What exactly is a diagnosis?
Written by Heather Fraser, LPC-MHSP
To be human means to have a wide range of emotional experiences and to perceive things in nuanced ways. Experiencing bouts of emotional reactions in circumstances in which they are expected is a truly normal human experience. Sometimes, though, these emotional reactions and behaviors extend beyond a reasonable reaction to circumstances or stressors and lead to impairment in occupational, emotional, and social functioning. When functioning is impaired, treatment is recommended.
An occasional sneeze wouldn’t cause concern, but constant sneezing causing nosebleeds would warrant a doctor’s visit. The symptoms themselves could be manageable, but when the frequency or intensity of the symptoms is problematic, treatment is indicated.
What makes a diagnosis?
A mental health diagnosis is simply a label for what mental illness or disorder is present. This label helps providers and doctors know what type of symptoms may need to be treated.
In the clinical world, we have a list of criteria that need to be met in order for a diagnosis to be given. These sets of criteria include not just the type of symptoms but also the frequency, intensity, and impact of the symptoms as well. These diagnoses are listed in a book called the Diagnostic Statistical Manual (DSM).
There is a wide range of how symptoms show up and are categorized, even within the same main diagnosis. Think of how many ways a cold or the flu can manifest. Sometimes it’s a sore throat and fever, other times there is no fever but a cough and sneezing. There are many ways each diagnosis can look. This also applies in mental health diagnoses. If you compare three individuals with the same diagnosis, you may get three vastly different presentations of the same disorder.
An example of this in the mental health world is depression. To feel depressed for a short duration after losing a loved one or facing a difficult challenge is a normal expected reaction. Yet if the depression persists over time or it’s so severe it interferes with employment, self-care/hygiene, or causes isolation, therapeutic intervention is required to effectively manage the symptoms.
When someone feels deep sadness, they can describe that feeling as depression, but it may just be a fleeting depressed feeling and not an ongoing clinical disorder. In order to have clinical depression, one must have at least 5 of the 9 symptoms listed in the DSM. Someone can meet a minimum threshold for “mild depression” with only 5 symptoms causing minimal impact on mood and relationships. Another person could have all 9 criteria symptoms and a higher level of impairment (missing work due to low motivation, isolating from all relationships, not bathing or brushing teeth or hair, etc.). These would both be considered clinical depression, but they can look very different from person to person depending on which symptoms are present and how intense those symptoms are.
Another example is anxiety. If you have ever seen the movie Inside Out 2, you know we all have access to feeling anxious when circumstances create nerves or fear. We all feel anxious at times as a part of human life. Anxiety is a vital emotional experience that keeps us safe! Yet when anxious feelings occur consistently, cause panic attacks, impact appetite, and/or are not manageable, they may meet the threshold for a clinical anxiety disorder.
Th misuse of diagnostic terms
We live in a society where information about diagnoses is prevalent but not always accurate. Social media helps disseminate information, but this information is often misinterpreted and inaccurately applied to the general public. Many diagnostic words are used in general society in less formal capacity than a true diagnosis. In a way, the informal uses of these phrases are not completely inappropriate descriptions, but they do differ from a clinical diagnosis. Here are some common ways these phrases are used that have complicated how society views these diagnoses:
| Diagnostic word | How it is used informally | Clinical usage |
| OCD | Someone might say “I am so OCD” because they like things to be in order or a certain way | Obsessive compulsive disorder can present in MANY ways and includes the presence of obsessive thoughts and/or compulsive behaviors. (These have specific criteria.) |
| Depression | Labeling any sadness as depression | Clinical depression is much more than run of the mill sadness, it affects thoughts, mood, actions, and social interactions. |
| Anxiety | Labeling any level of worry or fear as anxiety | An anxiety disorder is more than worrying. It occurs when the worry exceeds the intensity of the circumstance causing it. |
| Psychosis/Psychotic | The word Psychotic is interchanged for describing someone as “crazy” or “wild” | Psychosis is a very serious symptom that can include hallucinations, delusions, or other loss of touch from reality. |
| Bipolar | Attributing any mood swings to being “bipolar” | Bipolar disorder includes episodes of both depression and mania/hypo-mania. |
| ADHD | Describing moments of distraction or inability to focus | ADHD is a combination of symptoms that affect impulsivity and concentration. |
| Narcissism | Used to describe someone who is selfish or manipulative | Narcissism is a personality trait that includes persistent and problematic iterations of grandiosity, lack of empathy, and deep need for admiration. |
Who can give a diagnosis?
Due to the complexity and nuance of these clinical terms, a diagnosis can only be given by a trained mental health professional who has studied the DSM and can interpret the presenting symptoms appropriately in a clinical setting.
If you have a cough and a sore throat, you may not effectively determine the source of the symptoms and the most effective treatment without seeking medical care. The doctor will evaluate ALL symptoms (Fever? Any other pain? Runny nose? etc.) and potentially do some tests to determine if your presenting symptoms are the result of allergies, a cold, the flu (which strain?), COVID-19, or other viruses or infections.
Similarly, if you are experiencing mental health symptoms of any degree, a mental health professional will evaluate all symptoms, impact, and management strategies during an intake/assessment to determine what is the most likely cause and most effective treatment plan to manage those symptoms.
Do I need a diagnosis?
Most of the time, a diagnosis is needed to determine treatment options and strategies. If you have a few symptoms yet are managing them with the help of your support system, spiritual integration, or coping strategies, there is no need to seek a formal diagnosis.
Yet if you are experiencing symptoms and are unsure how to manage them, or need additional support to address them, you may benefit from seeing a mental health professional to gain language for what you are experiencing, explore the impact on you, and decide next steps towards healing and improvement.
Heather Fraser, LPC-MHSP, helps clients heal from trauma, navigate life transitions, and manage stress and anxiety. She has appointments available at Insight’s office in the Donelson neighborhood of Nashville and through telehealth.