Sometimes people will say “Everybody gets down at times or most people are anxious now and then. That doesn’t mean they have a mental health problem. Doctors over-diagnose normal problems of living to get people to take medicines. Every fidgety child doesn’t have ADHD. Every person who feels down doesn’t have major depression or even dysthymic disorder.”
But in fact, diagnosis of mental health problems follows the same methods that doctors use to diagnose physical problems. In both cases we ask what is bothering the patient (why did you decide to come to the office?) and we ask what symptoms the patient is having. We ask how are the symptoms affecting you (and the other people in your life). Are the symptoms causing serious disability or suffering in your life?
Doctors diagnose psychiatric problems like depression or anxiety using the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. The doctor notes the symptoms that the patient is having and compares them to the list of symptoms that define a given diagnosis, say depression. If the symptoms fit and the symptoms are causing significant impairment of functioning or significant mental distress, then the doctor diagnoses a psychiatric or mental health disorder.
The most important part of making a mental health diagnosis is that the patient have significant trouble in accomplishing his duties or his goals or have significant mental suffering due to the diagnosis. No matter if he has the symptoms that define a mental health disorder, if he is able work and take care of his family and is not suffering mentally and not causing others to suffer then we don’t make the diagnosis. His problem, if it is one, is so minor that we don’t call it a mental health diagnosis or problem—rather like a mild chronic physical problem that doesn’t really bother him or anyone else around him.
There are six areas which the doctor needs to ask about to determine if the possible mental health diagnosis is causing a problem in the persons life.
1. Are you having problems in getting along with your spouse or children?
2. Are you having problems participating in family activities?
3. Are you having problems making or keeping friends or getting along with friends?
4. Are you having problems doing your work adequately (or doing your school work adequately if a student)?
5. Are you having problems getting along with your boss (or with your teachers)?
6. Are you having mental suffering due to your symptoms?
The doctor then goes into details about the areas where the patient is having problems. So these questions are just as important as the symptoms the patient has in making the diagnosis of a mental health problem and in planning the treatment.