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Getting a Mental Health Diagnosis

Personal and family history are important information in diagnosis.

Key points

  • Mental health disorders are common worldwide.
  • Different mental health conditions can have overlapping symptoms.
  • Clinical experts align their diagnostic assessment with the ICD and the DSM.

Mental illness is common. Each year, millions of people are diagnosed with some form of mental, behavioral, or emotional disorder, which may or may not be accompanied by some degree of functional impairment. Depression alone affects 300 million adults worldwide. Post-traumatic stress disorder is common after highly threatening or disruptive events and is especially rife in countries affected by war and conflict. Schizophrenia affects about 1 in 300 people worldwide, and while those affected may experience difficulties with cognitive functioning, effective treatments are increasingly available.

Symptoms of most mental health disorders and the ability to function improve with treatment, which may include psychotherapy, medication, or techniques such as brain stimulation. The existence of effective treatments makes a strong case for seeking a diagnosis. According to the U.S. National Institute of Mental Health, fewer than two-thirds of all those with a mental illness receive mental health services each year.

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How is a mental health diagnosis made?

Mental health disorders may be manifest in observable cognitive, emotional, and behavioral disturbances, but accurate diagnosis often cannot be based solely on the presence of such symptoms. For one thing, psychiatric disorders often have overlapping symptoms, such as memory disturbance, cognitive difficulty, or low mood. Problems with impulse control, for example, typify attention deficit hyperactivity disorder, but they also are common in conduct disorders, developmental disorders, and bipolar disorder.

Further, symptoms of mental disorders can overlap those of physical conditions: for example, the lethargy commonly seen in depression is also typical of thyroid disease. Neural inflammation can create an array of psychiatric symptoms and has been linked to depression, obsessive-compulsive disorder, and other mental health conditions.

As a result, a physical examination is often required to rule out physical problems that could be creating mental symptoms. In addition, laboratory tests may be helpful for screening out such possible causes as thyroid disease or drug use.

The importance of history

Diagnosis, usually made by a clinical psychologist or psychiatrist, both of whom have doctoral degrees, requires the assessment of a lot of information gathered from an individual seeking help. It usually starts with a clinical interview in which the person provides a detailed symptom history in response to many questions. A person will be asked about their main concerns, when symptoms started, under what conditions symptoms are most intense, and how the symptoms affect everyday functioning. A personal history is important as well, and it typically includes questions about upbringing, family relationships, and childhood experiences.

In addition, a family history of behavioral issues, mental symptoms, and disorders can aid individual diagnosis. Besides a personal and family history, information about lifestyle can provide valuable diagnostic clues: Questions about work, relationships, and leisure can reveal stresses that are causing or contributing to symptoms.

Skilled diagnosticians not only consider the answers to all such questions in establishing a diagnosis, they also take into account a person’s emotional tone, demeanor, attitude, appearance, and responsiveness. What’s more, they are also assessing a person’s mental status, such as the ability to think clearly, remember facts, and sustain attention.

Diagnosis may also involve the use of psychological screening tools, in which a person fills out a short questionnaire that can reveal symptoms related to a disorder or assess the severity of symptoms. Such screening tools may be helpful in clarifying a diagnosis related to stress, depression, forms of anxiety, and insomnia.

According to the ICD and the DSM

Once the information-gathering is complete, clinical experts align their diagnostic assessment with the comprehensive classification of mental health disorders known as the International Classification of Diseases as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). These are updated as research and clinical data add to the knowledge base, they list specific criteria for establishing the diagnosis of every recognized mental health condition.

The specificity of the criteria can be especially clinically helpful in distinguishing disorders that share symptoms. For example, major depression and bipolar disorder are both characterized by extensive periods of low mood, and depressed mood may be the presenting complaint of a person seeking help. But bipolar disorder can be diagnosed only after careful information-gathering reveals a history of one or more episodes of mania or its more subtle variant, hypomania. In such a case, as in all others, differential diagnosis is extremely important for determining the most helpful treatment.

Once a diagnosis always diagnosis?

A mental health diagnosis is not necessarily a lifetime pronouncement. Like other illnesses, psychiatric disorders can vary in duration and intensity, and many individuals recover fully from an episode of mental illness or experience sufficient alleviation of symptoms that they no longer meet the criteria for a diagnosis.

Even for chronic conditions such as schizophrenia and bipolar disorder, the most effective interventions for mental health disorders usually involve education, lifestyle changes, and social support as well as medication and psychotherapy (which can be viewed as a form of education). It is increasingly the mark of modern care that, after an acute episode of illness, diagnosis and treatment involves helping people understand their own vulnerabilities so they can manage their lives in the most healthful ways possible.

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