If you thought treatment is the purpose of a psychiatric a diagnosis, consider:
That anti-anxiety and anti-depressant medications, mood stabilizers, anti-psychotics, tranquilizers, hypnotics (sleep meds), even stimulants, are specific for symptoms. Not for a specific diagnosis.
Symptoms like anxiety; persistent low mood; loss of interests; hopelessness; wanting to die; disturbed sleep & appetite; and repetitive worry are not diagnoses. Yet you will find these (and many other) symptoms in abundance in psychiatric diagnostic manuals, like the “Bible” of American Psychiatry, the DSM5, where symptoms function as criteria to make a psychiatric diagnosis.
When a psychiatric treatment is recommended, like a medication and a type of psychotherapy, it is specific to a person’s symptoms, not to a particular diagnosis.
What were called “anti-depressants” (like Paxil, Prozac, Lexapro, Citalopram) are now prescribed for people diagnosed with Major Depression, Generalized Anxiety and Panic Disorders, PTSD, OCD, and Premenstrual Dysphoric Disorder (PMDD). These medications target the symptoms seen in these conditions. As do psychotherapies, like CBT, Interpersonal, Exposure, and Analytically Oriented Psychotherapy.
Anti-psychotic medications (Zyprexa, Haldol, Abilify) are prescribed for symptoms of hallucinations, delusions, agitation, severe depression, and mania. These symptoms are common to conditions diagnosed as Schizophrenia, Schizoaffective Disorder, Bipolar Illness, Treatment-resistant Depression, and Delirium. Here too, psychotherapy, is focused on specific symptoms, not a diagnosis.
And so it goes for an abundance of the 299 diagnoses listed in the (revised) DSM-5.
The purpose served by a psychiatric diagnosis is for mental health professionals, hospitals, clinics, and related services to get paid. A diagnosis is necessary to bill for a service covered by an insurance company as well as by federal health and mental health programs.
“How do I know if I have schizophrenia”, a young woman asked me after a public lecture. The social media response I later posted (anonymously) has been viewed over 265,000 times.
If you want to be paid, be sure your medical record has a DSM5 Diagnosis. When you consider a treatment that may reduce psychic suffering and enhance the quality of a life, guide your decision by symptoms – with careful attention to your patient’s psychological and social circumstances.
Lloyd Sederer, MD, is an adjunct professor, Columbia/Mailman School of Public Health, former NYC Commissioner of Mental Health, and Former Chief Medical Officer of the NYS Office of Mental Health. www.askdrlloyd.com
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