Psychology Today: The Myth of Mental Health Diagnosis
Disagreement between clinicians is the norm, not the exception.
“In the lead-up to the release of the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5) in 2013, field trials were conducted in real-world settings to essentially see how useful this bible for mental health clinicians was in producing valid, reliable diagnoses.
For each major mental health diagnosis (e.g., schizophrenia, PTSD, alcohol use disorder, etc.), a score was calculated for inter-rater reliability—how much two clinicians agree with one another that a person has a certain diagnosis.
You would think it would be fairly obvious if someone is depressed, right? Wrong. Highly trained psychiatrists who independently evaluated an individual could only agree that the person had depression between 4 and 15 percent of the time.1.
The inter-rater reliability score also fell in this 'questionable' range of 4 to 5 percent (the possible ranges being 'very good,' 'good,' 'questionable,' and 'unacceptable') for diagnoses of generalized anxiety disorder, mild traumatic brain injury, and antisocial personality disorder.2
One reason for clinicians' striking lack of consistency can be understood by comparing anxiety and depressive disorders. Historically, we have treated anxiety and depression as two distinct disorders. The DSM, most recently revised in March 2022 and released as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), defines generalized anxiety disorder (GAD) as "excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about several events or activities (such as work or school performance)
According to the DSM-5-TR, to meet the criteria for major depressive disorder (MDD), "five (or more) of the following [nine] symptoms [must] have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure." Four of these symptoms refer to difficulty concentrating, difficulty sleeping, being easily fatigued, and changes in psychomotor movement. Interestingly, these symptoms that are criteria for diagnosing MDD are also criteria for diagnosing GAD.
As you can guess, this overlap in symptoms has led to high comorbidity between GAD and MDD, meaning that many people diagnosed with one condition are also diagnosed with the other. For example, a worldwide survey found that 45.7 percent of individuals with lifetime major depressive disorder also reported a lifetime history of one or more anxiety disorders."
This does not mean that diagnoses are completely useless, but it does mean we should treat them less literally and understand that two clinicians may be looking at the same symptoms but seeing and naming them differently based on different contexts, which can include the clinician's own biases, differences in training, and what the client chooses to report.”
Read the full article here!
Reflection: How can mental health professionals lower the chances of misdiagnosing and increase the consistency in diagnostic work?
#MentalHealth #Diagnosis #DSM-5 #GAD #Depression
"defines generalized anxiety disorder (GAD) as "excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about several events or activities (such as work or school performance)"
This is not backed by any sources I looked it up on. Could you give me a source?
I feel like you need to also refer the study you had on where psychiatrists disagree, yes they do, and you should always get a second opinion, but i need to see that percentage.
@funnyWriter805 I think getting treated for mental health helps the patients more than the doctors. Honestly even if I was completely sane, I would go for it to optimize my brain.
@funnyWriter805 Also depression, I guess the criteria is should fix the criteria for atleast 5 I guess, I could be wrong, like here is the list I found.
- Feelings of sadness, tearfulness, emptiness or hopelessness = No, quite the contrary even when faced with extreme stress and pressure.
- Angry outbursts, irritability or frustration, even over small matters = No not really.
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports = Could be, but I still enjoy them. Was there for a while.
- Sleep disturbances, including insomnia or sleeping too much = Yes
- Tiredness and lack of energy, so even small tasks take extra effort = The first part maybe.
- Reduced appetite and weight loss or increased cravings for food and weight gain = Yes
- Anxiety, agitation or restlessness = Yes
- Slowed thinking, speaking or body movements = No
- Feelings of worthlessness or guilt, fixating on past failures or self-blame =No, maybe anger.
- Trouble thinking, concentrating, making decisions and remembering things = No.
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide = No
- Unexplained physical problems, such as back pain or headaches = Sometimes, yes.
So thats 4 to 6 symptoms at a stretch from 12. Moderate depression maybe. Could be just insomnia from the anxiety and the physical effects from anxiety though. i dont think I am unhappy.
@funnyWriter805 I think the only thing I actually have the criteria for is probably some form of anxiety disorder, most likely GAD. But even then not most or all symptoms, probably just a few like insomnia, which I was born with, and physical effects on my body. Otherwise I am fine.
@funnyWriter805
This description of GAD comes from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
You can read the following article that is talking about low diagnostic reliability among mental health professionals:
Lieblich et al. (2015). High heterogeneity and low reliability in the diagnosis of major depression will impair the development of new drugs. doi:10.1192/bjpo.bp.115.000786
@professionalVision2624 I think mental health professionals should see a patient over the span of multiple appointments before making a diagnosis. I don't think that people are faking, but I sometimes think doctors diagnosis and prescribe medications too fast. Medications are definitely needed in some cases, but I think there are people why may depend on them a little too quickly.
@fruityPond7887 In developing countries, unlike 1st world countries where its a lucrative business, almost no one goes to a shrink. So if they give you medication, it is honestly your last resort.
@funnyWriter805 I definitely think we need to take both of these extreme perspectives and fizzle it down to a little bit of both. I think that America sometimes hands out diagnoses and medications like candy, but developing countries need to catch up a little bit and realize that mental health is a very real struggle for a lot of people.
@fruityPond7887
Yes! I agree completly! Thank you for pointing it out and spreading awarness. It can be a tricky thing for both patients and proffesionals to ńavigate around.
@professionalVision2624
I agree with @fruityPond7887 that mental health professionals should take enough time to make sure their diagnosis is correct. It might worsen the person's condition if they are given unsuitable treatment. I also think that psychotherapy should be tried first and only after not working for an extended period the medication should be given (depending on the condition both at the same time). I think that a health professional should not get too carried away by common gender stereotypes neither (e.g. that more males suffer from ADHD) as this could also result in an incorrect diagnosis.
@globalBraid3744
You are absolutly right! Couldn't have said it better myself <3 Thank you so much for commenting!
