Discussion How do they diagnose mental illness? Do you agree with their diagnosis?

[Forever Sleep]

This is just out of curiousity to be honest...

For those of you who have been diagnosed with a mental illness- how did they do this? Is it ALL via talking about your symptoms? Are there any actual physical tests they do? Brain scans or blood tests to check hormone levels or something?

As you can tell- I have no clue! I was diagnosed with mild to moderate depression ages ago. They ascertained that I suppose from a multiple choice questionnaire I filled in- as well as the fact I burst into tears when I started talking.

Still- I'm just curious. It doesn't seem like an exact science to me. Did you suspect you had a particular illness before going in? Did you agree with what they diagnosed you with?

 

[MidnightDream]

Psychiatrists use the DSM or the ICD, both of which are big fat books of every recognised mental illness with their symptomology and diagnostic criteria.
DSM is more commonly used in the USA, ICD is more global but they're both pretty much the same thing designed for the same purpose.
For the most part, yeah, diagnostic criteria is established by talking to the patient and establishing patterns of behaviour or symptoms that align with the big books.

Definitely not an exact science, these books are open to interpretation, bias, and other human error. But so is medicine, law, and other essential aspects of society.

More common mental illnesses such as depression and anxiety usually aren't escalated to the level where you would be diagnosed by a psychiatrist, in that case it's basically just up to whoever's listening to you talk that day. Tools such as questionnaires may be used too. There's no physical tests for any kind of mental illness, the only time blood tests, scans etc will be used is to rule out physical reasons for your symptoms.

As for my experience, I was diagnosed with BPD by a psychiatrist, only saw him once. He diagnosed me based on the reports and opinions from the psychologist i'd been seeing for a few months, and through talking to me and deciding whether my symptoms aligned with the ICD diagnostic criteria. My psychologist already believed I had it, so it wasn't a surprise and I didn't disagree.

 

[Forever Sleep]

Psychiatrists use the DSM or the ICD, both of which are big fat books of every recognised mental illness with their symptomology and diagnostic criteria.
DSM is more commonly used in the USA, ICD is more global but they're both pretty much the same thing designed for the same purpose.
For the most part, yeah, diagnostic criteria is established by talking to the patient and establishing patterns of behaviour or symptoms that align with the big books.

Definitely not an exact science, these books are open to interpretation, bias, and other human error. But so is medicine, law, and other essential aspects of society.

More common mental illnesses such as depression and anxiety usually aren't escalated to the level where you would be diagnosed by a psychiatrist, in that case it's basically just up to whoever's listening to you talk that day. Tools such as questionnaires may be used too. There's no physical tests for any kind of mental illness, the only time blood tests, scans etc will be used is to rule out physical reasons for your symptoms.

As for my experience, I was diagnosed with BPD by a psychiatrist, only saw him once. He diagnosed me based on the reports and opinions from the psychologist i'd been seeing for a few months, and through talking to me and deciding whether my symptoms aligned with the ICD diagnostic criteria. My psychologist already believed I had it, so it wasn't a surprise and I didn't disagree.

This was so interesting- thank you. You're absolutely right- even physical illness is largely diagnosed via describing symptoms- which can be misinterpreted... At least to begin with. Then it seems to hinge on whether you get better with what they prescribe or otherwise, how bad your symptoms have gotten and just how much they want to spend on diagnosis.

 

[MidnightDream]

This was so interesting- thank you. You're absolutely right- even physical illness is largely diagnosed via describing symptoms- which can be misinterpreted... At least to begin with. Then it seems to hinge on whether you get better with what they prescribe or otherwise, how bad your symptoms have gotten and just how much they want to spend on diagnosis.

Glad to be of help :) yeah, unfortunately the majority of healthcare disciplines including medicine and psychiatry are a case of ruling things out and narrowing down until a diagnosis is reached. Everything can be misinterpreted, and that's just human nature. The issue with psychiatry is that at least with medicine, you do have physical testing available such as blood testing, scans, etc to support the final diagnosis, whereas with psychiatry you really don't. A lot of symptoms of mental illness overlap, information can become outdated in between publications, and there are also plenty of practitioners that have argued against the DSM and the ICD for one reason or another. There is also the question of money as well as collaboration with the pharmaceutical industries and how that impacts mental health research.

In terms of illnesses like depression, it's much easier for a doctor to hand you a prescription & a diagnosis and send you on your way than it is for them to refer you to a service that might help you explore and treat the root of the problem - if you even have a service like that in the area with enough funding to take you. That's why it's so important for patients to do their own research and advocate for themselves and their treatment should they want it, and ultimately understand that a diagnosis really doesn't define you

 

[Forever Sleep]

Glad to be of help :) yeah, unfortunately the majority of healthcare disciplines including medicine and psychiatry are a case of ruling things out and narrowing down until a diagnosis is reached. Everything can be misinterpreted, and that's just human nature. The issue with psychiatry is that at least with medicine, you do have physical testing available such as blood testing, scans, etc to support the final diagnosis, whereas with psychiatry you really don't. A lot of symptoms of mental illness overlap, information can become outdated in between publications, and there are also plenty of practitioners that have argued against the DSM and the ICD for one reason or another. There is also the question of money as well as collaboration with the pharmaceutical industries and how that impacts mental health research.

In terms of illnesses like depression, it's much easier for a doctor to hand you a prescription & a diagnosis and send you on your way than it is for them to refer you to a service that might help you explore and treat the root of the problem - if you even have a service like that in the area with enough funding to take you. That's why it's so important for patients to do their own research and advocate for themselves and their treatment should they want it, and ultimately understand that a diagnosis really doesn't define you

I really don't know much about the subject- evidently! Still- I have heard that depression for example can cause physical differences in the brain. Or, maybe those physical differences are there to begin with- to make you more susceptible to it?

I expect I kind of already know the answer- that it likely isn't good to flood the brain with radiation in an x-ray and just the cost of it I expect. Still, I suppose I am still kind of puzzled why more physical tests aren't performed. Surely- it could be a way of linking visible physical symptoms with mental illness and thereby make it easier to diagnose if more tests and research were done- rather than a 'describe your pain' type approach. I guess they probably are doing research now to be fair though... Anyway- thanks for chatting- it's been interesting.

 

[MidnightDream]

I really don't know much about the subject- evidently! Still- I have heard that depression for example can cause physical differences in the brain. Or, maybe those physical differences are there to begin with- to make you more susceptible to it?

I expect I kind of already know the answer- that it likely isn't good to flood the brain with radiation in an x-ray and just the cost of it I expect. Still, I suppose I am still kind of puzzled why more physical tests aren't performed. Surely- it could be a way of linking visible physical symptoms with mental illness and thereby make it easier to diagnose if more tests and research were done- rather than a 'describe your pain' type approach. I guess they probably are doing research now to be fair though... Anyway- thanks for chatting- it's been interesting.

Despite the fact that it's a pretty widely accepted theory in society that depression in general is caused by a chemical imbalance in the brain, it's actually a pretty highly debated topic within scientific research.

To preface, there's actually a distinct difference between depression as we mostly discuss it and clinical depression (also known as Major Depressive Disorder), the latter of which is considered much more severe and does require diagnosis by a psychiatrist (Source). Obviously, not everyone diagnosed with depression will fall under the diagnosis of MDD or clinical depression, in fact the majority won't.

In terms of 'standard' depression (for lack of a better term), it's actually most attributed to to faulty mood regulation (which isn't quite a chemical imbalance), trauma response and situational triggers (Source) rather than anything wrong with the brain. This source actually suggests that the idea of depression being caused by a chemical imbalance was actually brought about to promote the sale of pharmaceuticals.
In terms of clinical depression, there are studies such as this one that actually did show significant changes in the brain within patients (Source), but state that it's a pretty complex topic and they can't really ascertain whether these caused the depression, or were a result of.

General consensus across a range of sources suggests that depression can and does impact the brain over time, but this is a result rather than a cause.

Because of all of that, physical testing for depression really wouldn't work. Whilst some patients might show differences in the brain, not all will and so it can't really be used as an effective diagnostic technique even if funding wasn't an issue. A 'describe your pain' type approach allows for depression to be diagnosed regardless of cause and takes into consideration people who have experienced emotional trauma, loss, or are experiencing depression as a result of situational/environmental factors etc etc. Is that a good thing? Who knows. But it does speak to why depression (and anxiety) are the most commonly diagnosed mental health disorders.

Anyway, thanks for the discussion. I find this stuff fascinating and enjoyed doing the research to write this response, took my mind off studying for my upcoming exam haha. If you wanna keep talking on this you're welcome to dm me, otherwise I hope this info was helpful for you!

 

[Forever Sleep]

Despite the fact that it's a pretty widely accepted theory in society that depression in general is caused by a chemical imbalance in the brain, it's actually a pretty highly debated topic within scientific research.

To preface, there's actually a distinct difference between depression as we mostly discuss it and clinical depression (also known as Major Depressive Disorder), the latter of which is considered much more severe and does require diagnosis by a psychiatrist (Source). Obviously, not everyone diagnosed with depression will fall under the diagnosis of MDD or clinical depression, in fact the majority won't.

In terms of 'standard' depression (for lack of a better term), it's actually most attributed to to faulty mood regulation (which isn't quite a chemical imbalance), trauma response and situational triggers (Source) rather than anything wrong with the brain. This source actually suggests that the idea of depression being caused by a chemical imbalance was actually brought about to promote the sale of pharmaceuticals.
In terms of clinical depression, there are studies such as this one that actually did show significant changes in the brain within patients (Source), but state that it's a pretty complex topic and they can't really ascertain whether these caused the depression, or were a result of.

General consensus across a range of sources suggests that depression can and does impact the brain over time, but this is a result rather than a cause.

Because of all of that, physical testing for depression really wouldn't work. Whilst some patients might show differences in the brain, not all will and so it can't really be used as an effective diagnostic technique even if funding wasn't an issue. A 'describe your pain' type approach allows for depression to be diagnosed regardless of cause and takes into consideration people who have experienced emotional trauma, loss, or are experiencing depression as a result of situational/environmental factors etc etc. Is that a good thing? Who knows. But it does speak to why depression (and anxiety) are the most commonly diagnosed mental health disorders.

Anyway, thanks for the discussion. I find this stuff fascinating and enjoyed doing the research to write this response, took my mind off studying for my upcoming exam haha. If you wanna keep talking on this you're welcome to dm me, otherwise I hope this info was helpful for you!

Thanks so much for such a thoughtful reply and for compiling all those sources. I agree- it's very interesting.

Makes sort of sense too- the brain is so complex afterall. I suppose a list of symptoms is as descriptive in a way as an x-ray.

Oh- sorry! You're meant to be studying and I'm meant to be job hunting... If only this was our research/job huh? Good luck with your exam.

 

[MidnightDream]

Of course! I'm on my second degree so it feels wrong at this point to not back up statements with sources lol.
Thank you so much, good luck with your job hunt! Hope you find what you're looking for :)
@makethepainstop why the angry react? Did my comment offend you in some way? That wasn't my intention at all, would be good to know so I can either edit or explain