 118(5), 347-356. doi: 10.1111/j.1600-0447.2008.01257.x

 

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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