When Does a Little Different Become a Diagnosis?

This article was originally published in the Summit Daily News as part of the Dear Drewbie column on February 27, 2017 by Drew Mikita.

My favorite class to teach is Abnormal Psychology, a class based on diagnosis and treatment of mental health disorders. I always hate the word “abnormal” it is outdated, offensive, and indicates that those with a diagnosis are freekish, still love the class though! The class deals with the incredibly important topic: When do emotions and behaviors go from odd, stressful, or uncomfortable to diagnosable?

All of us have experienced many of the symptoms of diagnosable disorders at some point. Sadness, anxiety, worry, substance abuse, self-worth doubts, or other negative feelings are very common. Just because these symptoms have some level of commonality, does not mean we all meet the requirements for a diagnosis, even us crazies in the high country.

When making a diagnosis there is substantial subjectivity and grey area. While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), the Bible of mental health disorders, identifies disorders and specific 

symptoms and requirements for diagnosis, but there is still an interpretation. Learning how to accurately use this system requires substantial training, education, and testing. The process must be respected and done by those with appropriate credentials for everyone’s safety.

Diagnosis can be both beneficial and harmful. Regardless of the pros and cons, diagnosis is necessary and the benefits far outweigh the drawbacks.  When done responsibly by a professional, the risks and dangers should be mitigated and minimizes.

Drawbacks to Diagnosis

  • The Self Fulfilling Prophecy This concept essentially states that if you believe something to be true it is more likely to come true. This is often done subconsciously and unintentionally. If a person is diagnosed with Generalized Anxiety Disorder, she may start to show signs of more anxiety because of the diagnosis.
  • Stigma Fair or not, there is a stigma that can come with the diagnosis of mental disorders. As a counselor, professor, and more importantly a person with a mental health disorder, this is too true. Our culture has a skewed idea of mental illness manifesting in assumptions, fears, and stereotypes. Appropriate or not, it is real.
  • Inaccurate Diagnosis Because of the subjective nature of diagnosis, client self-report, hidden symptoms, and other factors clinicians can miss a diagnosis. This can have major consequences including improper treatment methods, negative emotional consequences, and more. It does happen, and clinicians should understand that diagnosis can change over time and be willing to adjust accordingly.
  • Excuses A mental health diagnosis should not be an excuse for negative behaviors, but often it is an explanation. Do not let your diagnosis be an excuse to be the worst version of yourself. Use it to motivate you to be the best you can be.

Positives of diagnosis

  • Relief  For most people receiving a diagnosis can be a huge sense of relief, the “So that’s what this is called” moment. Understanding that while it may be a diagnosis, it is a starting point for recovery, and that is optimistic.
  • Validation When diagnosed Bi-polar some years ago, it made me like I wasn’t just making my symptoms up. It is real, and I am not crazy, just a little ill.
  • Treatment Not having a diagnosis can limit treatment options. In the field of psychology/counseling people have spent years learning the best treatment options for each specific disorder. Researching a disorder to see what treatment possibilities exist can allow healing and improvement to begin. For me, exercise, diet, art, and yoga have all been helpful to my overall mental health functioning, as has talking with friends and a counselor. The majority of treatments are non-medicinal and have holistic benefits is also useful.
  • Support Counselors, family and friends, and people with similar diagnosis can help support a person with a diagnosis. Find the people you need, let them know how they can encourage and support you best.
  • Acceptance For some people, a diagnosis can be helpful for self-acceptance, as well acceptance from others. While sometimes a diagnosis can seem alienating, it does remind people that they are not the only person with those issues.

Odd behavior or a diagnosis?

When does normal sadness turn into Major Depressive Disorder? Everyday life stress become Generalized Anxiety Disorder? This is the subjectivity of this entire process, that can also feel quite ambivalent at points. The line is grey at best. Even as a professional with a decade in the field it can be tough to tell.

Some of the most fascinating people I know are abnormal, weird, quirky, and may even have a diagnosis. Some of our favorite artists, writers, athletes, and people have diagnosable mental health disorders.

First, it is essential to always look at the context of the behavior. If a person is showing mild signs of depression but just got divorced, their mom died, dog ran away, lost their job, and has the flu, they may not have depression but could show signs, they just had a horrible stretch of life events where sadness is appropriate. Feelings of sadness and depression are expected. Understand life circumstances, cultural and religious values, and all other factors to make an accurate diagnosis.

Second, mental health disorders fall on a continuum or spectrum of severity. Ranging from mild, moderate, up to severe, and everything in between. Don’t assume that because you know me that you know what it is like for everyone who has Bi-polar. Everyone is unique and their symptoms will vary.

Expected and Normal to Diagnosable
Here are a few major differences between someone experiencing normal levels of emotions and a person who has a diagnosis. Every MH disorder is unique, has very specific criteria to be met for diagnosis, this is just an overview of the general differences between expected and diagnosable. Speak with a licensed clinician if you are experiencing mental health symptoms to get an accurate idea of what is going on.

  • Intensity: Being bummed out or melancholy is fairly normal, laziness, motivation, and sadness are common. People with a MH disorder will experience those feelings much more intensely and will disrupt their functioning in some way or another. The feelings can often be described as crippling, paralyzing, and debilitating. Suicidal thoughts, panic attacks and extreme symptoms.
  • Frequency: Occasionally or circumstantially (tourist season, work demands, or life stressors) experiencing depression or anxiety is typical for days or even a few weeks or months in some cases. For those diagnosed these negative feelings will be occurring with much more regularity, even constantly.
  • Duration: For most people the negative emotions will last a few hours, days or weeks, then fading back into the “normal.” People with a diagnosis will experience negative feelings with little or no relief for months and years.
  • Quantity of Symptoms: Every diagnosis is essentially a checklist, with a person needing to meet X number of Y symptoms (like 5 of 9 or 4 of 7). The more symptoms a person has the more likely a diagnosis. It would be expected to experience one or two symptoms, but those with a diagnosis will likely experience several.

If you are concerned you or a friend may have a diagnosis don’t delay. Get them to a licensed professional to determine if a diagnosis is present and the subsequent treatment options. Don’t stress if you get diagnosed, this is the beginning point for improvement. It is a start of treatment, relief, and recovery. And remember, isn’t normal kind of boring anyways!