Diagnosis … & why we rarely use it

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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 11?

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

  • The World Health Organisation’s International Classification of Diseases (ICD-11)
  • 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-11 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 :

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 that many psychiatric diagnoses are really only a name for a set of symptoms that tend to group together. For example, a person may be given a diagnosis of depression if they have a certain number of symptoms that may include low mood, low energy, low levels of activity, disturbed sleep, reduced appetite, loss of libido or loss of enjoyment.

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 makes sense to you. 

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. 

The formulation can and should adapt over time if your situation changes or your approach changes as a result of the skills you learn by working with a psychologist.

Example of formulation using Cognitive Behavioural Therapy (CBT):

Here is a simplified example of a formulation we might use in CBT (Adam is not a real client of ours because we never share information about clients without their permission):

Adam was 28 years old when he first met with a psychologist at Share Resolve. He had been struggling with low mood and feelings of anxiety and stress for the past few months. He works in a competitive office environment, where he feels constant pressure to perform well and meet high expectations. Adam was experiencing sleep difficulties, irritability, and found it difficult to concentrate at work.

The psychologist began by gathering information about Adam’s background, thoughts, feelings, and behaviours. Through this process, the psychologist identified several factors that may be contributing to Adam’s anxiety and stress.

Adam grew up in a family where there was a strong emphasis on achievement and he was criticised if he did not meet the high expectations set for him. He came to believe that he needs to be perfect or successful to gain approval, love, or a sense of worth. This may explain why Adam tended to have negative thoughts about himself and his performance at work, often thinking, “I am not good enough,” or “I will never succeed.” These thoughts led to low mood and feelings of anxiety and stress.

Adam’s anxiety led to him spending long hours working, trying to prove his worth, but this only made his stress and anxiety worse. He also avoided challenging tasks at work, which further reinforced his belief that he is not competent and made him feel low.

The psychologist and Adam worked together to develop a CBT-based treatment plan to address his low mood, anxiety and stress.

Adam learned to identify and challenge his negative thoughts. He practiced replacing these thoughts with more balanced and rational ones, such as “I have succeeded before, and I can do it again,” or “Everyone makes mistakes; it’s part of learning and growing.”

Adam and the psychologist developed a plan for gradually facing challenging tasks at work instead of avoiding them. They also worked on setting realistic goals and establishing healthy work-life boundaries to prevent burnout and reduce stress. Through this process Adam made more progress and his mood improved.

Example of Formulation using Acceptance & Commitment Therapy (ACT):

Here is a simplified example of a formulation we might use in ACT (Aisha is not a real client of ours because we never share information about clients without their permission):

Aisha is a 30-year-old woman who feels unhappy and lost in her life. She doesn’t like her job and finds it hard to keep close friends. She often thinks about how she has failed and worries about never being happy.

Aisha works with her psychologist to get a better understanding or what might be causing or maintaining her sadness and confusion. Here are some of the patterns that they noted:

Aisha believes her overly negative thoughts about herself and her life are true. These thoughts make her feel bad and cause her to respond in ways that make her feel even worse. For example, Aisha tries to ignore or push away her bad feelings and thoughts by watching YouTube for hours or eating junk food for comfort. These actions only give her short-term relief and make her feel worse about herself in the long-term.

Despite her efforts to push away bad thoughts and feelings Aisha still spends a lot of time thinking about past mistakes and worrying about her future. This stops her from enjoying the present and doing things that matter to her. She is also unsure about what is really important to her, so it’s hard for her to set goals and make good choices.

Based on this understanding the psychologist and Aisha make a plan to help her. They start by discussing what is really important to her, like family, creativity, or helping others. This helps her know what she wants in life. With a clearer idea of her values, Aisha sets small goals and starts taking steps to live a life that matches her values. She learns how to focus on the present moment rather than thinking too much about the past or present. This also helps her to spend less time worrying or thinking about past mistakes.

Aisha also learns how to respond differently to her thoughts and emotions. She starts to let herself feel her emotions without trying to change or judge them, understanding that everyone has these feelings sometimes. This frees her from trying to get rid of her emotions by watching YouTube or overeating. She also learns how to see her negative thoughts as just thoughts, not truths.

Using this approach Aisha learns to accept her thoughts and feelings, know her values, and make choices that lead to a happier life.


Meet with one of our Psychologists

If you would like to meet with one of our psychologists to discuss a diagnosis or develop a formulation by thinking through how the difficulties you are facing may have come about please get in contact with us.

For more information about our psychologists click here.

To arrange a meeting with one of our psychologists please contact our friendly administrator Kae. You can call or WhatsApp Kae at 012 5089910. You can also email her at info@resolve.my.


Any questions or comments about diagnosis?

Did you find this article helpful? If you have any questions about diagnosis please write them in comments section at the bottom of this page and we’ll reply to you as soon as possible.

We would also be happy to receive any comments or opinions you may have on this article.


Further Information on diagnosis …

Further Information on this Topic

Listed below are links to other websites and resources that give more information about psychiatric diagnosis.

If you know of any other websites or resources please let us know in the comments section below so that we can add them to the list.

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The New York Times Article on Redefining Mental Illness

This New York Times article from 2015 gives a good overview of the debate about psychiatric diagnosis.


Nature Article on The Hidden Links between Psychiatric Diagnoses

Nature is a prestigious scientific journal. This news article from 2020 discusses some of the issues and problems with psychiatric diagnoses.

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