Psychological diagnosis? Yes or no? - psychology - 2023



Since the beginnings of psychology as a science in charge of the study of the human mind and behavior, numerous investigations have been carried out to determine the origins, consequences and perpetuating factors of the vast majority of psychological disorders.

But... Does this initiative by naming psychological phenomena have any drawbacks?

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Research on mental disorders

The American Psychiatric Association (APA) and the World Health Organization (WHO) are two of the organizations that have invested the most time and effort in trying to understand in greater depth and provide clarification about how mental disorders work, what are the symptoms associated with each of them, how to detect them (how many symptoms must be present in order to establish an accurate diagnosis and for how long), etc. This information is reflected in their corresponding diagnostic manuals: the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD-10).

Also, the APA and other institutions such as the National Institute for Health and Care Excellente (NICE) have been in charge since the 90s of verifying which treatments are the most effective for each type of disorder, trying to establish empirical validations of different ways of leading to carry out a therapeutic process.

Specifically, division 12 of the APA, created in 1993 a working group on the promotion and dissemination of psychological treatments based on the conclusions of their research, leading to the development of treatment guides with a theoretical-practical basis adapted to the characteristics of each disorder.

On the other hand, the action of NICE includes the provision of information, education and guidance, the promotion of prevention and the proposal of ways to proceed in primary care and specialized services.

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Different perspectives from which to investigate

The main difference that we can find between one organism and another is how the APA focuses on the investigation of "classic" or "pure" disorders, while the NICE addresses problems that do not necessarily comply with a clinical diagnosis, but rather implements strategies to improve mental health in general (pregnancies, adherence to treatment, suspected abuse in childhood, well-being in the elderly, etc.).

In the case of the APA, “purism” is a factor that usually limits clinical performance Because it is rare for a disorder to appear in its purest and easily recognizable form, but criteria for other disorders (comorbidity) are usually met or have more complex variations.

Therefore, in psychology today we have a wide margin of research not only on the different types of disorders that we can find, but on what are the most appropriate ways of approaching them (to date).

Is the psychological diagnosis useful?

Usually, the procedure when some type of psychological treatment is to be carried out is start with an evaluation phase. In this phase, the interview known as a clinic provides us with a great deal of information about the situation of the patient in question.

Depending on the current of therapy from which each psychologist works, the interviews may have a more open or more structured format, but will always have the objective of knowing in greater depth the functioning and environment of the person in front of you.

The evaluation phase can allow us to establish a diagnosis if there is a disorder, since some of the difficulties that arise in consultation (known as Z codes) are not included in the diagnostic manuals because they are considered critical situations / changes in the life cycle rather than mental disorders (cases of separation, marital dissatisfaction, difficulties in managing children's behavior, grief, etc.).

In the event of a disorder, in the evaluation phase (in which, in addition to interviews, standardized questionnaires can be used) we will have been able to clarify the symptoms, the course and the evolution of the patient's condition, as well as giving a name to the experience you are living.

This diagnosis, based on the aforementioned, allows us in a very useful way to know with what difficulty we are relating and to establish the most appropriate mode of treatment for each person, so that we address the problem in the most effective and efficient way possible.

Should we always offer a diagnosis?

As health professionals we must bear in mind that each person is completely different from any other, and that what we would transmit to one patient may be harmful to another.

The diagnosis helps professionals to understand and clarify the situation in front of us, as well as to lay out and plan our mode of action to solve it. However, we must be very careful when establishing diagnoses, since there are several dangers:

The label can indirectly become a definition of the person

That is to say, we no longer speak of “X has schizophrenia”, but we can incur “X is schizophrenic”.

The diagnosis can lead to victimization of the patient

Whether prudently or not, establish a diagnosis can lead to the person being absorbed by your label: "I can't do X because I'm agoraphobic".

Poorly detailed diagnosis can lead to a state of confusion in the patient

If not enough information is provided and the patient does not understand what is really happening to him, it is very likely that he will "fill in" the information gaps with data that he can extract from less reliable sources than a health professional, generating negative and unrealistic expectations about your mental state.

The diagnostic label can generate feelings of guilt

"I've done something to deserve this."


Taking this into account, it goes without saying that it is extremely difficult for psychologists not to establish a mental diagnosis of the situation that is presented to us, since diagnostic labels make it easier for us to understand the information in our mental schemes.

But despite this, if the patient does not directly request a diagnosis for some reason, it is likely that they do not need to know what the experience is called by, and simply seek to resolve it.

On the other hand, if we find great insistence on “labeling” what is happening, it is important that first it is clarified if the request has a solid basis in the person or may be influenced and pushed by other means with which it relates (social links, data on the internet, etc.).