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What does it mean ‘to have a diagnosis’ in the context of mental health difficulties and the onset of treatment

It is not uncommon that when someone who wants to start psychotherapy is asked about his or her reasons, they answer ‘I have diagnosis X’ or even ‘I have diagnosis F’ (and you can even hear a number, e.g. 5.1).

Moreover, when they are asked to elaborate on it, they will see it as ‘checking up’ on the patient or as an expression of uncertainty or unfamiliarity with medical nomenclature on the part of the therapist. This situation can be encountered not only by people who already have a formal diagnosis (i.e., made by a psychiatrist), but also by those who have searched for information on the Internet or in widely available literature, such as psychiatry textbooks.

It is therefore worth explaining what diagnostic codes are, how to understand a diagnosis, and finally, how professionals approach it.

Just like with any health problem, the starting point when someone is struggling with mental health difficulties is to offer a diagnosis. The medical diagnosis is made by a physician on the basis of a personal interview with the patient, which can be also done online but under specific conditions – interested readers may consult separate publications [e.g. 1, 2]. The medical diagnosis, together with the proposed options of treatment, should be discussed with the patient in a way that is understandable to him or her, and the medical records should include the name of the diagnosis and its code (number). It may happen, however, that a conversation with the doctor is not sufficient for the person who comes for advice, and the diagnosis written, for example, on the referral for psychotherapy (together with an unclear code being a combination of letters and numbers) triggers various emotions, from anxiety to anger.

If you live in Europe, you should know that physicians of all specialties use the same classification system, the so-called International Classification of Diseases, developed by the World Health Organization (WHO). This classification, abbreviated as ICD (International Classification of Diseases) has been in operation for about 30 years (!) in version 10 (ICD-10), while version 11 is being prepared for implementation (among others, work is underway to translate it into national languages, including Polish) and it is expected to enter into force on 1 January 2022. It is an updated version with a number of changes introduced in line with the current medical knowledge and some coding modifications. One of such changes in the field of mental health disorders will apply to the definition and diagnosis of personality disorders [e.g. 3]. The first series of initial training in ICD-11 for clinicians is about to begin in Poland.

However, regardless of whether the name of the disease is accompanied by a code, such as F50.0 or 6B80.00, it is important to remember that a conversation with a doctor, psychotherapist or psychologist will be about the nature of the difficulties and their impact on the everyday functioning of the person who needs help, rather than about the name - the diagnosis. It should be remembered - and this also applies to potential patients - that diagnosis is not synonymous with equalisation. Two people who are struggling with, for example, anorexia nervosa (one kind of eating disorders) may have similar symptoms resulting in the same diagnosis, but they may obviously differ in terms of the intensity of particular symptoms, the context in which they appear, etc.. All this will need to be considered when determining the objectives and the plan of treatment, its course and cooperation with the physician. Each patient is, above all, an individual, not a ‘case’ examined by some diagnostic entity. This is why the interview with a specialist is usually accompanied by additional examinations, most often tests, aimed at collecting as comprehensive information about the (potential) patient as possible. Here again, it is important to choose such methods in a thoughtful way, which is the task of the specialist. Not in every case is the so-called neuropsychological examination (e.g. of memory or attention) necessary, nor is the examination by means of personality inventories justified for every patient. Some of these methods involve questionnaires to collect sociodemographic data, others can be used to collect information about the symptoms experienced or to assess motivation for treatment. Some testing methods can only be used by psychologists (psychological tests, e.g. to assess personality or intelligence). Some of them can be completed by the person under examination, others require an active participation of the person conducting the test. And here again a reminder - if psychological tests are applied, the results should be described/discussed by a psychologist in a way that is understandable for non-psychologists, including patients and physicians.

The extensive process of diagnosis - getting to know the patient - is necessary to treat the person in the best possible way. This objective may be hard to achieve in reality, e.g. there is not enough time, the patient may be afraid to tell the doctor everything or ask the doctor, psychotherapist or psychologist about details, which may be particularly important in the case of mental health disorders. I therefore encourage you to be open not only to questions from the specialist, but also to talk about yourself, your difficulties, anxieties and expectations. It should be noted that all activities related to the formal diagnosis, but also an informal search for a diagnosis by the person concerned (reading online forums or completing publicly available tests or even quizzes) helps him or her to increase the ability to self-reflect and come up with new observations and associations, which makes a starting point for further work within the therapy.

Reference literature

Krzystanek M, Matuszczyk M, Przybyło J, Dudek D, Gałecki P, Bieńkowski P i wsp. List do redakcji. Polski standard teleporady w psychiatrii. Psychiatr. Pol. 2021; 55(6): 1473–1477.

Krzystanek M, Matuszczyk M, Krupka-Matuszczyk I, Koźmin-Burzyńska A, Segiet S, Przybyło J. List do Redakcji. Polskie rekomendacje w zakresie prowadzenia wizyt online w opiece psychiatrycznej. Psychiatr Pol. 2020; 54(2): 391–394.

Mulder RT. ICD-11 Personality Disorders: Utility and Implications of the New Model. Front Psychiatry. 2021 May 10;12:655548. doi: 10.3389/fpsyt.2021.655548.  

About the author

Katarzyna Klasa, MA – research assistant at the Department of Psychotherapy of the Jagiellonian University Medical College, senior assistant at the Department of Psychotherapy of the University Hospital in Kraków, specialist in clinical psychology and certified psychotherapist of the Polish Psychiatric Association.

A graduate of postgraduate studies in sexology and a postgraduate programme in mediation, she provides training at a comprehensive postgraduate psychotherapy course and the Postgraduate Studies in Psychotherapy offered by the Department of Psychotherapy of the Jagiellonian University Medical College in collaboration with the Postgraduate Medical Education Centre.