Saturday, August 24, 2013

The Complications of Diagnosis

There's no point in talking about specific mental health disorders unless I give some info on what it takes to actually diagnose and thus, be able to properly treat one. Forewarning: for many, this may seem a little complicated. If it does, GREAT! That's the point of this post: to show how--not so easy--it can be to diagnose and treat mental health problems and thus, how much training a counselor actually needs in order to practice. So here I go.

There's this book called the DSM: The Diagnostic and Statistical Manual of Mental Disorders. The most recent edition (the DSM-V) was released in May of this year. Basically, it's the Bible for any type of psychiatric diagnosis and is used by clinicians, researchers, and insurers. Of course, it's not perfect, but it's the closest thing we have. So we use it.
Random side note: For those in the medical profession, the more widely used book is the ICD-10. (For those of us not in the medical profession, the ICD-10 addresses most things associated with physical health and injury, but includes many things pertaining to mental health as well.)

Here's how it works:

There are 16 major groups of disorders. Within those groups, there are 900 different disorders possible (different types, different levels of severity, and so on). That's not even mentioning new disorders that develop as time passes. For example, the DSM-V has a section on internet gaming disorder/addiction.

Obviously, mental health is different from physical health. While no one will argue that the two are inseparably linked, treatments can differ greatly. For example, many physical illnesses have a physical cause, like a bacteria of some kind or a lack of proper nutrition in one's diet that weakened the immune system. Once the cause has been isolated, one can create/prescribe a medication to help your body fight the infection and basically, problem solved. Sometimes, you don't even need to know the cause: in most cases, it doesn't matter how you pulled that muscle or how the bone was broken. Put some ice on it. Stay off your feet for a bit. Set the bone. Put a cast on it. Generally, that solves the problem...unless, of course, you don't do what the doc says to take care of yourself during the recovery period.

In the field of mental health, there are so many factors affecting people's lives that you can never say "You have all the symptoms of Anxiety. We know that Anxiety is caused by    x   , therefore we will give you    x    to treat it." Two people may have the same disorder, but the causes and factors contributing to it may be (and usually are) completely different. Therefore, knowing how to properly treat each person is imperative.

To help clinicians determine the best route for an individual, the DSM has what's called the Five Dimensional Axes:
  1. Axis I: Clinical Disorders
    1. This takes into account whether a person has anything from a sleep disorder to schizophrenia
  2. Axis II: Personality Disorders
    1. While this can fall into Axis I as well, this specifically focuses on problems that prevent the person from being able to properly interact with his/her environment on a regular basis. Usually, they are things that have been impeding the individual for a long period of time. Such things may include mental retardation, autism, and paranoia.
  3. Axis III: General Medical Conditions
    1. As I said, physical and mental health are inseparably connected. In order to make a proper mental diagnosis, it is important to know what type of physical condition the person is in. Sometimes, treating a physical condition can work wonders for a mental condition.
  4. Axis IV: Socioenvironmental Conditions
    1. If anyone ever says that your environment doesn't effect you, they're wrong. The type of environment you're in can most definitely be a key in your mental health. This category may include employment (or lack thereof), family situation, financial status, your neighborhood, a big/unexpected change in life, etc.
  5. Axis V: Overall Level of Functioning
    1. On a scale of 0-100, this axis evaluates the individuals' overall ability to function in life. It looks at the person's functional level at the time of therapy (compared to what is generally considered healthy) and compares it to what the person's functional levels throughout the previous year have been. If the therapist has a heavy caseload (i.e. a lot of patients), this axis can help him/her know the order in which to see each one and how frequently do so to.
Just like learning about proper diagnosing and treatment of physical health conditions takes time and effort (medical school, residency), becoming proficient at diagnosing and treating mental health conditions also takes time and effort...just in a different way.

I know that much of this will be very new to those reading. Because of that, I don't expect all of it to make sense. If you have questions about any of it or just want to know more of the specifics, please ask. That's what comment sections are for. Chances are that if you're wondering something, others are, too.   :)

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