I am watching a video of a psychiatrist analyzing mental illness TikToks right now, and he just went on a long description of the DSM. This has got me thinking a little bit, so let’s discuss a bit more about the DSM. I’m obviously not a psychologist, but I think I have enough of an understanding of these things to say the vague things I’m going to say.
I think I’ve said this before, but I’ll say it again: many mental illnesses’ symptoms overlap with each other, some of these symptoms even being typical for people who don’t meet criteria for diagnosis. There are different aspects of these symptoms that matter when it comes to diagnosing for an illness versus what’s “typical” for your particular demographic.
For example, lots of people have a period of time where they feel down, depressed, or hopeless, as is common in a major depression diagnosis. However, to be diagnosed, these symptoms should last for at least two consecutive weeks. This, the duration of symptoms, is one thing that is considered before making a diagnosis.
Another thing that is considered is severity. To me, this line seems a little more blurry, because severity can be kind of subjective. A licensed psychologist or mental health professional is infinitely better at judging the overall severity of symptoms in someone they’re evaluating than I ever will be, no doubt (again, I’m not a psychologist or anything). But I do know that they evaluate severity as well as duration of symptoms. Their evaluation questions are designed almost like a flow chart when it comes to narrowing down to a diagnosis or eliminating other diagnoses.
A psychiatrist will make a diagnosis based on criteria in the most up-to-date DSM: right now, the DSM-5. DSM stands for Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 includes almost every mental disorder, including all that I’ve talked about on this blog – the only one I know of that is still being considered is C-PTSD (complex post-traumatic stress disorder). C-PTSD tends to form from prolonged trauma over a period of time, as opposed to the (typically) short-term experience that leads to regular PTSD: witnessing a death, experiencing a near-death experience, experiencing rape or other relatively short, traumatic events.
Technically I am diagnosed with PTSD (in partial remission) and I’m pretty sure the reason is simply because C-PTSD isn’t in the DSM-5, but I exhibit (or have exhibited) many of the same symptoms from prolonged trauma in my younger life. One therapist told me I didn’t have it when I answered “no” to the very first question for evaluation: have you witnessed a death, experienced a near-death experience, or have you been raped? She didn’t care that my psychiatrist wanted her to evaluate me, so he did his own evaluation, and after some pondering over the initial trauma, he diagnosed me – but in partial remission, since some of my symptoms have died down over the years since. That’s one reason I haven’t made a post about PTSD yet, since I feel almost like I don’t have the right to. Anyway, back to the point.
Most of the time, in the DSM, a psychiatrist will consider how many of the symptom checkboxes you meet, and that will affect whether they officially diagnose you or not. In less common cases, you may still be diagnosed even if you don’t meet the (typically required) five or however many criteria, I believe usually due to severity and particularly how they manifest. Even if one doesn’t meet a full diagnosis, some forms of treatment may be recommended by a psychiatrist. Therapy, I would assume, is the most common treatment they would recommend to someone who doesn’t meet the criteria for a diagnosis. However, in cases of severe short-term symptoms, one may prescribe medication as a temporary crutch to help you get back to “normal”. If someone goes through a major loss in life (a loved one due to death, divorce, a major breakup, whatever) a doctor may give them a month or two of antidepressants to help them still function while they recover. However, the goal is always to get off of the medication again.
To summarize, a psychiatrist will go through the DSM’s symptoms for suspected mental illnesses, analyze duration and severity, and ask about how the symptoms manifest before they make a diagnosis. Their recommendation for treatment may be medication and/or therapy depending on the same things.