The Diagnostic and Statistical Manual of Mental Disorders (APA 2022; DSM-5-TR) is perhaps one of the least accurate diagnostic tools in medicine itself. Due to inaccurate information, subjective nature of diagnosis, client's either exaggerating or denying symptom occurrence, diseases that manifest mental illness symptoms, medication interactions, and the overlapping of symptoms with other diagnosis generally speaking it is not uncommon to receive two or three different diagnosis from various professionals describing similar symptoms. It is also widely accepted that many diagnoses have many causalities with regard to biological, psychological, and social influencers.

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Why then do we need diagnosis? Diagnosis is required for most forms of insurance reimbursement, research funding, psychotherapy and pharmacological treatment. Remember that many psychotherapy interventions not only target specific symptoms, but are likely to improve other aspects of your life. This means that even if a diagnosis is wrong from the clinician, that there is a great chance of getting your symptoms alleviated through the systemic process therapy takes. 

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Prognosis- A forecast of the likely course of a disease or ailment. With each diagnosis inside of the DSM-5, there are a multitude of factors that estimate the course or successful treatment of a mental health diagnosis

Diagnosis-The DSM-5 utilizes a plethora of criteria that is recommended for Clinicians (therapists, and other medical providers) to follow. Most diagnoses do not require a person to meet ALL of outlined criteria to be given a diagnosis. Generally speaking most diagnosis require several.

Provisional Diagnosis-This is mainly for insurance reimbursement. It is when a clinician feels as though a diagnosis will likely be the outcome of future testing and investigation. It is considered a “holding” diagnosis for insurance reimbursement purposes

Principal Diagnosis-Many people that suffer from mental illness do not simply suffer from ONE diagnosis. The diagnosis that has the greatest impact or needs the most attention is called the principal diagnosis

Comorbid Diagnosis-Comorbid diagnoses indicate that the person suffers from more than one mental health diagnosis. Examples include a person with ADHD also suffering from social anxiety disorder or a person with OCD suffering from hoarding (now with the DSM-5 a separate diagnosis) disorder

Co-occurring Diagnosis-Typical indicative of a person that suffers from both mental illness and substance misuse.

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Manic Episodes

• Inflated self-esteem or grandiosity

• Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

• More talkative than usual or pressure to keep talking

• Flight of ideas or subjective experience that thoughts are racing

• Attention is easily drawn to unimportant or irrelevant items

• Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation

• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

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Major Depressive Episode

• Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observation made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)

• Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing.

• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day.

• Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day

• Psychomotor agitation (e.g., restlessness, inability to sit still, pacing, pulling at clothes or clothes) or retardation (e.g., slowed speech, movements, quiet talking) nearly every day

• Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual).

• Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings).

• Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g. appears easily distracted, complains of memory difficulties).

• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or a specific plan for committing suicide

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Delirium- Results in confused thinking and reduced awareness of your environment.

Psychosis - Refers to an abnormal condition of the mind described as involving a "loss of contact with reality". May include delusions (thoughts), hallucinations (disturbances of one of the five senses), catatonia (agitated state, e.g. person walking in circles or fixed arm movements), and thought disorders

Acute-Something happening abruptly and usually happens once. Examples are acute brain injury (formerly traumatic brain injury), single harsh traumatic events, or symptom episodes

Chronic- Usually happening over a period of time and/or reoccurring. Examples include being in an abusive relationship and chronic nerve pain (pain that lasts longer than 6 months) that generally no longer becomes a signal from the nerve but lays simply in the brain

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Diagnosis Example:         

F90.2 ADHD (Combined Type, Principal)

F91.3 ODD (Moderate)

Z62.898 Child Affected by Parental Relationship Distress

GAF: 62