How Can My Therapist Tell If I Have A Real Psychological Problem?
There are a number of ways your therapist can diagnose any psychological problem that you may have.
There is a large, diagnostic “bible” called the DSM-5. Its full title is The Diagnostic and Statistical Manual of the American Psychiatric Association, 5th edition. Now you can see why we call it the DSM. It contains 806 pages (not counting appendices) describing and labeling every possible psychological problem a person can have. The current edition, published in 2013, has 340 specific diagnostic labels. You would think that this would be enough to describe every possible human disturbance. It is, for now, but every new edition adds to, subtracts from or changes the psychological labels we all share. Stay tuned for DSM-6.
Labeling psychological problems can be a tricky affair. For example, there are 14 different labels to describe a Major Depression. Each one tries to make refined distinctions about the severity and duration of the depression. There are 24 ways one may be diagnosed with a bipolar disorder and 16 categories of alcohol abuse or addiction. THE DSM covers every possible issue from trying to deal with a divorce (adjustment disorder) to the terrible and total withdrawal of someone into a catatonia. Some diagnoses have disappeared (Masochistic Personality Disorder) and some have been discovered and defined (Gambling Disorder). Mental Retardation has been renamed as Intellectual Disability and the field is still struggling with trying to understand and categorize different levels of autism.
If you use health insurance to help pay for your therapy, your clinician must give you one of these labels with a corresponding code number. You may be a 296.32 (one of the depressions) or a 309.28 (a form of an adjustment disorder). Older editions of the DSM even had a code for someone with “no diagnosis” (V71.09). It may be comforting to know that people do exist with no discernible issues – or at least we haven’t found them yet.
The United Nations publishes another classification system of psychological disorders through the World Health Organization (WHO). This is called the ICD-10 or The International Classifications of Diseases, 10th edition. Besides psychological problems, this system also includes all medical/physical problems a person may develop. The mental disorders categories substantially overlap those of the DSM system but with a different coding system. Under the ICD-10, you may be an F33.1 rather than the 296.32 mentioned above. Same depression, new and improved number! Some insurance companies are using this classification system now.
But these are just labels, systems of classification based on the problems or symptoms you describe to your therapist, counselor or psychologist. How does he or she know that your current thoughts, feelings or behaviors rise to the level of an actual mental health issue?
The first thing to remember is that psychological problems are just very human problems. All the diagnostic labels in the DSM-5 or the ICD-10 are characteristics of regular people that have gotten out-of-hand. For example, we have all gotten depressed or anxious at times; but, our emotional distress may not have reached the level of a disorder and it passes. Many people drink alcohol or gamble without having problems with those behaviors. A student may obsess about a big test coming up at school without having an obsessive-compulsive disorder. We all share the ability to have thoughts, feelings and behaviors in our daily life. A psychological disorder is a thought, feeling or behavior that has grown to have the following characteristics:
Severity
The thought, feeling or behavior has reached a very severe, very strong level of discomfort for us. The depression is very strong; the gambling behavior is very strong.
Chronicity
The psychological pain has been going on for some, lengthy period of time. It has not been diminishing over time and shows no signs of getting better. It is not just a couple days of having the “blues”.
Causation
In normal life, everyone has psychological trouble now and then and it is usually tied to some real event that is causing it. We are ill or lost a job or had a car accident. These things are also usually temporary and not chronic. Psychological disorders may not have an obvious cause; or, the cause may seem to be too minor to trigger off a strong depression or anxiety attack.
Uncontrollable
The psychological distress seems out of your control. You can’t “snap out” of the depression or the feeling of dissociation. You can’t stop the obsessive hand-washing behavior or the impulsive drinking. Those swirling obsessive thoughts just won’t go away no matter how you try.
Interference
The troubles have started to interfere with the smooth functioning of your normal life. Perhaps you can’t get to work; or, you are isolating from the family; or, feel edgy and anxious all day long. I’ve heard people say that they just want to “be me again” but; they can’t because the psychological issues are interfering with their normal sense of self.
So, this is how your expert clinician can tell you if you have a “real” psychological problem. The thoughts, feelings and behaviors have gotten very severe, have lasted over time, and have no obvious cause. They feel out of control and have started hurting or interfering with the smooth functioning of your life. Depending on how you describe the symptoms, your therapist will give you the appropriate diagnosis as found in one of the books described above.
The bad news is that it hurts. The good news is that most of these problems can be improved with psychological counseling.
Take care of yourself; you deserve it.
