[confused_77]

Whats your experience in getting a diagnosis. The therapist is the person who knows you best but does the diagnosis have to come from a psychiatrist? how can a psychiatrist who has seen you a few times decide on that?

[Amyjay]

I suppose it depends on their training and the rules of where you are. I have seen two psychologists who are both able to diagnose. The first one assessed and diagnosed me but then referred me to a psychiatrist for deeper assessment because my issues are complex with anorexia nervosa, complex PTSD, DID and MDD. I only saw the psychiatrist a couple of times though. Where I am I think only a clinical psychologist or a psychiatrist can diagnose psychiatric disorders.

[ChickenNoodleSoup]

My psychiatrist is my therapist and has diagnosed me after seeing him for about a year. I have one session a week with him for one hour, so he knows me fairly well. I also feel like they need to know you a lot more than just seeing you a few times to diagnose, it always confused me a bit that some people even only go to somebody for a diagnosis and then see their regular therapist again.

[junkDNA]

Yes he diagnosed me

[ScarletPimpernel]

My ex-Pdoc and ex-T both diagnosed me at the same time. Thankfully, they both basically came to the same decision.

[zoiecat]

My therapist diagnosed me initially with depression moderate which 6 months later changed to major depression severe, PTSD and DID. My psychiatrist does not believe in DID and diagnosed totally wrong after just session. I do not trust my psychiatrist at all.

My psychiatrist diagnoses with all the notes and opinions of my therapist.

I think psychiatrists usually use more formal, standardized methods for diagnoses that are supposed to be more objective and structured than many Ts personal experience over time. Also, many Ts are very against diagnoses and labels.

I am not against diagnoses and classifications at all - only wish I found something that described me really accurately and comprehensibly. I find it helpful to know what I am dealing with specifically. My formal diagnosis for insurance purposes was the same with both of my Ts: generalized anxiety disorder. If we want to have something that fits me long-term (pretty much whole life), I think that's the only really suitable one. It has fluctuated a lot in severity though as usually most mental issues do, sometimes virtually non-existent for a while, especially if I live a reasonably balanced, healthy life.

The other major problem, I think, about diagnoses is exactly how these things can vary across quite broad spectra, between people and even within the life of the same individual. I work in a field closely related to psychiatry, so have seen and completed tons of psychiatric surveys by myself. There were times, for example when I was deep in active substance addiction, when I easily met diagnostic criteria for most disorders than not, while none of those get even close when I am steadily sober. So it is very misleading because the outcome of the evaluation depends on so many factors and circumstances. In this sense, someone who diagnoses after one or a few visits may have a pretty low probability to get it right, even with something that involves as clearly defined symptoms as psychosis, as those also usually come and go for people and can be associated with a bunch of "disorders".

After all this, I really think that all I've truly got is eating disorder (far past), substance abuse (for a while) and the GAD is probably the only thing that exists as a universal, more or less steady current for me, I really identify with that one. I definitely think I had a nasty major depressive episode once but, again, during probably the worst of my substance abuse, and I will never know if it could have happened without. Definitely not before/after even though I do experience depressive symptoms intermittently. Maybe more isolated traits and symptoms of a few other things that come and go.

[confused_77]

Originally Posted by Xynesthesia

The other major problem, I think, about diagnoses is exactly how these things can vary across quite broad spectra, between people and even within the life of the same individual. I work in a field closely related to psychiatry, so have seen and completed tons of psychiatric surveys by myself. There were times, for example when I was deep in active substance addiction, when I easily met diagnostic criteria for most disorders than not, while none of those get even close when I am steadily sober. So it is very misleading because the outcome of the evaluation depends on so many factors and circumstances. In this sense, someone who diagnoses after one or a few visits may have a pretty low probability to get it right, even with something that involves as clearly defined symptoms as psychosis, as those also usually come and go for people and can be associated with a bunch of "disorders".

Diagnosis is subjective and there are no measurable criteria like with BP or sugar levels. If its based on a survey it relies a lot on how you percieve the severity of your conditions. I don't understand how anyone who has seen you lets say a couple of times can diagnose a mental issues baised on a bried conversation.

[nottrustin]

For the longest time pdoc had a diagnosis of Bipolar. I strongly disagreed. T dignpswd with Major depression and PTSD. Which I agreed with. After a few years I asked Pdoc about it and she agreed with T and should have changed her diagnosi9a couple of years before.

[skysblue]

I believe that therapists need to offer a diagnosis for insurance purposes. I don't know what my therapist has diagnosed me with.

[InnerPeace111]

My T has never diagnosed me. In fact, I diagnosed myself (with depression) and shared it with her. She gladly accepted it and, ever since then, I have been a very active participant in defining my own recovery and wellness goals as well as in developing my own well-rounded and integrated recovery plan.

[MoxieDoxie]

I check my insurance on-line and the claims say Chronic PTSD and Bulimia. My T is just a Licensed Social worker. I told him my old T diagnosed me with c-PTSD/Borderline so I guess he just used that. I am so glad I did not see him put down Borderline on the claims.

[ElectricManatee]

My T is a psychologist and she diagnosed me. I didn't know what her formal diagnoses were until I requested a superbill at one point. My experience has been that therapists don't draw a lot of attention to the diagnosis in therapy and instead focus on trying to understand the whole person.

[fille_folle]

My therapists have never put forward a diagnosis, nor have any psychiatrists EXCEPT the ones I saw while hospitalized. From what I understand, many therapists and psychiatrists really only use diagnoses for insurance purposes.

I have experience working in a behavioral health agency. Diagnostic assessments were conducted by provisionally-licensed or fully licensed clinical social workers. They would then summarize their findings to a senior clinician - either the executive director, who was a PhD, or the Clinical Director, who was an LCSW (the LICSW designation is not used in my state, btw). They would usually meet briefly with the client. One of them had to sign off on the assessment as the supervising clinician. Iirc, there were some services that required either a clinical psychologist or a psychiatrist to sign for medical necessity. So it's a bit complicated, but the short answer is yes, LCSWs can diagnose. I don't know about LPCs, LPAs, etc.

[kecanoe]

I was diagnosed after a formal assessment by a psychologist. I was seeing T1 at the time, he had no clue about my diagnosis. Pdoc was leaning toward DID when I was assessed and diagnosed. My diagnoses include MDD and mixed personality disorder.

T1 is now on board with that diagnosis. Ex T and T3 both have experience with DID and say that it fits, and that they would know if I didn't have it. T3 is also pretty clear about the PD. Pdoc agrees as well. So my treatment providers all agree.

Pdoc didn't want to diagnose DID without testing; said it is too serious of a diagnosis to be done lightly.

But even before the formal diagnosis, T1 and Pdoc were putting something on insurance claims. Probably MDD. Which was also true. But I don't know that I would consider what a treatment provider puts on their forms for insurance to be an accurate diagnosis. Perhaps a working diagnosis, but not definitive.

[annielovesbacon]

I honestly have no idea how diagnoses work. I see my T and my psych at the same clinic, and they have access to each others' notes about me (with my permission of course). My psych is the one who said to me "You have bipolar disorder," but my T is the one who wrote me a letter for the disability resource center at my school, which is the first time someone has put my diagnosis in writing.

[captgut]

My T is a psychiatrist and he diagnosed me

[Wonderfalls]

Originally Posted by confused_77

Diagnosis is subjective and there are no measurable criteria like with BP or sugar levels. If its based on a survey it relies a lot on how you percieve the severity of your conditions. I don't understand how anyone who has seen you lets say a couple of times can diagnose a mental issues baised on a bried conversation.

Actually psychiatric diagnosis is coded from the Diagnostic Statistical Manual (5)--not a self-survey--which tries to be as objective as it can. (Europe usually uses the ICD.)

Psychologists are trained in giving various tests and making assessments. I think, though, that a psychiatrist is the most common source of psychiatric diagnoses. Unless your insurance objects or you're trying to get disability, there's no particular reason your therapist and psychiatrist couldn't give you different reimbursement codes.

[feileacan]

Originally Posted by Wonderfalls

Actually psychiatric diagnosis is coded from the Diagnostic Statistical Manual (5)--not a self-survey--which tries to be as objective as it can. (Europe usually uses the ICD.)

It's widely known that DSM (and similarly ICD) are mostly useful for insurance companies and statistics. The diagnoses in both DSM and ICD have large overlaps and they don't give much clinical value per se.

[Wonderfalls]

Yes they are necessary for insurance companies (I don't know what statistics are taken from them.) Yes they overlap, you don't use both of them. The US uses the DSM. Other countries use the ICD--it would be very odd if they didn't overlap. All diagnosis is subjective; they were designed to unify and help qualify diagnoses. Obviously they're not perfect but it's a big stretch to contend that they don't give clinical value.

[BudFox]

I have actively avoided getting into situations where a DSM style diagnosis might be inflicted on me. I regard such diagnoses as poison, and as overt pseudoscience, and feel fortunate to have avoided them largely. I don't see much difference in terms of therapist vs psychiatrist making these assessments.

[Wonderfalls]

Your own doctor may not use it beyond coding, but if you get into a psychiatric hospital intake situation the guy in charge is probably going to assign you a diagnosis based on it or a quick summary of it. So, be thankful.

[feileacan]

Originally Posted by Wonderfalls

Yes they are necessary for insurance companies (I don't know what statistics are taken from them.) Yes they overlap, you don't use both of them. The US uses the DSM. Other countries use the ICD--it would be very odd if they didn't overlap. All diagnosis is subjective; they were designed to unify and help qualify diagnoses. Obviously they're not perfect but it's a big stretch to contend that they don't give clinical value.

Obviously I meant that the diagnoses in DSM (or ICD, respectively) have large overlaps - not that DSM and ICD have overlaps. DSM was originally created basically for statistical purposes and you mention it yourself - to unify diagnoses to make better(?) statistics.

About the clinical value. For instance, look around in this forum, here are tons of people who have been diagnosed with bipolar/major depression, gad, ptsd, bpd all at the same time. What particular clinical value does this mix of diagnoses give?

[Wonderfalls]

Of course there's no point arguing about it, and I'm not a huge defender of the resulting DSM's so far, but if you're interested there're some books and interesting articles about its origins and the travails and controversies and down-right fights about each revision as it's gotten longer and longer. Apparently they couldn't even agree about the style of numeration since they quit using Roman numerals for the DSM 5.