Unlike going to a doctor and getting a blood test to determine if you have diabetes, high blood pressure, or a host of other medical conditions, diagnosing a mental illness – or a lack of mental health – is not so specific.
Research taking place today suggests that genetics and biology play major roles in many mental disorders, along with a combination of environmental and psychological factors.
However, until more research uncovers direct biological markers and tests for these disorders, mental health professionals are trained to put together a type of psychological “collage” or “memoir” to arrive at a diagnosis.
To form this type of case history, mental health professionals do the following:
- Observe behaviors;
- Discuss emotions and thoughts;
- Sort through a history of stressful or traumatic experiences;
- Consider childhood development problems;
- Identify other disorders such as substance abuse and addictions;
- Learn about any other psychiatric or medical issues or illnesses.
Searching for signs and symptoms of possible psychological problems, the mental health professional identifies patterns of problematic issues. If these issues are impairing the individual’s normal life, as in affecting relationships, careers, or any day-to-day normal activities, the professional explores the possibility of a mental health disorder.
What Indicates a Mental Health Disorder?
The science behind the manifestation and expression of mental health disorders has been heavily researched and documented over the last century. Even over the past two decades, scientists and psychologists have made significant progress in substantiating the symptoms of these illnesses.
The Diagnostic and Statistical Manual of Mental Disorders 4th Edition, (DSM-IV) lists the signs and symptoms identifying more than 300 specific mental illnesses.
Anyone can pick up this thick manual published by the American Psychiatric Association and read about these mental illnesses. Yet professionals recognize that coming to an accurate diagnosis in the mental health field requires specialized training, and ongoing education to stay current with the research.
Diagnosis requires piecing together several components and influences of an individual’s entire life. It requires advanced knowledge of how brain chemistry affects moods, thoughts, and behaviors. And it requires a thorough understanding of human growth and development, and abnormal psychology.
This understanding forms what professionals call “clinical judgment,” and is gained through a carefully structured education and clinical experiences of practicing counselors and therapists.
For example, what separates a teenager who is overly conscious of her weight and diets regularly from one suffering with an eating disorder? Or when does normal grief over the divorce or death of a parent turn into clinical depression or an anxiety disorder? Or are mood swings within a normal range given what’s occurring in a client’s life, or do they signal the more serious bipolar disorder?
A Difficult Diagnosis: Bipolar Disorder
Bipolar disorder is one of the most difficult diagnoses for mental health providers because of its split symptomology of both mania and depression.
Patients show up for counseling or therapy only when they’re feeling down or depressed, describing typical symptoms such as sadness. (Read more about bipolar disorder)
What is Clinically Significant?
In other words, what symptoms translate into distressful problems, so distressful that they qualify as clinically significant? Many individuals exhibit distressful symptoms but are able to cope with them sufficiently, and these individuals don’t necessarily exhibit clinical disorders. Yet others cross a psychological line only recognized by trained professionals.
In addition, symptoms of mental health disorders differ according to individual differences and personalities. And it’s possible for the symptoms to change and look different over time.
A qualified mental health professional knows how to take often elusive and confusing signs and symptoms and compare them to not only the DSM-IV, but to the clinical case histories reported in empirically based scientific journals, and their own experiences of diagnosing and treating these disorders.
Important Diagnostic Tools
Asking the client questions and piecing together the client’s case history is not done haphazardly. That is, the counselor or therapist is well trained in how to structure questions in order to gather the type of information used for diagnosis. In some cases, written tests are also given to clients for certain conditions.
The tools used to gather information are called psychological assessments and tests, including the spoken initial interviews. These interviews have proven effective, requiring the asking of questions in certain, objective ways. During the initial assessment, the mental health professional takes many notes, also recording or writing the notes in an objective way.
While asking questions and taking notes during the interview, the mental health professional also conducts a mental status examination (MSE). The MSE involves evaluating the client’s hygiene and overall appearance and grooming. The examiner also observes behavioral patterns, such as the client making eye contact, any abnormal gestures or motions, or hyperactive behaviors.
Part of the MSE also involves carefully listening to clients’ responses to questions, how fluent they speak, the rate of their speech, and the clarity of their thoughts and speech patterns. Constructing an analysis of important cognitive functions such as memory is also an important part of the assessment.
Sometimes a diagnosis is made after the initial assessment, but often another session or even several sessions are needed to arrive at a correct diagnosis. The experience and expertise of a mental health counselor also plays a part in how quickly a diagnosis is made.
For many, diagnosis is an art, but an art that has a wealth of scientific research supporting it. Learning both the art and science of mental health diagnosis is essential for professionals desiring to work in the mental health field.
If you have a passion to help others suffering from a wide range of mental health disorders, diagnosing and treating individuals to help them live as functionally as possible, consider a career as a mental health professional.
In order to diagnose and treat individuals, most states require at least a master’s degree, and additional licensing.
If you are interested in working in the field of mental health counseling, request information from schools offering degree programs in mental health or related counseling degree programs.