Psychiatric Diagnosis: It Takes a Village

Any physician will tell you that a doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment. This is especially true with psychological symptoms, when a mind - already troubled and in pain - is asked to objectively describe problems it's having with itself. Here are a few ways you can make sure the information that goes into your diagnosis is likely to lead to the right treatment:

Get a physical: In the fall I turned 28, I was suddenly exhausted. Nothing hurt; I just had to drag myself out of bed every day. I didn't feel like going out or socializing. The few times I made it to the gym, I felt like I was aerobicizing in Jell-O.

After about six weeks of this, I was in a serious funk. On a whim, I popped into a local doc-in-the-box, who took about 3 minutes to tell me I had a bad ear infection and hand me a prescription for Amoxicillin. Seventy two hours later, I was back to normal.

The interplay between physical and mental illnesses is tricky. Both can occur simultaneously, independently, or interact with each other. They can also look alike; infections and thyroid problems can mimic depression, a vitamin B deficiency can distort reality, and hypoglycemia can mimic ADD. Both can occur simultaneously, independently, or interact with each other. A physical problem can make a coexisting mental illness worse and vice versa. Bottom line: Whether or not you have a history of mental illness, always rule out physical problems should your symptoms reoccur, especially if some of your symptoms are not explained by your psychiatric diagnosis.

See a specialist: Even if your family doctor or primary care physician gives you a specific diagnosis, ask him/her for a referral to a specialist. Not only will a second opinion lower the odds of a wrong diagnosis, a trained specialist is likely to be more knowledgeable than a generalist. In fact, not only are primary care docs more likely to misdiagnose, according to Mark Zimmerman, Director of Outpatient Psychiatry at Brown Medical School, they are likely to overdiagnose certain conditions like major depression.

Once you've gotten a specialist's name, do your own recon. When you call to make an appointment, ask the doctor how often s/he sees people with the symptoms or diagnosis you have. What percentage of his caseload is devoted to the same problems you're dealing with?

Ask the specialist what the evaluation process is like. Try to find a clinician who uses structured diagnostic interviews. Yes, it can be annoying to sit there with a broken heart while your therapist asks you irrelevant seemingly questions about your sex life or eating habits, but trust the process. Study after study show that structured clinical interviews, i.e., those that ask questions about a range of disorders, are much more diagnostically accurate than the typical "so, what brought you to see me" informality that characterize most first office visits.

Use collateral sources. Bring a trusted friend or family member to the initial consultation. Mental illness can sneak up on us so gradually that we may not realize how far down the rabbit hole we've fallen, or slap us upside the head so suddenly that we can't see the full impact on our behavior or mood. Our loved ones often can.

Along the same lines, know your family psychiatric history. Try to go back at least 3 generations and ask several family members the same questions. This can be difficult as people have only recently begun to talk openly about psychiatric disorders; sharing the reason you're gathering this information (to create a family medical history) can often defuse any lingering sense of shame or embarrassment. Asking about certain symptoms (rather than diagnoses) can be another icebreaker; for instance, start off asking about family members who've exhibited mood swings, suicidal behavior, impulsivity, prolonged periods of sadness and overall emotional demeanor.

"For most diagnoses, all that is needed is an ounce of knowledge, an ounce of intelligence, and a pound of thoroughness. " This Arabic proverb is especially true when it comes to mental illness, whose symptoms can be slippery and hard to define. Getting a second opinion, ruling out physical illnesses, and seeking objective input from people who love you are just a few of the ways you can up the odds that you'll get the best treatment for your problem. In other words, when it comes to psychiatric diagnosis, two heads (and sometimes more) are better than one.