By Jan Hittelman

All licensed mental health professionals are trained in making psychiatric diagnoses. The diagnostic system is standardized, meaning that everyone uses the same criteria. The “Diagnostic and Statistical Manual of Mental Disorders” or “DSM” is the accepted standard and is published and periodically revised by the American Psychiatric Association. Everything from disorders first diagnosed in infancy or childhood to psychological issues due to a medical condition are included. Each diagnosis has its own numeric code. These codes are often required by insurance companies in order for clients to get reimbursed for mental health services.

There has always been some degree of controversy regarding psychiatric diagnoses. One can argue that diagnosing clients amounts to pigeonholing, because if it were truly accurate we would each have our own unique diagnosis. While some clients’ symptoms neatly fit into certain diagnostic categories, many do not. Consequently, many view diagnosis as the application of a label in order to provide the insurance company with required information. On the other hand, the process of carefully assessing the client and determining an accurate diagnosis can have a significant impact on the subsequent treatment they receive.

A diagnosis like Bipolar Disorder or Attention Deficit Hyperactivity Disorder, for example, often results in recommendations for psychotropic medication. Consequently, it is very important that the diagnostic work is thoughtful and accurate as it is certainly not beneficial to put clients on unwarranted medications.

Similarly if we do not have a clear understanding of the disorder, then our treatment plan may miss important underlying issues that are fueling the symptoms that we see. A common challenge with children and adolescents, for example, is accurately diagnosing depression. Unique to children and adolescents, irritability can be a sign of depression. If an adolescent is brought in because of anger issues, which is quite common, it is important to rule out underlying depression. Otherwise simply treating the anger outbursts will be ineffective and put the child at risk for increased depressive symptoms.

As a client, it is a good idea to discuss your diagnosis with your mental health professional. Ask them to share the specific symptoms or criteria used to make the diagnosis and be sure that you’re in agreement. At the very least you should know what information is being submitted to your insurance company. Many clients are uncomfortable with this information “being on record” with the insurance company or elsewhere. There are concerns of being permanently labeled and this information being shared with others. This is not a real concern, however, as client records are strictly confidential by law and an insurance company or mental health provider is not allowed to share this information without your written consent. If you question the accuracy of your diagnosis, speak to your provider about it. You can always get a second opinion as well. Psychotherapy can be expensive and time-consuming. It is to your advantage to make sure that your treatment is based on a sound diagnosis from the start.