Written by: Dr. Erika Vivyan
HOW PSYCHOLOGICAL DIAGNOSES HELP & HURT
I had a conversation the other day about the pros and cons of a psychological diagnosis. In the psychology world, a diagnosis serves many purposes, but this particular conversation reminded me of the many drawbacks that people might see related to naming a particular problem or disorder. Words hold a lot of meaning in our society and they change their value based on context and culture. The words in a psychological diagnosis are no different. These words can be heavy – think about the reasons that mental health professionals changed the diagnosis “Mental Retardation” to “Intellectual Disability.” These words can also be used too lightly – think about the number of times you’ve heard “I’m so OCD!” or “My child is very hyper.” Words matter. Labels matter. Diagnoses matter. So why use them?
I’ll be honest with you. As a Licensed Psychologist and someone who uses psychological diagnoses on a regular basis (all hail the DSM-5!), I tend to think on the more positive side about why we use these labels. I provide both assessment and therapy services, so when I use a diagnosis I tend to be quite literally “by the book.” If a client meets all the criteria related to the symptoms and problems of a particular psychological disorder, I usually provide that diagnosis in my report or my therapy notes. To me, this label is a way to convey that this particular person fits into a group with other people who have similar symptoms. The way that diagnosis is used is often not up to me, but it does help to accomplish a few critical things:
1. PSYCHOLOGICAL DIAGNOSES HELP PROFESSIONALS TO COMMUNICATE IN SIMILAR LANGUAGE.
When any health care professional looks at a particular diagnosis, they can typically make sense of the primary presenting problem(s) and associated difficulties for that client. That means that one diagnosis can communicate volumes about a client’s concerns and options for treatment. That is, instead of saying “client struggles with constant worries, is tired, fidgety, and can’t fall asleep,” a simple “Generalized Anxiety Disorder” will suffice.
2. GIVING AN OFFICIAL NAME OR LABEL CAN HELP TO LEGITIMIZE CLIENTS’ FEELINGS OR PROBLEMS.
A client seeking mental health difficulties can often take weeks, months, or even years to seek help. Often, the first step in treatment is telling clients that their feelings and problems are real. Assuring a client that the issue they’ve been struggling with has a name, has a community, and has an evidence-based treatment that can help them in a relatively short amount of time is one of my favorite feelings as a psychologist! I love seeing the look on my client’s faces when they realize that they are not alone. A name or label can often provide that relief.
3. A MEDICAL DIAGNOSIS CAN OPEN DOORS TO SEEK PSYCHOLOGICAL, PSYCHIATRIC, AND MEDICAL TREATMENT.
Often, a client needs an official diagnosis to access treatment. For children and teens, schools determine eligibility for Section 504 accommodations or Special Education services. A psychological diagnosis from a psychologist or school psychologist (LSSP in Texas) is a key to open the door to increased support at school. For any client, a medical diagnosis points health care professionals towards the appropriate treatment, whether it’s medication, therapy, or other strategies.
4. HEALTH INSURANCE OFTEN REQUIRES A DIAGNOSIS IN ORDER TO PAY FOR TREATMENT.
Having access to treatment is great, but having the ability to pay for it is often a very different issue. For clients who have health insurance, a formal diagnosis is typically required in order to provide coverage or reimbursement for mental health care. The rules differ depending on your health coverage, so be sure to check with your provider to determine if a diagnosis is required and which diagnoses might be covered.
5. CERTAIN EVIDENCE-BASED TREATMENTS ARE INDICATED TO TREAT CERTAIN DISORDERS.
It’s not enough to just have access to and payment for treatment. A proper diagnosis can give providers a good idea about which treatment(s) will be most effective for a particular diagnosis. Together with the client’s age, developmental level, and cultural/linguistic background, a provider can use existing research to determine which treatment(s) are most likely to have a positive impact. If diagnoses mean more specific, effective treatments, they can’t be all bad, right?
There are a few downsides to labeling a client with a psychological diagnosis, though. In our current society, there are a number of judgments that might assault a person from the outside as well as from within. Before adding a diagnosis to a client’s file, I consider the following:
1. LIVING WITH A MENTAL HEALTH PROBLEM IS STILL STIGMATIZED BY SOCIETY AS A WHOLE.
Unfortunately, our society still looks at treatment for cancer as noble and strong but treatment for anxiety as feeble and weak. (HINT: Both of these battles are incredibly difficult and demand the most respect for those who are fighting them!) If the addition of a psychological diagnosis results in differential treatment by family, friends, healthcare providers, and/or teachers, then the harm can sometimes outweigh the benefits listed above. Slowly but surely, we are moving toward a world where mental health diagnoses and treatments are regarded as similar to
2. A PSYCHOLOGICAL DIAGNOSIS MAY FOLLOW YOU VIA YOUR MEDICAL OR EDUCATIONAL RECORD.
Again, this consequence is only problematic because of the societal stigma around mental health. Both medical and educaitonal records are kept confidential by law, which means that only healthcare professionals, educators, and administrators with a need to know would have access to this information. However, if any of these individuals treats a client negatively due to a previous diagnosis, there could be potential for an overall negative effect on the client’s well being.
3. WITHOUT PROPER TREATMENT, A PSYCHOLOGICAL DIAGNOSIS CAN BE INTERNALIZED AND BLAMED FOR ALL OF YOUR PROBLEMS.
Most clients are not immune to the stigma attached to their symptoms, let alone a full-blown diagnostic label metaphorically slapped across their forehead. Even the most intelligent and well-informed individuals can fall prey to feeling like they have become their mental illness: “I’m so depressed that I’ll never amount to much” or “My anxiety won’t allow me to do the things I want.” This type of thinking is exactly the target of most effective therapies. The individual is not the problem. The client likely has a problem (we all do), which is why they are seeking services, but the client themselves is not the problem. The problem is the disorder that we are treating – the depression, the anxiety, the OCD, or even the medical illness causing psychological symptoms. Internalizing a psychological diagnosis can certainly happen – and it does – but the best way to combat this internalization is by accessing a psychologist who can label, externalize, and treat the disorder effectively.
I’ll say it again: I am a psychologist, and I am certainly biased when it comes to this issue because I use psychological diagnosis in my daily work. I also have what feels like a balanced approach when I consider whether or not to provide a diagnostic label. If it provides more benefits than problems, then I usually include it in my client’s chart. For my clients seeking psychological assessment for access to services, this is almost always the case. In private practice or settings that don’t require a dignosis to provide the most appropriate treatment for symptoms, it may not be necessary. As with most things, a thorough consideration of the issue and the information available appears to be the best option.
© Erika J. Vivyan, PhD