Some people begin mental healthcare by seeking out a diagnosis first, others may have received a diagnosis years before and are wondering if it still applies, and some are concerned that starting therapy may lead to a diagnosis they don’t want.
We recognize that the idea of diagnosis can sometimes feel like a heavy topic. In the next few blogs, we want to unpack the concept of diagnosis to help you make an informed decision about starting therapy and the next steps you might want to take.
It is important to note that, as a psychotherapy clinic we do not diagnose patients. As well, you do not need a diagnosis to begin therapy.
In Ontario, only a general practitioner, psychiatrist, or clinical psychologist can provide a formal diagnosis. With this in mind, these blogs should not be taken as a replacement for medical advice. If you are interested in starting the process of diagnosis it is important to have a conversation with your doctor.
Through these blogs, we hope to offer you a better understanding of how we think about diagnosis and approach psychotherapy, so that you can make a more informed decision about the kind of mental health support that might be right for you. If our perspective resonates with you, we welcome you to reach out with any questions or to explore whether working together might be a good fit. These questions can be discussed during a complimentary consultation call which can be booked here.
Over the next few blogs, we will cover a number of important topics:
What is diagnosis and how does it work in the context of mental health treatment?
What is the relationship between therapy and diagnosis?
Finally, why might someone be diagnosed (or refrain from being diagnosed)?
Diagnosis is complex and nuanced, it may not always be necessary for everyone in every situation, but it is both real, important, and should be taken seriously.
The confusion as we see it is that mental health diagnoses are often more complicated than other health diagnoses. You can see the effects of a diabetes diagnosis on a glucose monitor, but it is generally much harder to verify whether someone actually has the mental illness that they have been diagnosed with.
That doesn’t make them a myth, though. We recognize that it does make navigating diagnosis and therapy that much more complicated. You may be thinking: It’s one thing to know that the medical journals are right, and the diagnosis and treatment for a disorder are both legitimate paths for someone to follow. But it’s another to think about whether you yourself need to get diagnosed for something.
Discourse like this might give you pause. It’s that little voice in your head that says “What if they’re right? What if all this language about diagnosis is overblown? What if I’m just falling for the hype, or spending too much time on TikTok?”
These are valid concerns, and we suggest that rather than try to push them down or use them as an excuse to avoid therapy all together, tackle them head on.
This is a big topic, and so we will take our time with it over several blogs. First, what is a diagnosis?
What is a diagnosis?
At a very basic level, a diagnosis is a judgement made by a clinician or certified authority about what might be going on with a patient.
For example, a doctor might take the evidence of a sore throat, fever, cough, and headaches as the sign of a cold or flu. They may run further tests to confirm that a strain of flu is present within the patient. They then diagnose them with a flu.
Doctors make diagnoses to serve a practical function. The reason you generally don’t get a diagnosis when you go in for a minor illness like a cold is because the treatment would be the same: bed rest, maybe a mild painkiller, etc.
However, a diagnosis can be complicated, and it can mean a lot to a patient. Some diagnoses represent a fundamental change in how someone views themselves or how they think about their life. A mental illness diagnosis might cause someone to reframe how they see themselves. It might also be the first step toward receiving the treatment they need.
Mental Health Diagnosis
In the case of mental health, diagnoses are complex. Let’s start with how they work. First off, a psychiatric diagnosis can only be given by a certified professional, like a psychologist, psychiatrist, or general practitioner. Licensed therapists like the ones at this practice may be a great choice to help treat or manage a mental disorder, but they will not be able to diagnose you.
Diagnosing clinicians in Canada generally use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to guide their diagnosis. The DSM was first created in the mid-20th century to help standardize the definitions for mental disorders, since before that time it was largely up to individual clinical opinion. Today, the book is in its 5th edition and is constantly evolving to better reflect the research and the needs of patients.
Since the DSM needs to be applicable across patients and life contexts, it focuses primarily on observable behaviours and symptoms. That means that it is not a resource to learn more about what it is like to experience or recover from a mental disorder, it is a resource to help guide diagnosis.
Furthermore, a DSM diagnosis is only one way to think about the experience of mental illness. Some reasons that a diagnosis are helpful include getting the right medications, work or education accommodations, or for some insurance documentation.
How does someone get diagnosed?
Generally, someone gets diagnosed using a combination of tests and clinical judgement. Think about the case of a cold or flu. A doctor might order a blood test which looks for the presence of the pathogen (a virus) in the bloodstream. If that pathogen is present, it will show up in the numbers on the blood test result.
The doctor then makes a judgement. Is this test reliable? Is it showing a clear enough result to know one way or the other? If so, and if the result shows the presence of a virus, then that’s a pretty good sign a patient should get that diagnosis.
Mental Health diagnosis is considerably more complicated in most cases, however. Symptoms, tests, a patient’s history and more all play a factor in whether the doctor should go with one diagnosis over another. Think again about cold or flu. The symptoms for both these diagnoses can be identical: fever, coughing, sore throat, soreness, confusion, fatigue etc. These could also be symptoms of dozens of other diseases.
The same can be true for mental illness. Difficulties with attention, for example, could be a result of ADHD, anxiety, trauma, or not sleeping well.
Mental illness diagnoses happen in much the same way, just that the tests look a little different. Instead of a blood test, a doctor might give the patient a questionnaire which asks them to rate how they feel. Or a personality test that gets them to work through various scenarios. An interview with the patient is still very important to understand who they are and what might be bothering them.
Importantly, a clinician only delivers a mental illness diagnosis after they are confident that no other disorder could be present. For example, a doctor will only diagnose someone with anxiety if anxiety is a better fit than depression, bipolar disorder, ADHD, borderline personality disorder, and several others than can present in a similar way.
What role does diagnosis play?
This is important to keep in mind in your therapeutic journey. A diagnosis can serve several practical functions and could be an important part of mental healthcare. However, it is only one aspect of effective mental health treatment, and it isn’t always necessary.
Like with other illnesses, mental illness diagnoses serve an important practical function. They are often necessary for prescribing psychiatric medication, for example. They may also be necessary for getting accommodations from an employer or teacher.
They may also just help to log in your health record. Future doctors can see a diagnosis on your file and make decisions based on that knowledge. For example, some medications may have special side effects for people with a mental disorder, and some treatment plans might exacerbate symptoms.
Here is what a diagnosis doesn’t mean:
A diagnosis isn’t a ticket to therapy. You may not need or have a diagnosis and still need therapy.
A diagnosis is not a replacement for therapy. Just because you have received a diagnosis does not mean that therapy is not valuable. This is why people often begin with therapy before seeking a diagnosis.
A diagnosis is not a definitive statement on who you are, or even on your mental health. You could receive a diagnosis for one thing and still need therapy for something else, potentially stuff that isn’t diagnosable.
These are big questions, and we’ll begin to unpack them in our next blog. You may be wondering how a formal mental health diagnosis relates to psychotherapy, and that’s exactly what we’ll explore next.
In the meantime, if you have questions about what kind of mental health services and support might be best for you, our therapists are here to discuss this with you during a complimentary consultation call.