Deciphering Your DSM-5 Diagnosis

If you’ve ever heard the terms “OCD,” “PTSD,” or “ADHD,” you probably know they’re all abbreviations for mental health diagnoses. Respectively, they stand for “obsessive-compulsive disorder,” “post-traumatic stress disorder” and “attention deficit-hyperactivity disorder.” No wonder we tend to use the abbreviations since the complete descriptions are quite a mouthful.

These diagnostic terms (and over two hundred others!) are listed in the Diagnostic and Statistical Manual of Mental Disorders (5th edition), better known as the “DSM-5.” It’s the official manual of mental illness diagnoses, and is published by the American Psychiatric Association. The first DSM was written in 1952, and the current edition came out in 2013. While the DSM-5 is widely used in the US, another diagnostic system, the ICD (International Classification of Diseases), published by the World Health Organization, is preferred in most other countries around the world.

The DSM-5 is an impressive book. Weighing in at well over 900 pages, it’s densely packed with technical information and terminology. Accordingly, it’s difficult to read, since it was written primarily for a professional audience. The different diagnoses are organized by chapters according to their central features. For example, there are chapters related to depression, anxiety, trauma, schizophrenia, bipolar disorder, eating disorders, sleep problems, sexual difficulties, addictions, childhood issues, and more.

It’s important to note that the DSM-5 is a diagnostic manual and not a resource for types of treatment. In other words, it’s used to determine an accurate psychiatric diagnosis, but it’s silent on how to treat the designated conditions.

How the DSM-5 is used for diagnosis

In a recent post, I summarized the process used by a health care professional to determine a mental illness diagnosis. The three primary steps include:

1) Gathering information through interviews and other sources of data
2) Narrowing down the options by comparing the person’s symptoms to those of established diagnoses
3) Offering an initial diagnostic impression based on the overall evaluation

The DSM-5 comes in during the second step. As a person discusses their symptoms, when they started, and how they have developed over time, the professional begins to compare the reported symptoms with those in the DSM-5. For example to diagnose a major depressive disorder (known informally as  “major depression”), the person has to have displayed 5 or more out of 9 symptoms over a 2 week period.

The listed symptoms (called “diagnostic criteria”) for major depression include a depressed mood, a loss of interest in activities, significant weight loss or gain, sleeping too much or too little, observable agitation or being slowed down, fatigue or loss of energy, feeling worthless or overly guilty, decreased concentration or increased indecision, and recurring thoughts of death or suicide. Finally, the symptoms must cause significant distress or impairment in overall functioning, and they can’t be due to drugs or alcohol, certain other psychiatric conditions or another medical condition.

If all this sounds pretty straightforward, it’s often not. Sometimes symptoms can suggest several different diagnoses. Then the professional must obtain more detailed information to see which diagnosis is more accurate. This is called “differential diagnosis,” and it can be quite exacting. Sometimes a relatively minor variation in how symptoms occur or change over time can lead to an entirely different diagnostic impression.

A new “Guide” to understand the DSM-5

Recently, the American Psychiatric Association published a new book called “Understanding Mental Disorders: Your Guide to DSM-5.” (I’ll refer to it as the “Guide.”) As in the DSM-5, the Guide is organized into chapters describing each of the major types of mental illnesses. However, it was written for the general public, and is a deliberate effort to present the DSM-5 diagnoses in more accessible language. To a large degree, it accomplishes this goal. For example, the Guide has a chapter on “disorders that start in childhood” rather than the equivalent DSM-5 term “neurodevelopmental disorders.”

Additionally, the DSM-5 “diagnostic criteria” or symptom lists are put in much simpler and clearer language in the Guide. This is a real plus, because it retains the main points from the DSM-5, but presents the information in a manner that most people will be able to understand much more easily.

Additional useful features in the Guide are a glossary with clear definitions of common psychiatric terms and a list of common medications used in the treatment of mental illnesses. Unlike the DSM-5, the Guide does (briefly) discuss common types of treatment in each chapter, including medications, psychotherapies, and the benefits of healthy lifestyle choices including nutrition, exercise, and maintaining social support. Finally, the Guide contains a lengthy appendix of “helpful resources,” which are organizations (and their web sites) which promote better mental health.

Understanding your diagnosis

If you or someone you care about has a mental health diagnosis, all of this information can be helpful to understand how a particular diagnosis was determined. Keep in mind that not all diagnoses are initially correct, and that diagnostic impressions can and do change over time. Despite the legitimate concerns about possible misdiagnosis or stigma associated with a mental illness diagnosis, it is important to have an accurate diagnosis so that effective treatments for a specific condition can be identified and implemented.

Here are few simple tips and reminders to better understand your diagnosis and treatment options:

  • If you are receiving treatment for mental health concerns and aren’t sure about your current diagnosis, ask your health care provider what it is.
  • Ask your provider to explain the common features, typical course, and future outlook for your condition.
  • Ask for information regarding the scientific evidence supporting the effectiveness of the medications and therapies you are currently receiving or considering.
  • Use an easy to understand resource like the Guide to learn more about your own particular diagnosis and possible treatment options.
  • Become well informed about your condition and keep a dialogue going with your health care provider as treatment continues.

Here’s a question: What questions or concerns do you have about your mental health diagnosis or that of a loved one? Please leave a comment. Also please consider subscribing to my blog and feel free to follow me on Twitter, “like” my Facebook page, or connect on LinkedIn. Thanks!

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