Diagnosis … & why we rarely use it

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

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Clinical Psychologists are trained to be able to give a psychiatric diagnosis. However, you are more likely to receive a diagnosis from a psychiatrist or medical doctor.

What is a a psychiatric diagnosis and what are the DSM-5 & ICD 10?

The two main diagnostic systems used around the world and in Malaysia are:

  • 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)

Some countries have their own diagnostic systems. For example, China uses the Chinese Classification of Mental Disorders (CCMD-3).

The DSM-V and ICD-10 list the ‘mental disorders’ and the symptoms linked to those disorders. If you meet with a doctor or psychologist who uses diagnosis they will ask questions to determine if you meet criteria for a certain diagnosis. If you have a sufficient number of the symptoms of a mental disorder and those symptoms are not better explained by another disorder then you will be given that diagnosis.

Listed below are some common psychiatric diagnoses. The percentage next to each diagnosis shows the proportion of people who would receive that diagnosis at some point in their lifetime.

The figures below are mainly from a US study that was summarised in a UK government report (NICE guidelines on Common Mental Health Disorders).

Common Psychiatric Diagnoses:

When do we use psychiatric diagnosis?

At Share Resolve we only use psychiatric diagnosis when there is a good practical reason to do so. The most frequent practical reason why we use diagnosis is because of insurance company requirements (we always ask our clients if they are happy for us to share a diagnosis or any other information with an insurance company). We may also give a diagnosis if it will help to secure support, such as extra time in examinations, from schools, universities and examining boards.

In countries, such as the UK or Norway, a psychiatric diagnosis can mean free housing or paid disability benefits each month. Unfortunately, this level of support is not available in Malaysia and even in countries with these advantages psychiatric diagnosis is controversial.

The problem with psychiatric 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.

The neurocognitive and neurodevelopmental diagnoses (e.g dementia and autism) do have strong evidence of a biological basis but there seems to be a lot of variation in how they affect people.

Most psychiatrists now agree that psychological problems are, at least partially, a result of our past experiences and our environment. 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, also discusses the problems with diagnosis and how researchers are trying to make changes.

The British Psychological Society 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.

At Share Resolve we rarely use psychiatric diagnoses because of the significant problems with psychiatric diagnosis and the limited practical benefits to having a diagnosis in Malaysia. Instead we use an approach called ‘Formulation’ which is briefly explained below. However, all of our psychologists would be happy to discuss diagnosis with you if you would like to do so.

Formulation not Diagnosis

The British Psychological Society recommends the use of ‘Formulation’ as an alternative or supplement to diagnosis. All of our psychologists at Share Resolve use this approach. Initially, we 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 then we continue working on it together until it does make sense. 

A good formulation helps us decide what we need to do to. We 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 any of our psychologists please see our ‘arrange a consultation‘ section.

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