Diagnosis … & why I rarely use it

Using formulation rather than the DSM-5 or ICD-10

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I don’t use psychiatric diagnosis unless I’m asked to or a diagnosis is needed for an insurance claim. The British Psychological Society actually recommends avoiding diagnosis whenever possible. This is because most psychologists believe that a diagnosis does not tell us enough. One person with a diagnosis of ‘depression’ can be very different from someone else with the same diagnosis.

The DSM-5 & ICD 10

I’ve explained some of my own reasoning for avoiding diagnosis below. If you’re interested in learning more about diagnosis there are two main diagnostic systems used around the world and in Malaysia:

  • The World Health Organisation’s International Classification of Diseases (ICD-10)
  • The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Diagnosis in the UK

The usefulness of diagnosis depends on the situation. When I worked for the UK’s National Health Service (NHS) I  often gave psychiatric diagnoses. The NHS used diagnoses to allocate resources and to justify the type of intervention people received. Healthcare from the NHS is free and there are practical benefits to having a diagnosis in the UK. For example, people with certain psychiatric diagnoses are given free housing or are paid disability benefit every month. Despite these advantages, even in the UK, psychiatric diagnosis is controversial.

The problem with diagnosis

The main problem with psychiatric diagnosis is that people often treat those with a psychiatric diagnosis badly.

Another key problem is that diagnosis may not be valid. In the past doctors assumed that they were illnesses and we would soon find clear biological explanations for each of them. However, scientists have not been able to find the biological causes of depression, schizophrenia, generalised anxiety disorder or any of the other ‘functional’ psychiatric diagnoses. This means psychiatric diagnosis is really only a name for symptoms that tend to group together. For example, depression is the combination of sadness, low energy and loss of libido.

Most psychiatrists now agree that psychological problems are, at least partially, a result of our past experiences and the environment that we are in. If you would like to read more about the diagnosis debate this article in the New York Times gives a good overview. This article in the prestigious journal, Nature, discusses the problems with diagnosis and how researchers are trying to make changes.

It is because of these disadvantages and the relative lack of advantages in Malaysia that I tend not to use diagnosis unless I am specifically asked. 

Formulation not Diagnosis

Instead of diagnosis the British Psychological Society recommends an approach, that I use, called ‘Formulation’. Initially, I will ask questions and listen to your story. Then we work together to decide how your difficulties started and what might be stopping them from going away. We consider how your past experiences may have affected you, what strengths you may have and how the situation you are in, or the people you are with, might be influencing you. If you don’t agree with the formulation (i.e the explanation for why you are having difficulty) then we continuing working on it until it does make sense. 

A good formulation helps us decide what we need to do to. I can teach you new skills to break the problematic patterns and replace them with better ways of coping. 

For more information about common difficulties and how to deal with them please access our ‘Information & Advice‘ section. If you would like to meet with me please see my page on how to ‘arrange a consultation‘.

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